Evaluation of exposure to airborne bacterial endotoxins and peptidoglycans in selected work environments.

The aim of this study was to assess workers' exposure to endotoxins and peptidoglycans, as well as associations between workers' reported symptoms and the detected bacterial exposures. From the filter samples, biologically-active endotoxins were analysed with the Limulus amebocyte lysate (LAL) assay. The total amount of endotoxins was analysed as 3-hydroxy (OH) fatty acids with a gas chromatography-mass spectrometry (GC-MS) assay, which was also used to assess peptidoglycans as muramic acid. Biologically-active endotoxins related better to the self-reported symptoms than total endotoxins. Specific 3-OH-14:0 fatty acid in the total endotoxin samples associated better with the symptoms than other 3-OH fatty acids. Half of the surveyed 77 workers reported respiratory symptoms, 27% eye symptoms, and 10% fever or shivering. The proportion of workers with respiratory symptoms was greater when the concentration of endotoxins was over 25 ng/m3. These endotoxin levels were occasionally found in the air of most studied occupational environments. The muramic acid concentrations of peptidoglycans were highest (medians over 100 ng/m3) in the garbage-handling plant and in the grain/vegetable storage houses. The LAL assay for endotoxins, as well as the GC-MS assay analysing muramic acid for peptidoglycans or specific 3-OH fatty acids for endotoxins, seem to be suitable methods for evaluating workers' exposure to airborne bacteria.

Self-reported health, illness, and self-care among finnish physicians: a national survey.

BACKGROUND: Physicians' health problems have been discussed mainly in relation to substance abuse and psychiatric disorders. In this study, the prevalence of common chronic diseases and their treatment were determined. OBJECTIVE: To find differences in self-reported health status, amount of sick leave, and the use of health services among physicians according to sex and specialty. Data were also compared with those of the total employed population. DESIGN AND SETTING: Cross-sectional postal questionnaire survey in Finland. PARTICIPANTS AND METHODS: A random sample of licensed physicians younger than 66 years (n = 4477) was randomly selected from the register of the Finnish Medical Association. A total of 3313 physicians (74%) responded. MAIN OUTCOME MEASURES: Perceived health, prevalence of diseases, self-treatment of diseases, amount of sick leave, and medical consultations. RESULTS: Female physicians assessed their health as being better than other female employees and had used health services and had been on sick leave more often than their male colleagues. Male physicians assessed their health as being equal to that of other men. Both female and male physicians had fewer sick leave than other employees. However, physicians-especially men-reported many common chronic illnesses as often or more often than other employees. Physicians had consulted other medical professionals less often than other employees, and they primarily self-treated their illnesses. Of the specialties, psychiatrists had used health services and had been on sick leave more often than other physicians. CONCLUSION: This study indicates that the usual form of care of physicians' diseases is self-treatment and "working through" illnesses. Arch Fam Med. 2000;9:1079-1085

An outbreak of respiratory diseases among workers at a water-damaged building--a case report.

We describe a military hospital building with severe, repeated and enduring water and mold damage, and the symptoms and diseases found among 14 persons who were employed at the building. The exposure of the employees was evaluated by measuring the serum immunoglobulin G (IgG)-antibodies against eight spieces of mold and yeast common in Finnish water and mold damaged buildings and by sampling airborne viable microbes within the hospital. The most abundant spieces was Sporobolomyces salmonicolor. All but one of the employees reported some building-related symptoms, the most common being a cough which was reported by nine subjects. Four new cases of asthma, confirmed by S. salmonicolor inhalation provocation tests, one of whom was also found to have alveolitis, were found among the hospital personnel. In addition, seven other workers with newly diagnosed rhinitis reacted positively in nasal S. salmonicolor provocation tests. Skin prick tests by Sporobolomyces were negative among all 14 workers. Exposure of the workers to mold and yeast in the indoor air caused an outbreak of occupational diseases, including asthma, rhinitis and alveolitis. The diseases were not immunoglobulin E (IgE)-mediated but might have been borne by some other, as yet unexplained, mechanism.

Ovarian volume may predict assisted reproductive outcomes better than follicle stimulating hormone concentration on day 3.

This study was undertaken to compare ovarian volume with other factors which are important for the success of assisted reproduction. The first treatment cycle for 261 patients meeting all entry criteria between September 1993 and June 1995 was considered. All cycles employed the same stimulation protocol and no interventions were based upon pre-treatment indicators. Pre-treatment ovarian volumes, cycle day 3 follicle stimulating hormone (FSH) and oestradiol concentrations, smoking status and age were compared to subsequent peak oestradiol concentrations, numbers of oocytes retrieved, cycle cancellation and occurrence of clinical pregnancy. Statistical evaluation was performed using simple and multiple logistic regression analysis to determine odds ratios. The resultant odds ratios suggest that age and small ovarian volume may predict retrieval of fewer mature oocytes, while the failure to achieve clinical pregnancy was predicted by current smoking and small ovarian volume. Day 3 FSH values failed to be a significant predictor when maternal age, smoking status and ovarian volume were known. It can be concluded that, like maternal age and smoking status, ovarian volume may be a clinically important predictor of reproductive success, being superior to cycle day 3 FSH or oestradiol concentrations as an assessment of ovarian reserve.

Powered dust respirator helmets in the prevention of occupational asthma among farmers.

OBJECTIVES: This study investigated the value of powered dust respirator helmets in the treatment of farmers with occupational asthma. METHODS: The study population consisted of 33 asthmatic agricultural workers, 24 with occupational asthma induced by cow dander or grains, 2 with other forms of atopic asthma, and 7 with nonatopic asthma. The efficiency of a powered dust respirator helmet with a P2-class filter in preventing asthmatic symptoms was assessed for 1 year. Morning and evening peak expiratory flow rates and daily symptoms of the subjects were monitored for 3 months without the use of the helmet and for 10 months with the helmet. RESULTS: Objective evidence of protection was obtained for farmers with occupational asthma. The morning peak flow rate increased and the variation in daily peak flow rate and the symptoms of cow-barn rhinitis diminished significantly during the helmet period. In the group of farmers with nonatopic asthma there was no improvement in peak flow rate or symptoms of asthma, although some of these farmers also seemed to benefit from helmet use. CONCLUSIONS: The results of this study suggest that especially dairy farmers with occupational asthma benefit from the use of a powered dust respirator helmet.

Respiratory health of cigar factory workers.

OBJECTIVES: To determine whether occupational exposure to raw tobacco causes respiratory or allergic diseases, an excess of respiratory symptoms, a decrease in lung function, or parenchymal changes in chest radiography among Finnish cigar workers. METHODS: This cross sectional study included all Finnish cigar workers (n = 106) exposed to raw tobacco and also a group of unexposed matched referents. Data were collected with a self administered questionnaire, flow volume spirometry, measurements of diffusing capacity of the lung for carbon monoxide, chest radiography and skin prick tests. A questionnaire was also sent to former workers of the factory. RESULTS: There were no significant differences between the groups in the prevalence of respiratory symptoms and chest radiography findings. Nine of 102 tobacco workers had pulmonary fibrosis of at least 1/0 (according to the International Labour Organisation (ILO) 1980 classification) and the corresponding figure was five for the referents. The tobacco workers tended to have a low forced vital capacity (FVC), and they had impaired forced expiratory volume in 1 second and lower means of the maximal expiratory flow at 25% of the FVC significantly more often than the referents. Diffusing capacity tended to be lower among the referents. The referents more often had atopy and earlier atopic diseases than the exposed workers. These results indicate the possibility of selection among the exposed workers. CONCLUSIONS: No excess of prevalence of respiratory symptoms in the tobacco workers was found. According to the questionnaire episodes of allergic alveolitis may have occurred in the cigar factory workers. However, in the absence of impairments in lung function and radiological changes it was not possible to distinguish humidifier fever and allergic alveolitis. In exposure conditions that include humidification of the air humidifier, fever and allergic alveolitis constitute a risk for tobacco workers. No effects were shown of exposure to tobacco dust on lung function.

Long-term outcome of pulmonary function in farmer's lung: a 14 year follow-up with matched controls.

The long-term outcome of pulmonary function was evaluated in farmer's lung (FL) patients compared to representative control farmers. This is, to our knowledge, the first such study which has included a control group. Clinical examinations were conducted in 89 FL patients and 84 control farmers, matched by age, sex, and smoking habits. The mean time after the first diagnosed episode of FL was 14 yrs. The mean transfer factor of the lung for carbon monoxide (TL,CO) was on average 12% lower (p < 0.001) in FL patients compared to control farmers. In spirometry, the mean maximum expiratory flow at 50% of vital capacity (MEF50) was lower (p = 0.08) in FL patients but there were no differences in mean vital capacity (VC) or forced expiratory volume in one second (FEV1) between FL patients and control farmers. However, airway obstruction, defined as an FEV1/VC less than 88% of predicted, was more common in FL patients than in control farmers (33 versus 17%; p = 0.02). Patients who had had recurrent episodes of FL had a significantly lower mean TL,CO compared to those FL patients who had experienced only a single episode. In conclusion, impairment of the pulmonary transfer factor is the most important long-term consequence of farmer's lung. However, farmer's lung may also lead to development of airway obstruction.

Perceived work conditions and work-related symptoms among employed Finns.

The aim of the study was to determine the number and nature of perceived harmful work conditions and perceived work-related symptoms among employed Finns by sex and socioeconomic group. The associations between perceived harmful work conditions and perceived symptoms were also investigated. Knowledge of perceived work-related ill health can serve as a basis for health promotion at work. In a computer-assisted telephone interview of 2744 salaried employees and wage-earners, the respondents were asked about perceived harmful work conditions as well as perceived health complaints, and their relatedness to work. At least one harmful factor at work was reported by 94% of the respondents, and half of them reported more than three such factors. The most commonly occurring harmful factors were increased work pace, mental demand, repetitive movements, and noise. Of the symptoms perceived as work-related, musculoskeletal symptoms were the most common. They were reported by 44% of the respondents, followed by mental symptoms (26%), psychosomatic symptoms (19%), and respiratory or sensory symptoms (15%). Both the reporting of perceived harmful work factors and perceived work-related symptoms varied by socioeconomic group and sex. Perceived work-related musculoskeletal symptoms were associated with perceived ergonomic harmful work factors among both the men and the women, with physical or chemical work factors among the men, and with psychosocial or work organizational factors among the women. Perceived work-related respiratory symptoms were associated with perceived harmful physical or chemical work factors among both the men and the women, and both groups also reported mental and psychosomatic symptoms in relation to harmful psychosocial or organizational work factors. Among the women psychosomatic symptoms and harmful ergonomic work factors were also related. Perceived harmful factors at work and work-related symptoms are common among the work force. Even though the degree of work-related ill health was related to socioeconomic group, the reporting of particular symptoms indicated the probability of a particular work factor being considered harmful independently of socioeconomic group, although there was some relationship to sex. The implications for occupational health services are evident; employees' work-related symptoms can serve as an indicator of (preventable) perceived problems at work.

The performance follow-up of Finnish occupational health services.

OBJECTIVES: The aim of the study was to describe the structure, input and output figures of occupational health services (OHS) in Finland as basic data for a revised follow-up system. DESIGN: A cross-sectional postal survey. STUDY PARTICIPANTS: All OHS units in Finland (n = 1025). The response rate was 94%. The more extensive questionnaire was returned by 82% (n = 837), and an additional 12% (n = 127) returned a shorter questionnaire. MAIN OUTCOME MEASURES: The variation in structure (number and education of personnel, number of clients and size of client enterprises), input indicators (employees per full-time equivalent physician and nurse) and output indicators (worksite visits per 100 employees, health checks per 100 employees, office visits per 100 employees) were compared by the five prevailing OHS models and within the models. RESULTS: There were often two- to threefold differences in the median figures of the different manpower and performance indicators between the OHS models. Although the lowest and highest deciles were excluded, the differences within the models were usually even greater. CONCLUSIONS: We found a great variation in both input and output figures within OHS in Finland. Part of this variation can be explained by the different needs and contents of services. The data can serve as a basis for evaluation of OHS activities both at the national level and as benchmark data for the individual OHS units. However, these types of data do not allow us to assess the quality or outcome of services.

Work-related interventions during office visits to occupational health physicians.

BACKGROUND: Systematically applied work-related interventions during visits to occupational health (OH) physicians support the preventive and health promotive goals of OH. The proportion of the visits including a work-related intervention was analyzed according to patient, health problem, and physician determinants in a sample of visits to OH physicians in Finland. METHODS: A cross-sectional study was carried out among 55 Occupational Health Services (OHS) units. Office encounters with 4,404 male and 5,373 female employed patients ages 18-64 years, recorded by 114 OHS physicians, were analyzed. RESULTS: Altogether 856 (8.8%) encounters included a work-related intervention. The work-related interventions were distributed across all the main disease categories, the majority of which were musculoskeletal diseases. Of the patient determinants, occupational group (the residual group of non-white-collar or non-blue-collar workers) associated positively with a work-related intervention, while age or gender did not. The physician's female gender and experience associated positively with work-related interventions. Work-related interventions took place more often in integrated and joint model OHS than in municipal health care centers and private medical centers. CONCLUSIONS: Work-related interventions are used by OH physicians for diverse health problems. More research is needed to better understand the reasons for the observed differences in work-related interventions. Also, research is needed to evaluate the efficiency of such interventions.

Hand eczema in Finnish farmers. A questionnaire-based clinical study.

In a population of 2005 Finnish farmers, 172 (8.6%) reported hand or forearm dermatoses in a self-administered questionnaire. 138 (80%) of them attended a clinical examination. Skin prick tests (SPTs) were done to 80% and patch tests (PTs) to 77% of the examined farmers. 93% of hand dermatoses were eczema and 70% were considered work-related. Cow allergy was found in 41 of 104 prick- and patch-tested farmers (39%). Immediate allergy to cow epithelium was encountered in a total of 28/41, in 20 with SPTs, and in 8 only with 20 min PTs. Delayed contact allergy to cow dander was found in 27/41. The result suggests that in addition to SPTs using commercial cow epithelium extract, PTs using fresh cow dander should also be done, and both immediate and delayed responses should be read.

Workers' exposure to airborne bacteria and endotoxins at industrial wastewater treatment plants.

A study of sewage workers' exposure to airborne culturable bacteria and inhaled endotoxins was performed at nine waste-water treatment plants that treat mainly industrial effluents. Airborne endotoxins were collected on glass fiber filters and analyzed using a chromogenic limulus assay. Endotoxin concentrations measured in the immediate vicinity of the waste-water treatment process varied from 0.1 to 350 ng/m3. The eight-hour time weighted average concentrations of endotoxin to which workers were exposed exceeded the suggested exposure limit (30 ng/m3 endotoxin) at four of the plants. Air samples of culturable bacteria concentrations varied between 10 and 10(5) colony-forming units/m3. Of the particles carrying culturable bacteria, 88% had an aerodynamic diameter of less than 4.7 microns. The most common genera of airborne gram-negative bacteria were acinetobacter, citrobacter, enterobacter, klebsiella, and pseudomonas. High levels of exposure to bacteria and bacterial endotoxin usually were related to certain phases of the treatment process. The microbiological contamination of air was highest near the inlets where incoming wastewater entered the basins, in the sludge treatment area, and inside the biofilter tower. In these spaces it is necessary to control and reduce exposure to airborne bacteria and endotoxin at wastewater plants.

Prevalence of hand dermatoses among Finnish farmers.

OBJECTIVES: The goal of this study was to determine the prevalence and risk factors of hand dermatosis among farmers. METHODS: A questionnaire survey was carried out in a geographically defined sample of the Finnish farming population between the ages of 18 and 64 years (N = 10,847). RESULTS: The one-year prevalence of self-reported hand and forearm dermatoses was 16% for the women and 7% for the men. These figures were similar to the prevalence of hand eczema in two large Scandinavian questionnaire surveys. The highest one-year prevalence of hand dermatoses was found for women on farms with more than nine dairy cows (20%). Atopy (both the personal history of atopic dermatitis and respiratory atopy), female gender, and, among the women, also age under 35 years were the most important risk factors for the occurrence of hand dermatosis. Work-related risk factors were handling disinfectants daily, handling silage preservatives, milking cows, and machine servicing. CONCLUSIONS: Occupational risk factors for hand dermatoses were found, especially for dairy farming. The results may be useful for the prevention of hand dermatoses in farming since they direct attention to related occupational hazards, and they may also aid vocational guidance for the atopic population. In order to lower the prevalence of hand dermatoses in dairy farming, both preventive and protective measures should become everyday practice in farming work.

Seven-year follow-up of white-finger symptoms and radiographic wrist findings in lumberjacks and referents.

OBJECTIVES: In 1978, a cross-sectional study of 279 lumberjacks exposed to hand-arm vibration and 178 unexposed referents was conducted. The aim of the present study was to provide a seven-year follow-up on (i) the changes in the white-finger symptoms among the lumberjacks and the referents, (ii) the effect of white-finger symptoms on the professional prognosis of the lumberjacks, and (iii) the relationship between hand-arm vibration and changes in wrist bones. METHODS: The methods consisted of a questionnaire, a routine clinical examination, and radiographs of the wrists and hands. The examinations were conducted as a field study using a mobile unit. RESULTS: The prevalence of white-finger symptoms was 18% among the lumberjacks and 3% among the referents in the original study. Seven years later 213 lumberjacks and 140 referents participated in the follow-up. The prevalence of white-finger symptoms was 24.9 among the lumberjacks and 5.7 among the referents, and the seven-year cumulative incidence was 14.7% among the lumberjacks and 2.3% among the referents. After allowance for age, there was no difference in the incidence of white-finger symptoms between the lumberjacks with fewer than 15 years of exposure and the referents, but the risk increased with increasing duration of exposure (risk ratio 8.9, 95% confidence interval 2.5-28.9 for those exposed at least 25 years). There was no difference between the two groups in the prevalence of radiographically detectable translucencies or osteoarthrotic changes in the wrists and hands. CONCLUSION: According to the results, white-finger symptoms are still a problem among lumberjacks who started chain-saw work before 1970.

Airborne endotoxin concentrations in different work conditions.

Workers from various occupations have described symptoms of upper respiratory tract, gastrointestinal tract as well as eye and skin irritation. Exposure to endotoxins may cause these symptoms. Structural differences of endotoxins from different working environments are present on the sources of Gram-negative bacteria.

Principles and pitfalls in health services research in occupational health systems.

The purpose of this paper is (1) to view the aims and specific objectives of occupational health service systems and (2) to highlight some essential concepts and methods of health systems research in the evaluation and development of occupational health services. None of these tasks will succeed if the objectives of such services are not defined, or if the links with the different interest groups, (employers, employees and state) and with the primary health care are not taken into consideration.

Role of the occupational health services as a part of illness-related primary care in Finland.

The aim of the study was to evaluate the employees' illness-related utilization of physicians' services in Finland with special reference to Occupational Health Services (OHS). The data are based on a national health-survey conducted by a Computer Assisted Telephone Interview (CATI) in autumn 1991. There were 1,856 people aged 25-64 interviewed. The "risk" of having visited a physician in six months was in association with perceived chronic illness and gender. Half of those employees who were covered by OHS (90% of all) usually visited their OHS unit for health problems. The potential use of the OHS unit depended on the OHS model. The study shows that the Finnish employees use OHS units for physicians' services a lot and this might have implications in the planned reorganization of the Finnish primary care to the so-called population responsibility-based system.