Lead poisoning in telephone cable strippers: a new setting for an old problem.

Lead poisoning among workers processing lead sheathed telephone cable was identified at five worksites. High blood lead levels (BLLs) were identified during the medical evaluation of symptomatic workers following employer mandated air monitoring and through employer mandated blood lead levels. Once high BLLs were identified, governmental agencies became involved at every site, either as a result of worker complaints to OSHA or as a registry reporting mechanism. Workplace evaluation revealed significant overexposure to lead, particularly among workers mechanically stripping the lead sheaths. After intervention by a government agency, four of the workplaces chose to stop lead cable processing. Because the ongoing replacement of lead sheathed telephone cable with fiber optics may be continuing in many areas of the country, there is concern that the clusters we have identified represents a widespread and little recognized setting for lead overexposure. Recommendations for preventing overexposure to lead in this setting are given.

The World Trade Center bombing: injury prevention strategies for high-rise building fires.

The WTC disaster provided an opportunity to look for ways to prevent morbidity among occupants of high-rise buildings during fires. This paper first describes the overall morbidity resulting from the explosion and fire, and second, presents the results of a case-control study carried out to identify risk factors for smoke-related morbidity. The main ones include: increased age, presence of a pre-existing cardio-pulmonary condition, entrapment in a lift and prolonged evacuation time. Study results point to the importance of the following safety systems during high-rise building fires: smoke-control systems with separate emergency power sources; lift-cars, lift-car position-monitoring systems, and lift-car communication systems with separate emergency power sources; two-way emergency communication systems on all floors and in stairwells; stairwells with emergency lighting and designed for the rapid egress of crowds; evacuation systems/equipment to assist in the evacuation of vulnerable people (elderly, infirm). Also important are evacuation plans that include regularly scheduled safety training and evacuation drills.

Control of tuberculosis in the workplace: toward an integration of occupational health and public health.

The authors discuss current efforts at and obstacles to forging a link between public health and occupational health in the control of tuberculosis. They trace the historical roots of TB in the workplace as well as the current crisis that has resulted from the emergence of both the AIDS and tuberculosis epidemics. The authors also detail how the CDC's guidelines embody a comprehensive approach to TB control.

A joint labor-management hazard communication training program: a case study in worker health and safety training.

The 1983 OSHA Hazard Communication Standard requires training of employees exposed to hazardous chemicals. The authors provide a detailed look at the successes and failures of a joint labor-management training program that was designed to bring a firm with more than 50 manufacturing facilities into compliance with the standard.

Lead poisoning due to hai ge fen. The porphyrin content of individual erythrocytes.

A 45-year-old Korean man developed abdominal colic, muscle pain, and fatigue. Following a 3-week hospitalization, acute intermittent porphyria was diagnosed based on the symptoms and a high level of urinary delta-aminolevulinic acid (378 mumol/L [4.95 mg/dL]). However, discovery of an elevated blood lead level (3.7 mumol/L [76 micrograms/dL]) subsequently led to the correct diagnosis. No occupational source of lead exposure was identified. The patient reported ingesting a Chinese herbal preparation for 4 weeks prior to becoming ill. A public health investigation revealed that the source of lead exposure was hai ge fen (clamshell powder), one of the 36 ingredients of the Chinese herbal medicine. We used fluorescence image-based cytometry to determine the frequency distribution of the zinc protoporphyrin content in circulating red blood cells and found that 70% of the patient's cells contained elevated levels of zinc protoporphyrin, consistent with the duration of lead exposure and effect of lead on heme synthesis. Analysis of zinc protoporphyrin content in circulating red blood cell distributions may be useful in the diagnosis, therapy, and kinetic modeling of lead poisoning. Environmental lead poisoning is best addressed through the close collaboration of clinicians, public health specialists, and laboratory scientists.

Lead exposure among automobile radiator repair workers and their children in New York City.

Despite a comprehensive Occupational Safety and Health Administration lead standard, exposure to lead continues in many industries. This paper describes a blood lead screening and education program for automobile radiator repair workers and their families in New York City. Results showed that 67% of automobile radiator repair workers (n = 62) in 89% of the shops tested (n = 24) had blood lead levels in excess of 25 micrograms/dl. The vast majority of workers had never been tested previously, and none had received health and safety training regarding occupational lead exposure. Although none of the workers' children's blood lead levels were in excess of then-current guidelines, several had levels which may be associated with subclinical toxicity and in excess of the revised Centers for Disease Control guidelines of 10 micrograms/dl. This project demonstrates that lead exposure in the automotive radiator repair industry continues to be widespread and that local health departments can assist in hazard identification and remediation.

Preventing lead poisoning in New York City: priorities for lead abatement in housing.

The major challenge for lead poisoning prevention programs is to increase the availability of lead-safe housing as quickly as possible. The approach proposed by the City of New York maximizes the impact of the limited resources available to address this problem. The approach, however, is based on an assumption that in the short-term, modest lead hazard reduction measures such as restoring surfaces to an intact condition is adequate for most units and that more extensive abatement should be reserved for the relatively fewer units in which there is a high risk of exposure of lead-poisoned children reside. Ideally, this plan would be implemented with voluntary efforts to abate lead hazards when other renovation or remodeling occurs or when dwellings are vacant and more extensive abatement work can be performed at lower cost and without the attendant difficulty of abating occupied units. Approaches ranking hazards and implementing varying levels of hazard reduction must be fully evaluated and modified as new information becomes available. The specific criteria used to rank hazards should be evaluated to determine what measures best differentiate risk. Given the magnitude of the problem and the numerous obstacle--lack of funding, limited trained workers, and limited technical knowledge--it will probably take years, if not decades, to abate lead hazards in all the dwellings in which they exist. We must not be deterred, however, from beginning this effort in the communities and dwellings that need intervention the most: deteriorated, older housing units in which young children reside. In major urban centers such as New York City the greatest lead hazards will generally be found in areas where poverty is greatest. Thus, every effort must be made to ensure that adequate resources are available to improve housing in the communities in greatest need.

Implementation of the Federal Hazard Communication Standard: does training work?

A joint labor-management training program intended to bring a large US manufacturing firm into compliance with the training requirements of the Federal Hazard Communication Standard appeared to achieve increases in employee knowledge and improved work practices. The program also evidenced positive indirect effects on management's institution of hazard control measures and organizational handling of health and safety issues. Most observed effects were maintained over a 2-year period after the training. More interactive, trainer-intensive delivery methods to smaller groups were associated with more positive effects on reported training usefulness and changes in work practices and working conditions.

Work stress, nonwork stress, and health.

This paper examines the interface between work stress and nonwork stress and how it relates to health. Results indicate that the way people feel at work is largely a function of conditions at work. Similarly, the way people feel outside of work is largely a function of things that occur outside the job. Both work and nonwork stress are independently associated with physical and mental health, although the relationship between nonwork stress and health is slightly stronger. Excessive demands or stresses in one domain can interfere with life in the other. Such conflict operates equally in both directions. When present it can be an added source of stress and adversely affect health. Taken together these findings suggest that the stress people experience at work is not simply a reflection of their "personal problems." This has implications for the design of health promotion and stress prevention programs in the workplace.

The impact of the physical environment on the psychological well-being of office workers.

This paper examines the relationship between the physical office environment and the psychological well-being of office workers. The results indicate that adverse environmental conditions, especially poor air quality, noise, ergonomic conditions, and lack of privacy, may effect worker satisfaction and mental health. The data also provide substantial evidence that worker assessments of the physical environment are distinct from their assessments of general working conditions, such as work load, decision-making latitude and relationships with other people at work. Stated another way, people who reported problems with the physical environment could not simply be characterized as dissatisfied workers exhibiting a tendency to 'complain' about every aspect of their working conditions. Taken together, these findings lend support to the position that the stress people experience at work may be due to a combination of factors, including the physical conditions under which they labor. Both theoretical and practical considerations arise from these data, including the need for work site based health promotion and stress reduction programs to consider both the physical and psychological design of jobs.

Hazard communication in a large U.S. manufacturing firm: the ecology of health education in the workplace.

This article describes the design, implementation, and evaluation of a workplace health and safety education program intended to bring a large U.S. manufacturing firm into compliance with a Federal regulation, the Hazard Communication Standard. The methods of program delivery and levels of resources allocated were decided by local plant management and union representatives resulting in marked variations among the five plants studied. These differences in program delivery were associated with differences in employee assessment of the training's usefulness, changes in employee work practices, working conditions, and organizational handling of health and safety problems. In all five plants, the program evidenced indirect beneficial effects on the use of hazard control measures and organizational approaches to health and safety issues which went beyond the requirements of the federal Standard. The results appear well-explained by an ecological model which views health and disease as outcomes of a complex system of interactions between the individual worker and multiple levels of environmental influences. Implications of these findings for health educators are discussed.

Air quality and ergonomics in the office: survey results and methodologic issues.

A survey of office workers at four sites was conducted by Columbia University School of Public Health during 1981 and 1982 to explore the relationships between office working conditions and employee health. Walk through surveys of each site were conducted by the research team with joint labor-management sponsorship. A total of 2074 non-managerial office workers filled out a 30-minute self-administered questionnaire at their respective workplaces. Multiple item scales were tested and constructed to measure indoor air quality and ergonomic factors. Significant differences in ergonomic conditions and air quality between the sites were observed. These differences corresponded with researcher observations prior to the surveys. Significant associations between the reported air quality and respiratory symptoms and between ergonomic factors and musculoskeletal symptoms were found. Specificity of the relationship between reports about the environment and health symptoms was demonstrated. The implications of this approach for industrial hygiene investigations of non-industrial environments are discussed.