Predictors of early leaving from the cotton spinning mill environment in newly hired workers.

OBJECTIVE: This longitudinal study aimed to identify the predictors of leaving during the first year of employment from the cotton spinning mill environment in newly hired workers. METHODS: One hundred and ninety eight consecutively appointed new employees were investigated by questionnaire, lung function test, and skin test. They were examined before employment and at the end of the 1st week, and the 1st, 3rd, 6th, and 12th month after starting work and when possible before leaving their job. 572 personal dust sampling and 191 endotoxin measurements were performed to assess the environmental exposure. For the univariate analysis chi2, Student t tests, ANOVA, and Kruskall Wallis tests were used. Cox proportional hazards analysis was used to identify factors associated with leaving the job. RESULTS: Fifty three per cent of workers left the mill environment during their first working year. Work related lower respiratory tract symptoms reported at the third month were associated with an increase rate of leaving the industry compared to those remaining in the industry (25% v 4.8%; p<0.005). Having respiratory symptoms at the first month of work predicted those leaving the industry at some point in the next 11 months. According to the Cox model, increasing age and having work related lower respiratory tract symptoms were found to be predictors for leaving job at the first working year. Atopic status, dust and endotoxin levels, and lung function changes were not consistently predictive of workers who left the industry in the follow up period. CONCLUSION: This study demonstrated that work related respiratory symptoms can predict workers likely to leave the cotton mill environment during the first year of employment, but atopy or acute lung function changes do not.

Low bone mineral density in adults with cystic fibrosis.

BACKGROUND: Patients with cystic fibrosis have several risk factors for the development of low bone mineral density (BMD). To identify the prevalence and clinical correlates of low BMD in adult patients with cystic fibrosis, densitometry was performed in 151 patients (83 men) aged 15-52 years. METHODS: BMD was measured in the lumbar spine (L1-4) using dual energy x ray absorptiometry (DXA) and quantitative computed tomography (QCT). It was also measured in the proximal femur (total hip and femoral neck) using DXA, and in the distal and ultra distal forearm using single energy x ray absorptiometry (SXA). Biochemical markers of bone turnover, vitamin D levels, parathyroid hormone levels, and a variety of anthropometric variables were also assessed. RESULTS: The mean (SD) BMD Z score was -0.73 (0.85) in the distal forearm, -0.31 (0.92) in the ultra distal forearm, -1.21 (1. 18) in the lumbar spine using DXA, -0.56 (1.36) in the lumbar spine using QCT, -1.25 (1.30) in the femoral neck, and -1.01 (1.14) in the total hip. 34% of patients had a BMD Z score of -2 or less at one or more skeletal sites. Body mass index (0.527, p = 0.01), percentage predicted forced expiratory volume in one second (0.388, p = 0.01), and physical activity (0.249, p = 0.05) were positively related to the mean BMD Z score. Levels of C reactive protein (-0.328, p = 0. 01), parathyroid hormone (-0.311, p = 0.01) and biochemical markers of bone turnover (osteocalcin -0.261 and bone specific alkaline phosphatase -0.249, p = 0.05) were negatively related to the mean BMD Z score. Vitamin D insufficiency (25-hydroxyvitamin D <15 ng/ml) was prevalent (53/139 patients, 38%) despite supplementation with 900 IU vitamin D per day. CONCLUSIONS: Low bone density is prevalent in adult patients with cystic fibrosis. Current levels of vitamin D supplementation appear to be inadequate.

Functional upper airways obstruction: two patients with persistent symptoms.

Functional upper airways obstruction is caused by vocal cord dysfunction and classically occurs in paroxysms closely resembling acute asthmatic attacks. We present two cases in which the symptoms and signs of the vocal cord dysfunction demonstrate very little variability with time. We suggest that as part of this disorder, a syndrome of chronic unremitting symptoms may occur.

Lung function in Lancashire cotton and man made fibre spinning mill operatives.

OBJECTIVES: This survey was conducted to investigate current lung function levels in operatives working with cotton and man made fibres. Dust concentrations, smoking history, and occupational details were recorded so that factors influencing lung function could be identified. METHODS: A cross sectional study of respiratory symptoms and lung function was made in 1057 textile spinning operatives of white caucasian extraction. This represented 96.9% of the total available working population to be studied. Most (713) worked currently with cotton. The remainder worked with man made fibre. Lung function was assessed by measuring forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Exposure to cotton dust was measured in the work area and personal breathing zones, and retrospective exposure to cotton dust over a working life was estimated with accurate work history and best available hygiene data. RESULTS: 3.5% of all operatives had byssinosis, 55 (5.3%) chronic bronchitis, 36 (3.5%) work related persistent cough, 55 (5.3%) non-byssinotic work related chest tightness, and 56 (5.3%) work related wheeze. A total of 212 static work area dust samples (range 0.04-3.23 mg/m3) and 213 personal breathing zone samples (range 0.14-24.95 mg/m3) were collected. Percentage of predicted FEV1 was reduced in current smokers (mean 89.5, 95% confidence interval (95% CI) 88-91) in comparison with non-smokers (93.1, 90.5-94.1) and FVC was reduced in operatives currently working with man made fibre (95.3, 93.8-96.9) in comparison with cotton (97.8, 96.6-99.0). Regression analysis identified smoking (P < 0.01), increasing age (P < 0.01), increasing time worked in the waste room (P < 0.01), and male sex (P < 0.05) as being associated with a lower FEV1 and FVC. Current and retrospective cotton dust exposures did not appear as predictor variables in the regression analysis although in a univariate analysis, FEV1 was reduced in those operatives exposed to high dust concentrations assessed by personal and work area sampling. DISCUSSION: This study has documented loss of lung function in association with exposure to cotton dust. Those operatives with work related symptoms had significantly lower FEV1 and FVC than asymptomatic workers. Although lung function seemed to be affected by high dust exposures when operatives were stratified into high and low exposure groups, regression analysis did not identify current dust concentrations as an independent factor influencing loss. Smoking habit was found to explain most of the measured change in FEV1 and FVC. It is likely that smoking and dust exposure interact to cause loss of lung function in cotton textile workers.