Combined effect of back pain and stress on work ability.

BACKGROUND: Back pain and occupational stress are known risk factors for absenteeism and presenteeism. In addition, the relationship between back pain (BP) and psychosocial stressors has been examined in numerous studies. AIMS: To examine the prevalence of BP and perceived stress among employees of different occupational status and to investigate their combined impact on work ability. METHODS: A comprehensive survey combining questionnaire data and medical examination offered in one division of a major chemical company in Germany. Self-rated health and work ability were assessed using the Work Ability Index (WAI). A synergy index was used to assess a potential interaction between both exposures under an additive model. RESULTS: Of 867 voluntary participants, 653 returned complete questionnaires on BP and job stress perception. Although occupational stressors were perceived differently, there was no difference in the prevalence of BP between the occupational groups. Back pain and stress perception are correlated with each other and both are negatively associated with work ability. After adjustment for occupational status, demographic and lifestyle factors, we found a synergy effect of BP and stress perception with a modest to strong impact on declining WAI. CONCLUSIONS: Corporate health promotion interventions to reduce the impact of BP and stress perception on work ability should target both physical and psychological dimensions. Such interventions may be initiated in the context of regular (occupational) medical examinations.

[Shiftwork and health--experience from a chemical company]. / Schichtarbeit und Gesundheit in einem Großunternehmen der chemischen Industrie.

BACKGROUND AND OBJECTIVE: Shiftwork is an essential part of our society. At the same time scientific evaluations demonstrate possible negative effects of shiftwork on the health status of the employees. Against this background we performed different studies to evaluate these effects within the specific shift system in a large chemical site in Germany. METHODS AND STUDY GROUP: To evaluate the impact of the different working times on job-related stress perception and work-life-balance we performed a cross-sectional study with 1494 blue collar workers (825 shift- and 669 day workers). RESULTS: Employees working in the rotating shift system reported lower frequencies of perceived time pressure (p = 0.008), and lower stress levels (p = 0.01), compared to the day workers. No significant difference was found with regard to work-life-balance and other aspects of job-related stress perception within both groups. CONCLUSION: Against the general opinion and study-results in the past we did not find a negative effect of our shift-system on self-reported stress. These results are in accordance with results of other cohort-studies on the specific shift system within the company demonstrating no difference in the health status of our shift workers compared to day workers.

[Bladder cancer screening with urine-based tumour markers - occupational medical experience]. / Das Screening von Harnblasenkarzinomen mittels urinbasierter Tumormarker - Erfahrungen aus der Arbeitsmedizin.

OBJECTIVE: Bladder cancer responds favourably to treatment and has a good survival rate, provided it is diagnosed at an early stage. Established methods exist for the early detection, however, their specificity and positive predictive value are not yet satisfactory. Innovative markers have been proposed, but still require validation in prospective studies. We provide a literature-based short overview on the currently available and some proposed markers for the early detection of bladder cancer and evaluate the need for validation in further studies. We further provide some first results of such a recently finished study in an occupational setting. MATERIAL AND METHODS: We conducted a prospective screening study over seven years in 1610 males with former occupational exposure to carcinogenic aromatic amines. Annual bladder cancer screening according to statutory requirements was offered. In addition to the regularly performed check for hematuria and urine cytology, the markers NMP22, UroVysion™ and survivin were performed in voided urine samples of the participants. Positive findings (not for survivin) were further followed through urethrocystoscopy. RESULTS AND CONCLUSIONS: A total of 7219 urine samples were screened. During the study period 16 incidental and 4 recurrent bladder tumours, thereof three papillomas, occurred in a total of 19 participants. 14 out of twenty tumours were marker-positive, and all but two were early stage findings. Cell-based markers (cytology, UroVysion™) und molecular markers (NMP22, survivin) were largely complementary, thus acting as a "multi-marker panel". Eight of the tumours were identified by a positive cytology. Six tumours were not detected by any of the tumour markers. The results will be further evaluated through the inclusion of confounding factors, which have so far rarely been examined in other studies. This may lead to the development of tiered diagnostic strategies with the aim to reduce the number of invasive diagnostic procedures in the future.

Impact of an occupational health promotion program on subsequent illness and mortality experience.

BACKGROUND: Integrating general health initiatives into established occupational health programs may be an effective way of contributing more broadly to employee health. Objective assessment of the success of such initiatives is needed, but is often difficult to carry out because of their voluntary nature. METHODS: A cohort of 24,586 wage employees, 35+ years of age and with 15+ years of prior employment, was established to assess morbidity and mortality outcomes relative to participation in an ongoing health initiative instituted in 1983. Outcomes were evaluated for employees who attended the seminar program (attendees), those who had clearance examinations, but did not take part in the program (withdrawals), and non-participants. RESULTS: At entry to follow-up, the prevalence of chronic illnesses including diabetes, obesity, and diseases of the circulatory system was lowest among non-participants and highest among withdrawals. During the follow-up period, the incidence of new disease conditions was similar between attendees and non-participants; however, overall mortality was significantly reduced among attendees after adjustment for explanatory factors including age, job grade, smoking history, alcohol intake, and body-mass-index (relative risk = 0.83; 95% confidence interval: 0.69-0.99) and was still marginally decreased when withdrawals were combined with attendees. CONCLUSIONS: Although self-selection cannot be ruled out as a contributing factor to the reduction in mortality risk among attendees, our findings indicate that offering health promotion activities in the context of an existing occupational health program may benefit overall employee health.

Cancer incidence in the wastewater treatment plant of a large chemical company.

OBJECTIVES: To evaluate cancer incidence among employees assigned to BASF's wastewater treatment plant. METHODS: We conducted a retrospective cohort study including 477 male employees who had ever worked in the facility for at least 1 year since the start of operations in 1974. Cancers were identified by review of occupational medical records and a standardized questionnaire completed by the participants or their next of kin. Confirmation through hospital records was sought for all reported cases after obtaining informed consent. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were computed using comparison data provided by the Saarland Cancer Registry. Further comparisons were made between three different subgroups of employees, working in maintenance, wastewater processing, and sewage sludge treatment. RESULTS: A total of 50 cancers were observed (SIR 1.14, CI 0.85-1.51). Colorectal (1.14, 0.42-2.48), bronchial (1.40, 0.67-2.57) and prostate (1.15, 0.42-2.50) were the most frequently observed cancers. Five cases of bladder cancer were found in the total cohort (1.75, 0.57-4.09), with four of them occurring in the sewage sludge treatment area (6.82, 1.86-17.46). Allowing for a 10-year lag did not significantly change the results. CONCLUSIONS: The overall cancer experience among employees of the wastewater treatment plant was similar to that of the corresponding general population. The finding of an excess risk for bladder cancer in one subgroup of workers was unexpected with regard to the available literature. There is no straightforward explanation for this finding, and it may be due to chance. An extended follow-up of this cohort will take place after 5 years. Annual bladder cancer screening is offered to active and retired employees from this plant for the time being. The current working conditions and work practices have been re-assessed by occupational hygienists and deemed to be safe.

Neuropsychiatric symptoms in active construction painters with chronic solvent exposure.

A cross-sectional study was performed to assess whether chronic solvent exposure of painters is associated with increased neuropsychologic symptoms. 401 painters and 209 construction workers without solvent exposure, both groups with at least 10 years of employment, were subjected to extensive clinical examinations. Standardized questionnaires were used for medical and occupational history. Painters reported an excess of specific symptoms that could be assigned to mood and behaviour. The differences between specific and unspecific questionnaire outcomes as well as the positive correlation between chronic exposure index and symptom scores support the hypothesis of solvent induced effects. These symptoms are related to life-long solvent exposure rather than current exposure levels. At present the questions of time course and reversibility or irreversibility of symptoms cannot be answered. The predictive value of these symptoms for subsequent neuropsychiatric morbidity remains to be elucidated in a future follow-up study.

A multidisciplinary cross-sectional study on solvent-related health effects in painters compared with construction workers.

OBJECTIVES: The main aim of the study was to examine possible solvent-associated effects on the nervous system in currently employed painters. Special attention was paid to evaluate subtle health effects. MATERIALS AND METHODS: A total of 401 painters and 209 construction workers without solvent exposure with at least 10 years of professional experience were subjected to a clinical, neurological, psychiatric, neuropsychological and neurophysiological examination. For personal medical and occupational history, standardized questionnaires were used. A quantitative rating of exposure was obtained by expert rating of the respective occupational history without knowledge of the individual test results. RESULTS: There was no excess of somatic disorders or solvent-associated adverse effects on the nervous system. No distinct effects of solvent exposure on nerve conduction velocities (NCV) or cognition were found. Discrete NCV deficits in painters were not considered a sign of subclinical polyneuropathy. Painters, however, reported an excess of specific symptoms that could be assigned to "mood and behaviour". The differences between specific and non-specific questionnaire outcomes on the one hand and the positive correlation between chronic exposure index and symptom scores on the other hand support the hypothesis of solvent-induced effects. Because data is lacking on past solvent exposure, it is not possible to relate these effects to current exposure limits. CONCLUSIONS: Currently employed painters differ from controls not exposed to solvents with respect to the frequency of certain symptoms in mood and behaviour. These symptoms are related to life-long solvent exposure rather than to current exposure. At present, the issue of time course and reversibility or irreversibility of these symptoms cannot be answered. The predictive value for subsequent neuropsychiatric morbidity remains to be elucidated in follow-up studies.

[MCS, CFS, FMS, SBS and other "modern" illnesses]. / MCS, CFS, FMS, SBS und andere "moderne" Erkrankungen.

Common "environmental illnesses" are outlined with respect to their history and case definition. As no objective diagnostic criteria are available, these diagnoses may only be applied after sufficient exclusion of other known diseases. Profound knowledge regarding the etiology of these conditions is still lacking, and scientifically based somatic concepts for their therapy do not exist. Thus there is room for a multitude of unvalidated methods for diagnosis and therapy, and alleged causes are readily offered. The psychologic and economic consequences for the affected individuals are sometimes deleterious, the costs are a growing public concern. Proposals are made for the management of cases of suspected environmental illness.

Hepatotoxic effects of solvent exposure around permissible limits and alcohol consumption in printers over a 4-year period.

Two field studies were carried out in 1987 and 1991 in order to evaluate the effect of chronic exposure to solvent mixture on liver enzyme patterns. The results in 33 workers who participated in both studies and had complete sets of data are presented. The magnitude of chemical workload was assessed by means of ambient air monitoring and biomonitoring of solvent concentrations. Alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transpeptidase were used as markers for possible biological effects. No dose-response relationship was found between exposure to complex solvent mixtures in ambient air, reaching and sometimes even exceeding the threshold limit values for mixtures, and liver enzyme activities. Self-reported alcohol intake was the only factor identified as statistically related to increased liver enzyme activity.