Historical perspective on the department of energy mortality studies: focus on the collection and storage of individual worker data.

PURPOSE: To present how the Department of Energy's (DOE) Comprehensive Epidemiologic Data Resource (CEDR) is integrated into the Million Person Study of Low Dose Health Effects (MPS). The history of DOE's worker health surveillance and its epidemiology program are described. METHODS AND MATERIALS: A standard protocol is used to extract data from CEDR for use in the MPS. The data files are pulled from CEDR to form the basis for the cohort analyzed in the MPS. The previous study data are reviewed to formulate the protocol for the MPS study cohort. The activities needed to update the data to construct the new analytic files are carried out in parallel. The primary efforts relate to updating the vital status, retrieving cause of death information and calculating annual radiation doses for the specific organs of interest. Working data files containing the updated data are produced for construction of analytic data files used in the biostatistical analysis. At study completion the working and analytic data files are placed into CEDR for use by other researchers. RESULTS: The use of CEDR to study the scientific and maintenance workers at the Los Alamos National Laboratory which is currently underway is used to demonstrate the process. CONCLUSIONS: There is a pressing need to answer the question of the health risk of exposure to chronic low-level exposure to ionizing radiation. Using CEDR as the starting point to identify new cohorts to include in the MPS is a cost-effective and a time efficient way to expedite answering this question.

Occupational exposure and mortality among workers at three titanium dioxide plants.

BACKGROUND: A cohort of 3,607 workers employed in three DuPont titanium dioxide production facilities was followed from 1935 through 2006. METHODS: Combined and plant-specific cohort mortality was compared with the overall US population and other DuPont employees. The relationships between selected causes of death and annual cumulative exposures to titanium dioxide and chloride were investigated using Poisson regression methods to examine trends with increasing exposure. RESULTS: Among the 833 deaths, no causes of deaths were statistically significantly elevated either overall or plant-specific when compared to the US population. Compared to DuPont workers, statistically significantly elevated SMRs for all causes, all cancers, and lung cancers were found driven by the workers at the oldest plant. Comparing increasing exposure groups to the lowest group, disease risk did not increase with exposure. CONCLUSIONS: There was no indication of a positive association between occupational exposure and death from all causes, all cancers, lung cancers, non-malignant respiratory disease, or all heart disease.

Mortality among titanium dioxide workers at three DuPont plants.

OBJECTIVE: To evaluate the mortality among workers employed at three titanium dioxide plants in the United States. METHODS: We expanded and updated a cohort employed at titanium dioxide plants. Cause-specific standardized mortality ratios (SMRs) were calculated combined and stratified by plant for workers employed at least 6 months between 1935 and 2005. RESULTS: No indications of excess mortality from any cause were found. All causes SMR increased with length of plant operation as did most cause-specific SMRs. With lung, the target organ of interest, no increases in malignant or nonmalignant respiratory disease were observed. CONCLUSIONS: The mortality rates are comparable with the general US population. Increasing SMRs with length of plant operation is indicative of waning healthy worker effect with time since first employment. The results are comparable with other titanium dioxide cohort studies.

Pain and distress from bone marrow aspirations and lumbar punctures.

OBJECTIVE: To compare the efficacy of 3 different pharmacologic regimens to relieve pain and distress in children with cancer undergoing bone marrow aspirations (BMAs) and lumbar punctures (LPs). DESIGN: Retrospective cohort study with crossovers for some patients. PATIENTS AND METHODS: The pain and distress ratings of patients undergoing BMAs (n = 73) and LPs (n = 105) were examined in a comparison of 3 different interventions: (1) a topical eutectic mixture of lidocaine and prilocaine (EMLA cream), (2) oral midazolam and EMLA cream, or (3) propofol/fentanyl general anesthesia. The choice of the intervention depended on patient/parent request. A validated faces pain scale was completed by the child or parent following each BMA or LP. The faces pain scale includes ratings of the severity of pain (from 0 = none to 5 = severe) and ratings of how frightened (from 0 = not scared to 5 = scared) the child was prior to each procedure. Comparisons of the pain and distress ratings were made among all patients for their first procedure and also within individual patients who had received >1 of the 3 interventions. Independent comparisons between the first treatments received by each patient were analyzed using Kruskal-Wallis tests. Comparisons of different crossover treatments received by individual patients were analyzed using Wilcoxon tests. RESULTS: For all first procedures, mean +/- SD pain and distress ratings during LPs were significantly lower when propofol/fentanyl was used (n = 43; 0.4 +/- 1.0 and 1.4 +/- 1.7) versus either EMLA (n = 29; 2.4 +/- 1.7 and 2.9 +/- 1.9) or midazolam/EMLA (n = 33; 2.4 +/- 1.8 and 2.7 +/- 1.8), respectively. Pain and distress ratings during BMAs were also significantly lower with propofol/fentanyl (n = 29; 0.5 +/- 1.0 and 1.2 +/- 1.7) versus EMLA (n = 21; 3.5 +/- 1.6 and 3.3 +/- 1.8) or midazolam/EMLA (n = 23; 3.3 +/- 1.5 and 3.0 +/- 1.9), respectively. When data were analyzed within each patient, these differences were also present. CONCLUSIONS: Children receiving propofol/fentanyl general anesthesia experienced significantly less procedure-related pain and distress than did those receiving either EMLA or oral midazolam/EMLA.