Healthcare attendance styles among long-term unemployed people with substance-related and mood disorders.

BACKGROUND: Both increased and decreased health service usage and unmet care needs are more prevalent among unemployed people than in the general population. STUDY DESIGN: This study investigates the associations of substance-related and mood disorders among long-term unemployed people with styles of healthcare attendance in Finland. METHODS: The study material consisted of the health register information on 498 long-term unemployed people in a project screening for work disabilities. The data were analysed by mixed methods: qualitative typological analysis was applied to identify differential healthcare attendance styles, and the associations of the obtained styles with mental health disorders were analysed quantitatively by multinomial logistic regression. RESULTS: Three styles, characterized as smooth, faltering and marginalized, were identified. Compared with participants with the smooth attendance style without mental disorders, those with the faltering style had tenfold relative risk for substance-related disorder and fourfold relative risk for mood disorder. Those with the marginalized style had fivefold relative risk for substance-related disorder and twofold relative risk for mood disorder. Adjusting for background characteristics did not alter the statistical significance of substance-related disorder. In the case of mood disorders, the statistical significance persisted throughout the adjustments in the faltering style. CONCLUSION: Dysfunctional use of health services is more common among people with substance-related or mood disorders, who are at risk of drifting towards long-term unemployment and work disabilities. The early detection of those with faltering or marginalized healthcare attendance style may prevent prolonged unemployment, enable rehabilitation measures and reduce the risk of disability pensions.

Effects of occupational cobalt exposure on the heart in the production of cobalt and cobalt compounds: a 6-year follow-up.

OBJECTIVE: It has been suspected that cobalt is toxic to the heart. It can cause cardiotoxicity in heavily exposed humans and in experimental systems. The issue of interest for this study is whether cobalt also affects the myocardium at occupational exposure levels. METHODS: To study the effect of occupational cobalt exposure on the heart, we conducted a follow-up of workers at a cobalt production plant. The workers' hearts had been examined by echocardiography in 1999-2000. Altogether 93 exposed and 49 non-exposed workers examined in 1999-2000 were re-examined in 2006. Occupational history and health data were collected with a questionnaire. Blood pressure was measured, and electrocardiography (ECG), laboratory tests, Holter registration, and echocardiography were conducted for all participants. Analysis of covariance (ANCOVA) was used to analyse the data. RESULTS: No differences were found between the exposed and unexposed groups for any of the echocardiographic parameters in 2006. There were no differences in the laboratory values, the ECG parameters, or the results of the Holter registration of the exposed and unexposed workers. CONCLUSIONS: Although the previous results in 2000 suggested an association between cumulative exposure to cobalt and echocardiographic findings, the results of this new cross-sectional study with a tissue Doppler 6 years later did not confirm the association in the present cohort. If cobalt exposure affects heart muscle functions at this exposure level, the effects are smaller than those caused by physiological changes due to ageing, medication, and traditional cardiovascular risk factors, such as elevated blood pressure.

The Presenteeism Scale as a measure of productivity loss.

BACKGROUND: Work Ability Score (WAS) is a common instrument for assessing work ability but its validity in assessing presenteeism and productivity loss is unknown. AIMS: To validate a WAS-based measure, the Presenteeism Scale (PS), and to evaluate its accuracy as a presenteeism instrument among forestry employees. METHODS: This validation study was based on questions of perceived WAS assessed using the Work Ability-Personal Radar (WA-PR) instrument and on questions of perceived productivity loss and presenteeism assessed using a cross-sectional questionnaire survey. Pearson's correlation test was used to ascertain the associations between variables. The association of productivity loss with presenteeism was evaluated using a logistic regression model. The predictive ability of presenteeism was tested using the receiver-operating characteristic curve. RESULTS: There were 339 respondents in the cross-sectional survey, 257 in the WA-PR and 107 respondents participating in both surveys. The prevalence of presenteeism was 48%. Presenteeism was significantly (P < 0.05) higher among those reporting productivity losses. Presenteeism is extremely accurate in predicting perceived productivity loss but less accurate in predicting PS-based productivity loss. The odds ratio (OR) of self-estimated productivity loss was 77 times higher (OR 77.39, 95% confidence interval [CI] 25.36-236.12) among those with presenteeism. Correspondingly, OR of productivity loss based on the PS was three times higher (OR 3.05, 95% CI 1.16-8.04). CONCLUSIONS: The PS may be a valid tool for predicting productivity loss and may be as good as other instruments. However, further research is needed to improve its accuracy.

Effects of growth and aging on the reference values of pulmonary nitric oxide dynamics in healthy subjects.

The lung just like all other organs is affected by age. The lung matures by the age of 20 and age-related changes start around middle age, at 40-50 years. Exhaled nitric oxide (FENO) has been shown to be age, height and gender dependent. We hypothesize that the nitric oxide (NO) parameters alveolar NO (CANO), airway flux (JawNO), airway diffusing capacity (DawNO) and airway wall content (CawNO) will also demonstrate this dependence. Data from healthy subjects were gathered by the current authors from their earlier publications in which healthy individuals were included as control subjects. Healthy subjects (n = 433) ranged in age from 7 to 78 years. Age-stratified reference values of the NO parameters were significantly different. Gender differences were only observed in the 20-49 age group. The results from the multiple regression models in subjects older than 20 years revealed that age, height and gender interaction together explained 6% of variation in FENO at 50 ml s-1 (FENO50), 4% in JawNO, 16% in CawNO, 8% in DawNO and 12% in CANO. In conclusion, in this study we have generated reference values for NO parameters from an extended NO analysis of healthy subjects. This is important in order to be able to use these parameters in clinical practice.

Cobalt asthma--a case series from a cobalt plant.

BACKGROUND: Cobalt has been shown to induce mainly asthma, allergic contact dermatitis and hard metal disease. The data on cobalt asthma are mainly based on case reports. AIMS: To characterize all the cases of occupational cobalt asthma encountered in a cobalt plant at the time of diagnosis and 6 months later. We also evaluated the incidence of cobalt asthma in different departments on the basis of data on occupational exposures. METHODS: We identified cases of cobalt asthma confirmed with specific bronchial challenge tests in the Kokkola cobalt plant in Finland where exposure levels have been regularly monitored. RESULTS: Between 1967 and 2003, a total of 22 cases of cobalt asthma were diagnosed in the cobalt plant. On challenge tests, mostly late or dual asthmatic reactions were observed. The incidence of cobalt asthma was the highest in the departments with the highest cobalt exposure levels. All cases of cobalt asthma were encountered in departments where irritant gases were present in the ambient air in addition to cobalt. At the time of the follow-up examination 6 months later, non-specific hyperreactivity had mostly remained at the same level or increased. CONCLUSIONS: The incidence of cobalt asthma correlated with the exposure levels of cobalt in corresponding departments. An irritating effect of gaseous compounds may enhance the risk of cobalt asthma and even the smallest amounts of cobalt may be harmful to susceptible workers. Symptoms of asthma may continue despite the fact that occupational exposure to cobalt has ceased.

Pulmonary alveolar proteinosis induced by silica dust?

Abstract Pulmonary alveolar proteinosis (PAP) is a rare disease, with several aetiologies. This study reports the first Finnish case of PAP with possible induction by silica dust. A 58-year-old male patient had a documented history of heavy exposure to silica dust over a long period, although he himself considered the exposure to be low. The patient's cumulative exposure to silica dust was approximately 10 mg m(-3) years according to the workplace measurements. The patient developed classical symptoms and signs of PAP that closely mimicked those of acute silicosis, but he did not have any signs of classic silicosis. We conclude that significant chronic exposure to silica favours the diagnosis of PAP rather than acute silicosis in this case. PAP should be taken into account when patients exposed to silica dust complain of respiratory symptoms. A patient's assessment of his/her exposure to silica may not always be reliable.

Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings.

The objective of the present study is to determine the feasibility of chest computed tomography (CT) in screening for lung cancer among asbestos-exposed workers. In total, 633 workers were included in the present study and were examined with chest radiography and high-resolution CT (HRCT). A total of 180 current and ex-smokers (cessation within the previous 10 yrs) were also screened with spiral CT. Noncalcified lung nodules were considered positive findings. The incidental CT findings not related to asbestos exposure were registered and further examined when needed. Noncalcified lung nodules were detected in 86 workers. Five histologically confirmed lung cancers were found. Only one of the five cancers was also detected by plain chest radiography and three were from the group of patients with a pre-estimated lower cancer probability. Two lung cancers were stage Ia and were radically operated. In total, 277 individuals presented 343 incidental findings of which 46 required further examination. Four of these were regarded as clinically important. In conclusion, computed tomography and high-resolution computed tomography proved to be superior to plain radiography in detecting lung cancer in asbestos-exposed workers with many confounding chest findings. The numerous incidental findings are a major concern for future screenings, which should be considered for asbestos-exposed ex-smokers and current smokers.

Validity and recall of information from questionnaires concerning respiratory infections among schoolchildren.

The aim of the study was to assess the reliability of questionnaire information on visits to a physician and the use of antibiotics taken for respiratory infections among schoolchildren attending a water-damaged school and a reference group of schoolchildren attending an undamaged school. Two similar questionnaires on respiratory morbidity in two consecutive years were sent to the parents. The information given on the questionnaires was compared with the patient's records of the local health centre. Although the overall total numbers of ambulatory visits in the patients' records and questionnaires seemed to indicate good reliability, a more detailed individual investigation showed poor recall validity from the questionnaires, including a high percentage of unreported visits to the local health centre from both schools. Underreporting was commoner in the control school than in index school. Recall was best for the children who had no visits to a doctor. Use of antibiotics had a better recall than ambulatory visits in both schools. The study indicates that information on health services in questionnaires is not reliable, at least when occurrences in a period of one year or more are evaluated. The use of patient records as a reference of accuracy is also unreliable, unless all the health care services available to the people in the community are covered.

IgG4 response to fur animal allergens among fur workers.

OBJECTIVE: The aim of this study was to determine whether IgG(4) antibodies to allergens in urine extracts from fur animals associated with positive prick tests to the same allergens and with the occurrence of respiratory symptoms among fur workers, especially among highly exposed fur farmers. METHODS: Among the fur workers and among their referents, IgG(4) antibodies to mink and silver fox urine were analysed in three groups; all workers with a positive skin prick test to any fur animal allergen (n=50), all workers who had reported shortness of breath or rhinitis or eye symptoms (n=159), and to a random sample of asymptomatic persons (n=178). In the two last groups none of the workers had a positive skin test to any fur animal allergen. RESULTS: The fur farmers had higher level of IgG(4) values than other groups and also had positive IgG(4) antibodies to urine extract more frequently than the other groups. Among the exposed subjects, there was a distinct overlapping of a positive skin prick test to fur urine allergens and positive IgG(4) antibodies to responding allergens. Among the fur farmers the IgG(4) levels were associated with symptoms. CONCLUSIONS: IgG(4) antibodies were shown to be a good indicator of exposure. Because of an overlapping of positive skin prick tests and IgG(4) response to the same allergens, and an association between symptoms and IgG(4) response, it is recommended that the potential role of IgG(4) antibodies as an indicator of alternative sensitisation should be further examined in prospective studies.

Exposure to cobalt in the production of cobalt and cobalt compounds and its effect on the heart.

AIMS: To investigate whether exposure to cobalt in cobalt plants has any measurable effect on the cardiovascular system. METHODS: Occupational, cross sectional study, using a self administered questionnaire, blood pressure measurement, electrocardiography, and laboratory tests in which 203 male workers with at least one year of exposure to cobalt and 94 unexposed controls participated. Echocardiography was performed on a subset of 122 most highly exposed cobalt workers, of which 109 were analysed, and on 60 controls, of which 57 were analysed. Analysis of covariance and a multiple regression analysis were used to evaluate the data. RESULTS: Two of the echocardiography parameters measured were associated with cobalt exposure. In the higher exposure group the left ventricular isovolumic relaxation time (mean 53.3, 49.1, and 49.7 ms in the high exposure, low exposure, and control groups respectively) and the deceleration time of the velocity of the early rapid filling wave (mean 194.3, 180.5, and 171.7 ms for those in the high exposure, low exposure, and control groups respectively) were prolonged, indicating altered left ventricular relaxation and early filling. CONCLUSION: Cumulative exposure to cobalt was found to be associated with the results of Doppler echocardiography measurements, indicating altered diastole. This finding supports the hypothesis that cobalt accumulation in the myocardium could affect myocardial function. Whether this finding has clinical implications remains to be evaluated.

The remediation of mold damaged school--a three-year follow-up study on teachers' health.

The health effects in teachers of a mold-damaged school before and during an extensive remediation process were assessed. Health data were collected with self-administered questionnaires from teachers (n=31) working in a moisture and mold damaged school and from the reference group of teachers (n=13) working in a non-damaged school. The questionnaire study was repeated three times. Spirometry was measured in 33 individuals in the spring 1997 and repeated in the spring 1999 and 2000. In the damaged school, a cluster of eight asthma cases was identified, the prevalence of asthma being 26%. Before the remediation, the number of sinusitis episodes was higher (p=0.040) and the mean duration of sick leaves longer (p=0.015) among the study group than in the reference group. A higher prevalence of hoarseness and perceived poor quality of indoor air were reported. During the follow-up, no new asthma cases appeared. After the remediation, bronchitis, conjunctivitis, symptoms of allergic rhinitis and the sum of respiratory infection episodes decreased significantly. Some of the asthmatics had low values in the spirometry but no changes in the lung function were observed at the group level. The remediation of the mold damage had beneficial effects on teachers' health.

Effect of work with visual display units on musculo-skeletal disorders in the office environment.

BACKGROUND: The increase in computer and mouse use has been associated with an increased prevalence of disorders in the neck and upper extremities. Furthermore, poor workstation design has been associated with an increased risk of developing these symptoms. Aim The aims of this study were (i) to estimate the prevalence of musculo-skeletal disorders among full-time visual display unit (VDU) users; (ii) to examine how the prevalence varies by work environment; and (iii) to explore the association with work factors. METHOD: A survey was carried out on the effect of work with VDUs on musculo-skeletal disorders in workers in the office environment of 56 workplaces. Office workers (n = 298), customer service workers (n = 238) and designers (n = 247) were studied. RESULTS: For all the occupations combined, the 12 month prevalences of musculo-skeletal symptoms in the neck, shoulders, elbows, lower arms and wrists, and fingers were 63, 24, 18, 35 and 16%, respectively. The study indicated that musculo-skeletal pain is common among computer workers in offices. There was no strong association between the duration of computer work and pain or between the duration of mouse use and pain, but workers' perception of their workstation as being poor ergonomically was strongly associated with an increased prevalence of pain. CONCLUSIONS: Musculo-skeletal symptoms are common, but the duration of daily keyboard and mouse use had no connection with musculo-skeletal symptoms. Instead, more consideration should be paid to the ergonomics of workstations, the placing of the mouse, the postures of the upper extremities and the handling of the mouse.

Prevalence of work-aggravated symptoms in clinically established asthma.

This population-based cross-sectional survey assessed the prevalence of work-aggravated asthma symptoms and the effect of the work environment on the aggravation of symptoms of established asthma. A questionnaire was sent to 2,613 persons (aged 20-65 yrs) with asthma. The analyses were restricted to the 969 respondents who were currently employed. The effect of occupational exposure on the aggravation of asthma symptoms at work was assessed according to both self-reported and expert-evaluated exposure. Approximately 21% of the respondents reported work-aggravated asthma symptoms at least weekly during the past month. The prevalence of those with work-aggravated symptoms increased by age, self-reported occupational exposure to dusts, abnormal temperatures or poor indoor air quality, physically strenuous work, and chemicals, and expert-evaluated probability of daily occupational exposure to airborne dusts, gases or fumes. Aggravation of asthma symptoms at work is common among employed adults with asthma. Both self-reported and expert-evaluated exposure to dusts, abnormal temperatures or poor indoor air quality, physically strenuous work, and chemicals explained the significant worsening of symptoms. The findings suggest a marked role of the work environment in the aggravation of symptoms of established asthma.

Trends in serum cholesterol and lifestyle indicators in Members of the Finnish Parliament.

OBJECTIVE: To examine the extent that public health promotion activity is reflected in life styles of national decision makers, by analysing trends in coronary heart disease risk factors in Members of the Finnish Parliament (MPs). METHODS: The MPs were studied at the beginning of two subsequent 4-year parliamentary periods between 1991 and 1999. The studies included analyses of serum total cholesterol and high-density lipoprotein (HDL) cholesterol, and a questionnaire about alcohol, smoking and physical activity. RESULTS: Serum total cholesterol was above the national recommendation of 5.0 mmol/l in 85% of the male MPs and 62% of the female MPs. The mean level of serum total cholesterol increased in female MPs during the 4-year follow-up period (P < 0.05), and male MPs showed an increase in mean HDL cholesterol (P < 0.001). The mean body mass index increased in both male (P < 0.01) and female (P < 0.01) MPs during the same period. Alcohol consumption, smoking and physical activity were unchanged during follow-up. CONCLUSIONS: From the public health perspective, serum cholesterol is too high in most MPs, and the level in males is above the national average. Both males and females put on weight during the parliamentary period, and male MPs also showed an increase in HDL cholesterol, which may be explained by other lifestyle factors.

Immunoglobulin G antibodies against indoor dampness-related microbes and adult-onset asthma: a population-based incident case-control study.

Immunoglobulin G (IgG) antibodies against microbes related to indoor dampness problems have been used as potential biomarkers of fungal exposure in clinical investigations. There is limited information on their relation to asthma. We conducted a population-based incident case-control study to assess the risk of asthma in relation to specific IgG antibodies to eight dampness-related microbes: Aspergillus fumigatus, A. versicolor, Cladosporium cladosporioides, Fusarium oxysporum, Sporobolomyces salmonicolor, Stachybotrys chartarum, Streptomyces albus and Trichoderma citrinoviride. We recruited systematically all new cases of asthma during a 2.5-year study period and randomly selected controls from a source population of adults 21-63 years of age living in the Pirkanmaa Hospital District, South Finland. The clinically diagnosed case series consisted of 521 adults with newly diagnosed asthma and the control series of 932 controls selected randomly from the source population. IgG antibodies were analysed with ELISA. An increased risk of developing asthma in adulthood was significantly related to IgG antibodies to T. citrinoviride, but not to the other moulds. There was no evidence of a dose-response relation between the IgG antibody level and the risk of asthma. T. citrinoviride may play a role in the aetiology of adult-onset asthma or serve as an indicator of other causal factors.

Respiratory health effects of long-term exposure to different chromium species in stainless steel production.

The aim of this study was to determine whether occupational exposure to chromite, trivalent chromium (Cr(3+)) or hexavalent chromium (Cr(6+)) causes respiratory diseases, an excess of respiratory symptoms, a decrease in pulmonary function or signs of pneumoconiosis among workers in stainless steel production. Altogether, 203 exposed workers and 81 referents with an average employment of 23 years were investigated for indicators of respiratory health on two occasions, in 1993 and in 1998. Data collection with a self-administered questionnaire, flow volume spirometry, measurement of diffusing capacity, chest radiography and laboratory tests were carried out by a mobile research unit. Exposure to different chromium species and other metals was monitored regularly and studied separately. No adverse respiratory health effects were observed in the group exposed to Cr(6+), either in comparison with the control group in the first cross-sectional study or during the additional 5 year follow-up. Among the Cr (3+) exposed people, the production of phlegm, shortness of breath and breathlessness on exertion were significantly more frequent than in the control group, but the frequency of the symptoms did not increase during the follow-up; no differences were observed in the lung function tests and the radiographic findings did not progress. In the chromite group, the prevalence of breathlessness on exertion was higher than in the control group. However, in the follow-up, the occurrence of symptoms did not differ from 1993 to 1998. In the first study, most parameters of lung function were lower among the smokers in the chromite group than among the smoking controls, but in 1998 the difference was less marked. An average exposure time of 23 years in modern ferrochromium and stainless steel production and low exposure to dusts and fumes containing Cr(6+), Cr(3+), nickel and molybdenum do not lead to respiratory changes detectable by lung function tests or radiography. The workers exposed to Cr(3+) had more respiratory symptoms than those in the control group. The workers in the chromite mine had lower lung function test results than the control group due to earlier exposure to higher dust concentrations.

The effects of asthma on the quality of life and employment of construction workers.

Relatively little is known about the consequences of asthma for patients' work ability. In particular, the relationship between asthma and construction work has not been studied previously. The aim of this study was to determine how asthma affects construction workers' work ability and quality of life, and the most important conditions that cause respiratory symptoms in construction work. A questionnaire was sent to all construction workers examined in the pulmonary clinic of Tampere University Hospital between 1991 and 1995 who were diagnosed as having 'asthma bronchiale' (n = 104). In addition, 206 non-asthmatic construction workers were recruited from the register of the local trade union. Altogether, 73% of the asthmatic construction workers and 70% of the controls completed the questionnaire. Of the asthmatics, 48% were retired, whereas only 24% of the controls were receiving a pension. The asthmatics evaluated their work ability and general health as significantly worse than did the controls. The asthmatics had more limitations in their work and everyday life than the controls. Asthmatic construction workers had often changed work tasks and also occupation because of their illness. Building renovation, cleaning and insulation with mineral fibre materials were the most common causes of respiratory symptoms in the workplace, among both the asthmatics and the controls. Cold air, physical exercise and all types of dust and smoke caused the asthmatics to experience symptoms. It was concluded that asthma limits the work and everyday life of construction workers. Exposure to dusty, non-sensitizing agents is associated with asthmatic symptoms among construction workers.

Increased prevalence of atopy among children exposed to mold in a school building.

BACKGROUND: The purpose of this study was to assess the occurrence of immunoglobulin E sensitization to common environmental allergens (atopy) and new allergic diseases among schoolchildren after starting school in a water-damaged school building. The staff and pupils of a Finnish elementary school with visible water damage and mold complained of respiratory and skin symptoms. The school building was examined and widespread moisture damage was found. A control school with no visible water damage was also examined. No indication of exceptional microbial growth was found in the samples taken from this school. METHODS: History of allergic diseases and the year of diagnosis were established by a questionnaire. IgE antibodies to the common environmental allergens were determined from randomly selcted groups from both schools. RESULTS: Elevated IgE values were significantly more common among the exposed children, as was the occurrence of new allergic diseases after the children started at the school. CONCLUSIONS: The odds ratios for the IgE values of the study groups indicated a possible relationship between exposure to microorganisms and IgE sensitization. Exposure to spores, toxins, and other metabolites of molds may have complex results with unknown immunogenic effects that may act as a nonspecific trigger for allergic sensitization leading to the development of atopy.

Respiratory morbidity among children following renovation of a water-damaged school.

The authors sought to determine whether exposure to molds, resulting from moisture damage in a school, was associated with increased respiratory symptoms and morbidity among schoolchildren and whether the renovation of this building resulted in a decrease in prevalence of respiratory symptoms and morbidity. The study was a follow-up (1-y interval) of children between the ages of 7 and 12 y from two elementary schools in a Finnish suburb. In addition to a questionnaire completed by the parents, the authors assessed the respiratory health of children by examining the health records of a local health center. In the cross-sectional study, the prevalence of symptoms and infections were higher in the exposed group, as were visits to a physician and use of antibiotics. The school was renovated, after which all prevalence decreased and no significant differences remained, except for visits to a physician (according to questionnaire responses). Therefore, moisture damage and exposure to molds increased the indoor air problems of schools and affected the respiratory health of children.