The U.S.-Russian radiation health effects research program in the Southern Urals.

The Joint Coordinating Committee for Radiation Effects Research (JCCRER) was established through a bilateral U.S.-Russian agreement to support research and exchange information on radiation health effects. The U.S. member agencies include the Department of Energy (DOE), Nuclear Regulatory Commission (NRC), Department of Health and Human Services (DHHS), Department of Defense (DoD), National Aeronautics and Space Administration (NASA), and Environmental Protection Agency (EPA). The Russians are represented by the Ministries of Emergencies (EMERCOM), Atomic Energy (MINATOM) and Health (MINZDRAV), and the Russian Academy of Sciences (IBRAE). The focus of this research is on the workers from the Mayak Production Association (MAYAK) in the Southern Urals and on the neighboring populations along the Techa River exposed to contamination from the plant. The goal of the program is to better define the relationship between the health effects and the chronic low dose and dose-rate exposure, these data being essential to validate current radiation protection standards and practices. The current primary areas of JCCRER research include dose reconstruction, epidemiologic health studies, molecular epidemiology/biodosimetry, and the creation of tissue banks. The organization of the ongoing research conducted under the aegis of the JCCRER and the rationale for this work are described.

Back pain among workers in the United States: national estimates and workers at high risk.

Back pain accounts for about one fourth of workers' compensation claims in the United States. The Occupational Health Supplement to the 1988 National Health Interview Survey provided an opportunity to assess the scope of this problem. The 30,074 respondents who worked in the 12 months before the interview were defined as "workers", and those with back pain every day for a week or more during that period were defined as "cases." A weighting factor was applied to the answers to derive national estimates. In 1988, about 22.4 million back pain cases (prevalence 17.6%) were responsible for 149.1 million lost workdays; 65% of cases were attributable to occupational activities. For back pain attributed to activities at work, the risk was highest for construction laborers among males (prevalence 22.6%) and nursing aides among females (18.8%). Our analyses show that back pain is a major cause of morbidity and lost production for U.S. workers and identifies previously unrecognized high risk occupations, such as carpenters, automobile mechanics, maids, janitors, and hairdressers, for future research and prevention.

Prevalence and work-relatedness of self-reported carpal tunnel syndrome among U.S. workers: analysis of the Occupational Health Supplement data of 1988 National Health Interview Survey.

To estimate the prevalence and work-relatedness of self-reported carpal tunnel syndrome (CTS) among U.S. workers, data from the Occupational Health Supplement of 1988 National Health Interview Survey (NHIS) were analyzed. Among 127 million "recent" workers" who worked during the 12 months prior to the survey, 1.47% (95% CI: 1.30; 1.65), or 1.87 million self-reported CTS, and 0.53% (95% CI: 0.42; 0.65), or 675,000, stated that their prolonged hand discomfort was called CTS by a medical person. Occupations with the highest prevalence of self-reported CTS were mail service, health care, construction, and assembly and fabrication. Industries with the highest prevalence were food products, repair services, transportation, and construction. The risk factor most strongly associated with medically called CTS was exposure to repetitive bending/twisting of the hands/wrists at work (OR = 5.2), followed by race (OR = 4.2; whites higher than nonwhites), gender (OR = 2.2; females higher than males), use of vibrating hand tools (OR = 1.8), and age (OR = 1.03; risk increasing per year). This result is consistent with previous reports in that repeated bending/twisting of the hands and wrists during manual work is etiologically related to occupational carpal tunnel syndrome.

Mortality patterns among construction workers in the United States.

Thirteen authors from the National Institute for Occupational Safety and Health contribute to this summary of recent and ongoing national occupational mortality surveillance studies of construction workers, including studies conducted under NIOSH's Fatality Assessment and Control Evaluation project, Sentinel Health Events project, National Occupational Mortality Surveillance System, and other projects.

The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data.

To estimate the prevalence of carpal tunnel syndrome among US adults, data from the Occupational Health Supplement of the 1988 National Health Interview Survey were analyzed. Based on a sample of 44,233 households (response rate, 91.5%), an estimated 1.55% (2.65 million) of 170 million adults self-reported carpal tunnel syndrome in 1988. Females and Whites had a higher prevalence of self-reporting carpal tunnel syndrome than males and non-Whites, respectively. Among 127 million adults who worked during the 12 months before the survey, 0.53% (0.68 million) reported that their "prolonged" hand discomfort was called carpal tunnel syndrome by a health care provider.

Occupation and lung cancer mortality among women: using occupation to target smoking cessation programs for women.

Lung cancer mortality rates are increasing for women, despite the fact that 90% of these deaths could be prevented by smoking cessation. Targeted workplace smoking cessation programs may increase the effectiveness of lung cancer prevention for women. This study uses proportionate mortality ratio analysis of occupationally coded death certificates, from 28 states between 1979 and 1990, to identify occupations in which women are at high risk of lung cancer mortality. The study found gender and racial variation in the results for broad occupational groups. Blue-collar occupations associated with potentially carcinogenic workplace exposures also had elevated proportionate mortality ratios, probably reflecting both occupational and tobacco exposure. For women, specific occupations such as managers and financial officers revealed significant elevations in lung cancer mortality. Cessation programs targeting women in these occupational groups may increase the effectiveness of lung cancer prevention.

Evaluating a fluorosis hazard after a volcanic eruption.

The August, 1991 eruption of Mt. Hudson (Chile) deposited ash across southern Argentina and contributed to the deaths of thousands of grazing sheep. Early ash analysis revealed high levels of fluoride, a potential ash constituent toxic to humans and animals. In order to evaluate fluorosis as the cause of sheep deaths and to examine the possibility that similar ash and airborne toxins could also have an effect on the human population, we conducted an investigation that included health provider interviews, hospital record review, physical examination of sheep, determination of sheep urine fluoride levels, and complete constituent analysis of ash samples collected at proscribed distances from the volcano. Ash deposited farthest from the volcano had highest fluoride levels; all fluoride measurements were normal after rainfall. There were no signs or symptoms of fluorosis observed in sheep or humans. Sheep deaths resulted from physical, rather than chemical properties of the ash.

Lead poisoning among battery reclamation workers in Alabama.

Lead exposures were evaluated at a battery reclamation facility in Alabama. A questionnaire obtained work and health information. Medical tests included blood lead, zinc protoporphyrin, hematocrit, creatinine, blood urea nitrogen, and uric acid. An investigation of workers' family members and neighborhood residents was conducted. Fourteen of 15 workers had blood lead levels greater than 50 micrograms/dL. Zinc protoporphyrin was > 79 micrograms/dL in 14 workers. Four workers had hematocrit < 40%; six had elevated serum creatinine (> 1.3 mg/dL). Workers' blood lead levels increased significantly over 2 years (beta = 1.004 micrograms/dL per month). Ten workers had elevated air lead levels. Twelve of 16 employee children had blood lead levels > 10 micrograms/dL; 3 were greater than 40 micrograms/dL. Workers' children had significantly higher blood lead levels than did neighborhood comparison children. Reclamation of lead batteries unaccompanied by smelting poses a health hazard to workers and their children.

Occupation as a risk identifier for breast cancer.

OBJECTIVES: Breast cancer mortality may be reduced if the disease is detected early through targeted screening programs. Current screening guidelines are based solely on a woman's age. Because working populations are accessible for intervention, occupational identification may be a way of helping to define and locate risk groups and target prevention. METHODS: We used a database consisting of 2.9 million occupationally coded death certificates collected from 23 states between 1979 and 1987 to calculate age-adjusted, race-specific proportionate mortality ratios for breast cancer according to occupation. We performed case-control analyses on occupational groups and on stratifications within the teaching profession. RESULTS: We found a number of significant associations between occupation and frequency of breast cancer. For example, white female professional, managerial, and clerical workers all had high proportions of breast cancer death. High rates of breast cancer in teachers were found in both proportionate mortality ratio and case-control analyses. CONCLUSIONS: These findings may serve as in an aid in the effective targeting of work-site health promotion programs. They suggest that occupationally coded mortality data can be a useful adjunct in the difficult task of identifying groups at risk of preventable disease.

Targeting of workplace inspections for lead.

The prevention of occupational lead poisoning requires identification of worksites with ongoing excessive lead exposures. The utility of different sources of surveillance data in identifying worksites was evaluated by comparing a list of companies inspected by the Occupational Safety and Health Administration (OSHA) for lead with 1) Ohio Bureau of Workers' Compensation (BWC) claims for lead poisoning, and 2) the New York Health Department's Heavy Metal Registry (NYHMR) reports of individuals with elevated blood lead levels. For the period 1981 through 1985, the NYHMR identified 179 companies with at least one employee having an elevated blood lead level. Of the 134 OSHA inspections conducted in New York during the same time period, 23 (17%) companies were identified by the NYHMR. In Ohio from 1979 through 1985, 50 companies had workers' compensation claims filed against them involving documented elevated blood lead levels. OSHA inspected 306 companies; 23 (7.5%) were identified by the BWC. In both states, companies inspected by OSHA were concentrated in larger industries with traditional, well-recognized lead hazards (e.g., primary metal and fabricated metals). Companies identified by compensation claims and laboratory reports tended to be in industries dominated by smaller establishments where lead is not a primary part of the industrial process (e.g., automotive repair and construction). Sources of surveillance data, such as workers' compensation claims and laboratory reports, identify worksites that tend not to be routinely inspected by OSHA and which need intervention to prevent excessive lead exposure. To maximize the impact of public health resources devoted to the elimination of occupational lead poisoning, follow-up efforts at companies identified by state health departments and workers' compensation systems offer an important opportunity to complement OSHA's inspection efforts.

Surveillance of occupational skin diseases: a method utilizing workers' compensation claims.

In order to determine the feasibility of using workers' compensation claims (WCC) for surveillance of occupational skin diseases, we reviewed all WCC received in the state of Ohio from 1980 through 1984. A total of 4,214 WCC for occupational skin diseases were filed by 2,610 Ohio companies, of which 1,656 (63%) companies were classified in Standard Industrial Classification (SIC) categories with average annual WCC rates above the overall state average for skin diseases. During the five year study period, 102 companies filed six or more WCC, of which 85 (83.3%) companies were classified in SICs with above-average WCC rates. WCC from 65 (63.7%) of these 102 companies implicated either the same occupation or causal agent in 50% or more of WCC received from each respective company. Using SIC classifications with WCC rates above the state average and six or more filed WCC as measures of risk, there was good correlation between company risk ranking by SIC categorization and number of WCC filed. This study suggests that active intervention strategies to prevent occupational skin diseases can be based on primary identification of companies filing WCC, followed by secondary identification of high-risk occupations or causal agent exposures within these companies.

Human immunodeficiency virus seropositivity in intravenous drug users in Ohio.

A seroprevalence survey of 508 intravenous (IV) drug users enrolled in methadone treatment programs in Ohio for evidence of infection with the human immunodeficiency virus (HIV) demonstrated a positivity prevalence of 1.4%. This seropositivity prevalence is low compared with 10% to 72% positive from surveys conducted in the IV drug-using populations of New York, New Jersey, Detroit and San Francisco. Although needle sharing was common (71% since 1983), the number of sharing partners was usually limited and regular. A potential for cross-infection from urban centers with higher seropositivity prevalence was indicated by patterns of travel and needle sharing while traveling to higher risk metropolitan centers such as New York. Hispanics appeared to be at greater risk for HIV infection (OR 17.7, 95% CI 2.4-133.0), as were male IV drug users with gay/bisexual lifestyles (OR 14.1, 95% CI 1.3-153.0). HIV positive individuals were identified in Cleveland (1.6%), Dayton (3.1%), and Columbus (0.8%), but not in the four other Ohio metropolitan areas participating in the survey. Study participants indicated that knowledge of AIDS had changed their IV drug-using habits with 60% reporting that fear of AIDS had caused them to give up IV drugs or needle sharing. Sampling from methadone clinics may underestimate the HIV seropositivity in Ohio's IV drug-using community; however, it appears that relatively few IV drug users in Ohio are currently infected with HIV. The low prevalence of HIV infection in the Ohio IV drug-using community provides the opportunity to intervene in limiting the spread of the virus by educating individuals to reduce or eliminate risk factors for the transmission of the disease.

Compliance with OSHA record-keeping requirements.

The Occupational Safety and Health Act of 1970 requires employers to maintain records of workplace injuries and illnesses. To assess compliance with the law, data from the National Occupational Exposure Survey (NOES) were examined. Of the 4,185 companies with 11 or more employees, 75 per cent maintained OSHA Form 200 designed for recording illnesses and injuries. The number of employees and the presence of a union were positive determinants in the record maintenance. Of companies with 500 or more employees, 95 per cent kept records compared with 60 per cent of companies with between 11 and 99 employees.

Occupational injuries due to violence.

Each year in the United States, an estimated 800 to 1,400 people are murdered at work, and an unknown number of nonfatal injuries due to workplace violence occur. Based on Ohio's workers' compensation claims from 1983 through 1985, police officers, gasoline service station employees, employees of the real estate industry, and hotel/motel employees were found to be at the highest risk for occupational violent crime (OVC) injury and death. Grocery store employees, specifically those working in convenience food stores, and employees of the real estate industry had the most reported rapes. Four previously unidentified industries at increased risk of employee victimization were described. Identification of industries and occupations at high risk for crime victimization provides the opportunity to focus preventive strategies to promote employee safety and security in the workplace.