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The paper by Thomsen et al 1 is a significant contribution to the now-substantial body of literature on the relationship between asbestos-related diseases and vehicle repair work. It is a large study, inclusive of all registered vehicle mechanics in the country for the designated years, with a mean follow-up time of 20 years and a maximum of 45 years. Several comprehensive administrative databases were linked for exposure and disease outcomes. The numbers of outcomes for the three main diseases of interest produced relatively narrow CIs. The authors present data indicating that reliance on administrative databases for health outcomes was unlikely to be a problem for mesothelioma and lung cancer; however, it is reasonable to question the validity of the diagnoses of asbestosis based on administrative data alone. As the authors point out, the statistically significant elevation in asbestosis mortality and morbidity is somewhat puzzling given the relatively high exposures required for asbestosis and the relatively low asbestos exposures experienced by vehicle mechanics. The existing literature does not support a positive relationship between asbestosis and vehicle repair work.2–5 The authors suggested that diagnostic bias may have played a role, but this is speculative. The result warrants further examination, possibly a nested case–control study with documentation of the diagnostic criteria supporting the database entries, blinded re-evaluation of the available diagnostic material, and further exploration of complete occupational histories. The investigators observed a slight elevation in lung cancer risk. The results are consistent with those from an earlier meta-analysis6 and are unremarkable. Studies of potential asbestos-related diseases among vehicle mechanics have focused primarily on risk of …

Background: We published a meta-analysis of the association between work as a motor vehicle mechanic and mesothelioma in 2004. Since then, several relevant studies on this topic have been published. Thus, to update the state-of-the-science on this issue, we conducted a new systematic review and meta-analysis. Methods: A comprehensive PubMed literature search through May 2014 was conducted to identify studies that reported relative risk estimates for mesothelioma among motor vehicle mechanics (in general), and those who were engaged in brake repair (specifically). Studies were scored and classified based on study characteristics. Random-effects meta-analyses generated summary relative risk estimates (SRREs) and corresponding 95% confidence intervals (CI). Heterogeneity of results was examined by calculating Q-test P-values (P-H) and I 2 estimates. Sub-group and sensitivity analyses were conducted for relevant study characteristics and quality measures. Results: Ten case-control studies, one cohort study, and five proportionate mortality ratio (PMR)/standardized mortality odds ratio (SMOR) studies were identified and included in the quantitative assessment. Most meta-analysis models produced SRREs below 1.0, and no statistically significant increases in mesothelioma were observed. The SRRE for all studies was 0.80 (95% CI: 0.61-1.05) with significant heterogeneity (P-H

BACKGROUND: It is postulated that children with asthma who receive an interactive, comprehensive education program would improve their quality of life, asthma management and asthma control compared with children receiving usual care.OBJECTIVE: To assess the feasibility and impact of ‘Roaring Adventures of Puff’ (RAP), a six-week childhood asthma education program administered by health professionals in schools.METHODS: Thirty-four schools from three health regions in Alberta were randomly assigned to receive either the RAP asthma program (intervention group) or usual care (control group). Baseline measurements from parent and child were taken before the intervention, and at six and 12 months.RESULTS: The intervention group had more smoke exposure at baseline. Participants lost to follow-up had more asthma symptoms. Improvements were significantly greater in the RAP intervention group from baseline to six months than in the control group in terms of parent’s perceived understanding and ability to cope with and control asthma, and overall quality of life (PCONCLUSION: A multilevel, comprehensive, school-based asthma program is feasible, and modestly improved asthma management and quality of life outcomes. An interactive group education program offered to children with asthma at their school has merit as a practical, cost-effective, peer-supportive approach to improve health outcomes.

The U.S. Environmental Protection Agency has begun discussions to consider its assessment of asbestos toxicity related to mineral form and fiber size. Brake workers are typically exposed to short chrysotile fibers. To explore the mesothelioma risk among brake workers, considering other occupational exposures to asbestos, data from a study that was published previously were obtained and the analysis was extended. The National Cancer Institute provided data from a case-control study of mesothelioma. Because many participants with a history of brake work also had employment in other asbestos-related occupations, mesothelioma cases and controls were compared for a history of brake work, controlling for employment in eight occupations with potential asbestos exposure. A stratified analysis was also performed excluding those with any of the eight occupations. Possible interactions between brake work and other occupational exposures related to risk of mesothelioma were also examined. The odds ratio (OR) for employment in brake installation or repair was 0.71 (95% CI: 0.30-1.60) when controlled for insulation or shipbuilding. When a history of employment in any of the eight occupations with potential asbestos exposure was controlled, the OR was 0.82 (95% CI: 0.36-1.80). ORs did not increase with increasing duration of brake work. Exclusion of those with any of the eight exposures resulted in an OR of 0.62 (95% CI: 0.01-4.71) for occupational brake work. There was no evidence of an interaction between brake work and other occupational exposures. These latter analyses were based on small numbers of exposed cases. The results are consistent with the existing literature indicating that brake work does not increase the risk of mesothelioma and adds to the evidence that fiber type and size are important determinants of mesothelioma risk.

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Background The study of near-fatal asthma (NFA) may provide a means to further our understanding of fatal asthma. Studies of NFA often are derived from a single ICU rather than from a defined population. We therefore aimed to identify factors distinguishing NFA patients (cases) from those persons treated in an emergency department (ED) [ED control subjects] and in the community (community control subjects [CCs]). Methods This was a population-based case-control study conducted over 20 months of 45 NFA patients (age range, 5 to 50 years), 197 ED control subjects treated in an ED, and 303 CCs, all of whom were residents of Alberta. Results The age distribution was similar between NFA patients and control subjects, with the majority being Conclusion NFA patients have many modifiable risk factors and many similarities to ED control subjects and CCs with asthma. General measures to improve asthma control and awareness of risks are required in all groups.

The relationship between crystalline silica and lung cancer has been the subject of many recent publications, conferences, and regulatory considerations. An influential, international body has determined that there was sufficient evidence to conclude that quartz and cristobalite are carcinogenic in humans. The present authors believe that the results of these studies are inconsistent and, when positive, only weakly positive. Other, methodologically strong, negative studies have not been considered, and several studies viewed as providing evidence supporting the carcinogenicity of silica have significant methodological weaknesses. Silica is not directly genotoxic and is a pulmonary carcinogen only in the rat, a species that seems to be inappropriate for assessing particulate carcinogenesis in humans. Data on humans demonstrate a lack of association between lung cancer and exposure to crystalline silica. Exposure-response relationships have generally not been found. Studies in which silicotic patients were not identified from compensation registries and in which enumeration was complete did not support a causal association between silicosis and lung cancer, which further argues against the carcinogenicity of crystalline silica.

Background Asthma mortality rates have increased in Canada and worldwide. Within Canada, the highest rates were seen in the prairie provinces. Objective The objective was to determine risk factors for fatal asthma by comparing those who died of an acute exacerbation with those who attended an emergency department for treatment of asthma. Methods The case-control study included all deaths from asthma among those aged 5 to 50 years in Alberta, Saskatchewan and Manitoba from November, 1992 through October, 1995 (cases). The 35 fatalities were matched to 209 controls by age, gender, time of the index event and residence. Results Cases were more likely than controls to have had severe asthma, an unscheduled physician visit in the past year, a past hospitalization for asthma, and to have been intubated. Both groups reported frequent, regular asthma symptoms. Beta-agonist bronchodilator use was more common among cases, as was use in excess of prescribed amounts. Use of inhaled steroids did not differ between groups. Prior to the index event controls were more likely to report a cold or flu (OR = 0.27; 95% CI: 0.10 to 0.72) and that medications were "not working" (OR = 0.30; 95% CI: 0.12 to 0.71). Cases were more often sad and depressed (OR = 2.88; 95% CI: 1.03 to 8.05). Time between onset/recognition of symptoms and the event was significantly shorter for cases than controls. Conclusions Both groups tolerated high levels of regular symptoms, suggesting poor management. Opportunities for intervention existed for both groups near the time of the event. The short time between recognition of symptoms and death suggests patients at increased risk should monitor their condition closely and take action in response to predetermined criteria.

Hepatitis C virus (HCV) is an emerging global public health issue with particular relevance in multiply transfused renal dialysis patients. This cross-sectional study evaluated the prevalence and risk factors for HCV infection among renal dialysis patients in northern Alberta, Canada. Ninety-two percent of eligible patients (n = 336) provided informed consent to participate. Participants were interviewed to gather risk factor information and, using multiple logistic regression analysis with exact inference, a predictive model for HCV infection in this population was developed. The prevalence of HCV infection in the population was 6.5%, and all positive patients had at least one identifiable risk factor. The multivariate analysis showed that the risk of HCV infection was greater for those in the 18-55 years age category (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.2-27.9), patients who had been on dialysis > 5 years (OR = 3.7, 95% CI 1.2-12.0), and patients who had > or = 2 high risk life-style behaviors (OR = 5.0, 95% CI 1.5-16.7). Transfusion prior to 1990 was marginally associated with HCV status (OR = 4.0, 95% CI 0.96-16.3). This study documented previously unreported life-style risk factors for HCV infection in patients with renal failure, confirmed the expected decline in transfusion-acquired HCV infection in this population, and provided evidence against nosocomial transmission of HCV.

The International Agency for Research on Cancer (IARC) recently reviewed the human and animal evidence relat ed to the carcinogenicity of silica, finding that there was sufficient evidence to conclude that crystalline silica in the form of quartz or cristobalite is a human carcinogen. A series of studies examining mortality of workers at several facilities processing diatomaceous earth was considered by the IARC committee to have provided strong evidence favouring their decision. A number of factors raise concerns about the results of these studies. These factors include modestly elevated risk estimates, the lack of adequate smoking information, bias in the estimates of exposures to crystalline silica and asbestos, and post hoc selection of historical exposure weightings and lag periods. Most of these shortcomings typify the literature available for the previous IARC review (1987) which concluded that there was only 'limited' evidence for the carcinogenicity of silica in humans, and suggest ed that studies be undertaken in populations of workers not exposed to known carcinogens. The limitations of

Background Construction boilermakers may be exposed to a variety of substances, including asbestos and welding fumes. Past studies of boilermakers have shown increases in mortality from lung cancer and asbestosis and radiographic changes consistent with asbestos exposure. Methods Respiratory symptoms, lung function, and radiographic changes were compared for 102 actively employed boilermakers with 20 or more years of union membership and 100 telephone workers. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating disagreed films. Union members were further categorized as boilermakers (n = 50) or welders (n = 52), based on longest service. Lung health was also compared with employment in a number of work sectors for time, and time-weighted exposure to dust and fumes. Results Boilermakers had more respiratory symptoms than telephone workers, but lung function did not differ. Radiographic changes were more common among the boilermakers (20% with any change, 8% circumscribed, and 9% diffuse pleural thickening). None of the boilermakers had small radiographic opacities. Several symptoms suggestive of bronchial responsiveness were associated with fume exposures in the gas and oil industry. Workers whose longest service was as a boilermaker demonstrated more symptoms than did welders. FEV1, FEV1/FVC, FEF25–75, and FEF50 were significantly lower among boilermakers compared with welders. Conclusion Health screening programs for these workers are warranted. Am. J. Ind. Med. 34:381–386, 1998. © 1998 Wiley-Liss, Inc.

To evaluate risk factors for asthma mortality, an unmatched case-control study was undertaken in the Canadian prairie provinces of Alberta, Saskatchewan, and Manitoba. Those between the ages of 5 and 50 (inclusive) who died from an acute exacerbation of asthma were compared to a control group of people with asthma from the same geographical areas who were contacted using random-digit dialing. Because no deaths occurred among residents less than 15 years old, this analysis was limited to cases and controls between 15 and 50 years old. Of the 38 deaths that occurred between November 1992 and October 1995, data were obtained from next of kin for 35 (92.1%). Of the 210 potential controls that were identified, 142 returned completed questionnaires (67.6%). Cases were more likely than controls to have asthma reported to be severe, to have experienced nocturnal symptoms, to have had cardiopulmonary resuscitation (CPR)/intubation, and to have had more healthcare utilization in the previous year. Medication use was also more common among cases compared to controls. Specific asthma triggers were reported more often for cases than controls; weather changes, excitement, depression, and stress showed the greatest case control differences. Although a number of very strong risk factors for death from asthma were identified, death from asthma is so rare in this age group that it is not possible to label an individual as "likely" to die from asthma. Nonetheless, patients, caregivers, and health professionals should be aware of indicators that would suggest greater risk.

A study was undertaken to assess pulmonary health effects of hydrogen sulfide (H2S) exposure in a group of workers (n = 175) extracting and processing oil and natural gas in west-central Alberta. Exposure to H2S was assessed by questioning the workers about “exposures strong enough to cause symptoms,” and exposures that resulted in loss of consciousness (a “knockdown”). Exposures strong enough to cause symptoms were reported by 34% of the workers. Fourteen workers (8%) reported having had a knockdown. Exposures severe enough to cause symptoms were not associated with lower spirometric values or excess symptoms. Knockdowns were not associated with lower spirometric values but were associated with statistically significant excesses of (1) shortness of breath while hurrying on the level or walking up a slight hill (OR = 3.55; 95% CI = 1.02–12.4); (2) wheeze with chest tightness (OR = 5.15; 95% CI = 1.29–20.6); (3) attacks of wheeze (OR = 5.08; 95% CI = 1.28–20.2). The pattern of excess respiratory symptoms is consistent with bronchial hyperresponsiveness, which has been documented in studies of high-level exposure to other irritant gases. Additional study is warranted and should include assessment of bronchial reactivity. Am. J. Ind. Med. 31:554–557, 1997. © 1997 Wiley-Liss, Inc.

The health effects of particulate air pollution were highlighted at the Eighth Annual Conference of the International Society for Environmental Epidemiology, held in Edmonton, Alberta in August 1996. Despite consistent evidence for adverse respiratory and cardiovascular health effects related to particulate air pollution, there are significant gaps in the knowledge of the mechanisms whereby particulate air pollution affects human health. Questions regarding the appropriate measure of dose for assessing exposures relevant to health outcomes and the methods used to analyze dose-response data remain unanswered. Health effects have been demonstrated across the range of exposures that have been examined, and further research in low exposure settings is necessary to explore the lower end of the dose-response curve. Although a significant body of literature has been generated, comprehensive risk assessments have not been undertaken. Examination of the chronic effects of particulate air pollution and identification of high risk populations are necessary. Although there are significant unanswered questions regarding the health effects of particulate air pollution, the available information suggests that particulate air pollution at levels consistent with current standards is associated with measurable health effects.

A study was undertaken in a plant producing oriented strand board (OSB) from aspen and balsam wood, bonded by methylene diisocyanate (MDI) and phenol formaldehyde. A group of 127 production workers in the plant was compared to 165 oil workers from the same geographic area. Measurements of MDI ranged from 6 to 33 micrograms/m3 (0.001-0.003 ppm), of respirable dust ranged from 0.05 to 0.5 mg/m3, and of formaldehyde were 0.05 ppm or less. The ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) was significantly lower among the OSB workers compared to the oil workers, and this was more pronounced for ex-smokers and current smokers. A number of respiratory symptoms suggestive of airway reactivity were significantly more common among the OSB workers. It was known that changes to reduce worker exposure had been made in the plant before the study, and it is unclear whether the health effects documented were the result of these low levels or if previous, probably higher levels were responsible.

Sixty-one individuals hospitalized for hip fractures received activities of daily living (ADL) assessments during the 3 days prior to discharge. Information was also collected regarding anticipated role loss, depression, mental status, health status, and social support. Independence in ADL at home was measured 3 weeks following discharge by telephone interviews. The concordance between predischarge and post discharge ADL scores was low but statistically significant (Kw= .223; p < .05). Approximately 50.8% of the subjects demonstrated greater dependence post discharge. More dependent ADL performance at home was not related to role loss, depression, mental status, health status, or social support. Predischarge ADL assessments are often taken into consideration when formulating discharge plans. However, these evaluations do not always accurately predict post discharge ADL independence. It is recommended, therefore, that community follow-up be carried out with patients who have fractured hips.

Controversy regarding the association between silicosis and lung cancer has been clouded by the fact that studies examining this association generally do not include information on smoking. A causal association between smoking and silicosis would seriously confound the association between silicosis and lung cancer. The current analysis assessed the association between silicosis and smoking using data on deceased white gold miners who underwent postmortem examination between 1976 and 1981. Smoking histories and exposure information were available. A subset analysis in a group of deceased miners for whom more detailed smoking and exposure information was available confirmed the findings of the larger analysis. Both analyses showed a slight inverse relationship between smoking and silicotic collagenization of the parenchyma and a stronger negative relationship between smoking and silicotic collagenization of the pleura, controlling for age and cumulative exposure to silica dust. No association between silicotic collagenization of the hilar glands and smoking was detected. The data should not be construed as advocating that workers exposed to silica dust should smoke. The hazards of cigarette smoking are likely to far outweigh the hazards of silicosis. The data suggest that the lack of smoking histories in studies of the association between silicosis and lung cancer probably does not seriously confound risk estimates. The distribution of silicotic collagenization in the lungs of smokers and nonsmokers is consistent with enhanced mucus interception, more central deposition in the lungs, and proportionally more lymphatic clearance to the hilum (as opposed to the pleura) of silica particles in smokers compared to nonsmokers.

Recent studies of the association between lung cancer and silicosis and silica dust have been inconclusive; some showing positive association and some showing none. The present study matched 231 cases of lung cancer with 318 controls by year of birth. Subjects were selected from the necropsy records of the National Centre for Occupational Health. Data on intensity and duration of exposure to silica dust were obtained from personnel records. Presence or absence of lung cancer and the presence and severity of silicosis of the parenchyma, pleura, and hilar glands were documented from necropsy reports. Smoking data were abstracted from records of routine examinations. No case-control differences were noted for any of the exposure indicators including cumulative dust exposure, total dusty shifts, weighted average intensity of exposure, total underground shifts, and shifts in high dust. Similarly, no association was found between lung cancer and the presence or severity of silicosis and any site. Stratified analyses showed neither significant nor suggestive trends when case-control comparisons for silicosis were examined by level of dust exposure or smoking. Reasons for disparity between these results and those of some other studies may include concomitant exposures to radon daughters, asbestos, diesel emissions, and cigarette smoking; idiosyncracies of the compensation process; and the possibility of a threshold in the relation(s).

BACKGROUND: Most children with asthma should be able to achieve acceptable control. However, are there differences between those with acceptable and poor control, and if so, how can health care approaches be modified accordingly?OBJECTIVE: To examine the characteristics of elementary school children aged five to 13 years with acceptable and poor levels of asthma control.METHODS: The present cross-sectional study of children with asthma used five indicators of control, as outlined by the Canadian Asthma Consensus Report, to categorize acceptable and poor asthma control.RESULTS: Of 153 children, 115 (75%) were rated as having poorly controlled asthma. Of those with poor control, 65 (64%) children were currently using inhaled corticosteroids, and 65% of those reported using inhaled corticosteroids daily versus as needed. Fifty-one per cent of the children with poorly controlled asthma had exposure to tobacco smoke, whereas 79% of the children with asthma under acceptable control were from households with no smokers (P=0.002). The poor control group also had significantly worse parental perceptions of the psychosocial impact of asthma on their child. No significant difference was found in the percentage of those who had written action plans in the poor control group (28%) compared with the acceptable control group (26%), and similar percentages in each group stated that they used the plans.CONCLUSIONS: Despite the high use of inhaled corticosteroids, the majority of children had poorly controlled asthma. The poor control group had more exposure to tobacco smoke and a worse psychosocial impact due to asthma. Few children had past asthma education and action plans, suggesting that there is a need to improve access to and tools for education.

The aim of this study was to determine men’s perceptions about family planning and how they participate or wish to participate in family planning activities in Mpigi District, central Uganda. Four focus group discussions were conducted with married men and with family planning providers from both the government and private sector. In addition, seven key informants were interviewed using a semi-structured interview guide. The results indicate that men have limited knowledge about family planning, that family planning services do not adequately meet the needs of men, and that spousal communication about family planning issues is generally poor. However, almost all men approved of modern family planning and expressed great interest in participating. The positive change of the beliefs and attitudes of men towards family planning in the past years has not been recognized by family planning programme managers, since available services are not in line with current public attitudes. A more couple-oriented approach to family planning is needed. Measures could include, for example, recruiting males as family planning providers, offering more family planning counselling for couples, and promoting female-oriented methods with men and vice versa.

We conducted a systematic review and analysis of the epidemiological literature that examines the risk of lung cancer and mesothelioma among motor vehicle mechanics who may have been engaged in brake repair and, thus, were potentially exposed to asbestos. All relevant studies were classified into three tiers according to their quality. Tier III (lowest quality) studies were cited for completeness, but were not included in the meta-analysis. Meta relative risks (meta-RRs) were calculated for mesothelioma and lung cancer using both fixed and random effects models for Tiers I and II, separately, followed by stratified analyses based on study design or exposure characterization (garage workers versus brake workers) and, for lung cancer studies, based on adequate adjustment for smoking. The meta-analysis for Tier I (higher quality) and Tier II (lower quality) studies of mesothelioma yielded RR estimates of 0.92 (95% CI 0.55-1.56) and 0.81 (95% CI 0.52-1.28), respectively. Further stratification according to exposure characterization did not affect the results. The meta-analysis for lung cancer produced RR estimates of 1.07 (95% CI 0.88-1.31) for Tier I and 1.17 (95% CI 1.01-1.36) for Tier II. When the lung cancer analysis was limited to studies that used adequate control for smoking, the resulting RR estimate was 1.09 (95% CI 0.92-1.28). Based on these findings, we conclude that employment as a motor vehicle mechanic does not increase the risk of developing mesothelioma. Although some studies showed a small increase in risk of lung cancer among motor vehicle mechanics, the data on balance do not support a conclusion that lung cancer risk in this occupational group is related to asbestos exposure.

Elevated prostate cancer incidence was found at a plant producing atrazine that had an intensive prostate screening program. This study tested the relationship among atrazine exposure, prostate cancer, and the screening program. Twelve cases and 130 control subjects were selected from the original cohort. Prostate screening and occupational histories were abstracted from company records and atrazine exposures were estimated. Hire date was comparable for cases and control subjects. Nearly half of the control subjects and no cases left before the prostate-specific antigen (PSA) screening program. Cases had more PSA tests than control subjects (odds ratio for > or =1 test, 8.54; 95% confidence interval, 1.69-82.20). There was no association between atrazine exposure and prostate cancer when those with > or =1 test were compared. There was no evidence for an association between atrazine and prostate cancer.

In an examination of the relationship between silicosis and lung function, relevant studies of silica-exposed workers were reviewed. Smoking, dust exposure, and emphysema are three important factors that can confound the association between silicosis and lung function. Despite the importance of smoking in relation to lung function, some studies did not control for smoking, or smoking was controlled inadequately. The data suggest a weak association between lung function (mainly obstruction) and dust exposure, although some studies had crude measures of exposure. In general, the lung function of those with radiographic silicosis in category 1 was indistinguishable from those in category 0. Those in category 2 had small reductions in lung function relative to those with category 0 and little difference in the prevalence of emphysema. There were slightly greater decrements in lung function with category 3 and more significant reductions with progressive massive fibrosis. Emphysema was related to higher categories of silicosis, as well as to smoking. Silica exposure was often inadequately controlled in studies examining silicosis and lung function. A few studies suggested that emphysema is an independent risk factor associated with significant reductions in lung function.

An evaluation of the relationship between silicosis and smoking is important in exploring the etiology of silicosis, and the relationship could have an impact on studies dealing with silicosis and lung cancer. Data addressing this relationship were found in studies designed explicitly to evaluate this association and studies that explored other questions. Studies based on compensation registers were excluded. Smoking data and methods varied across the studies considered. Of the 13 studies, 3 supported the hypothesis that smoking was positively associated with silicosis, 8 provided limited support (most included subpopulations showing positive associations), and 1 did not support the hypothesis. The only autopsy study suggested an inverse association. It is unclear whether the generally positive results indicate that smoking predisposes to silicosis or that nonspecific radiographic appearances from smoking were interpreted as silicosis in some studies. A positive association between radiographic silicosis and smoking would bias studies of silicosis and lung cancer, especially those lacking smoking data.

Contexte : La fumee de bois est associee a divers symptomes d'atteinte de l'appareil respiratoire. Nous avons etudie la prevalence des symptomes respiratoires et les effets sur la sante de l'exposition a la fumee de bois (provenant du chauffage domestique, du fumage des viandes et di tannage des peaux) chez les residants de Deline (Territoires du Nord-Ouest). Methode : Sondage aupres de tous les residants et examen des liens entre la fumee de bois et les symptomes respiratoires. Resultats : Le taux de reponse etait de 70,2 % (n=402). Soixante-et-onze p. cent des personnes de 18 ans et plus etaient des fumeurs actuels. La prevalence des symptomes etait superieure chez les femmes (rapports de cotes [RC] de 1,3-3,1). Les fumeuses etaient aussi plus susceptibles d'etre exposees a la fumee provenant du fumage et du tannage a l'interieur des habitations. Les RC des symptomes respiratoires etaient superieurs chez les femmes, augmentaient avec l'âge et etaient tres influences par le tabagisme. Chez les femmes de 18 ans et plus, la mucosite les matins d'hiver (6,5 [IC de 95 % = 2,3-18,1]), la dyspnee (5,1 [IC de 95 % = 1,9-13,2]) et le larmoiement ou les yeux qui piquent (3,6 [IC de 95 % = 1,4-9,0]) presentaient des liens significatifs avec la fumee de bois a l'exterieur et le fumage declares par les interessees. Le chauffage domestique presentait un lien marginal avec la respiration sifflante. Aucune association significative n'a ete constatee chez les hommes. Conclusions : La prevalence des symptomes respiratoires etait plus elevee chez les femmes qui s'adonnaient au fumage ou au tannage. L'importance culturelle de ces activites ecarte la possibil qu'elles soient abandonnees, mais le renoncement au tabac, la reduction des durees d'expositior la fumee de bois et la modification des methodes de fumage et de tannage pourraient reduire le risque d'effets indesirables sur la sante.

To evaluate the effectiveness of a comprehensive asthma management education program for 7- to 12-year-old children with asthma, entitled Roaring Adventures of Puff (RAP), 18 elementary schools in Edmonton were randomized to intervention and control groups. Participating in the program were 76 students with asthma in the intervention schools and 86 in the control schools. Children in the intervention schools had statistically significant improvements in unscheduled doctor visits, missed school days, moderate-to-severe parent rating of severity, severity of shortness of breath, limitations in the kind of play, and correct use of medications. Unscheduled doctor visits and missed school days were the only significant improvements in the control group; however, improvements were about half that of the intervention group. The results showed that a comprehensive, school-based asthma education program is feasible and improves outcomes.

Objectives. Globally, 86% of exposure to particulate matter (PM) occurs indoors. Wood furnaces and smoke curing are known sources of PM in isolated communities in northern Canada. Study Design. Three homes with wood furnaces, three with oil furnaces, and nine tipis (smoke curing huts) in Deline, Northwest Territories were sampled for carbon monoxide, carbon dioxide, total hydrocarbons, formaldehyde, and for PM of less than 10 microns in diameter (PM 10 ). Results. All gaseous contaminants were below relevant air quality standards. In contrast, all but one environment had PM 10 concentra- tions above standards. The presence of smokers correlated with higher PM 10 levels within fuel categories. PM 10 did not differ significantly between heating types (means, 0.12-0.53 mg/m 3 ). Exposures to PM 10 in tipis averaged 2.3 mg/m 3 . Conclusion. Residents were exposed to substantial concentrations of PM 10 from cigarette smoking, wood stoves, and smoke curing. Concentrations were within the range where respiratory symptoms have been observed. Measures to reduce exposure should consider prevention of adverse health effects and preservation of traditional activities. (Int J Circumpolar Health 2003; 62(2):120-129) Keywords: indoor air quality, particulate matter, PM10, smoke curing, wood stoves

Background Noise exposure in the sawmill industry is an area of concern. This study documents the level of noise exposure in nine sawmills in the province of Alberta, Canada. Methods Personal noise monitoring data were collected in nine Alberta sawmills, in winter and in summer (n = 213). Exposures were considered in light of an estimated “real world” noise reduction rating (NRR) calculation assuming use of conventional hearing protection. Limited comparisons were made with spot area monitoring data. Results Only 10% of the personal monitoring measurements were below the Alberta 8-hr exposure limit of 85 dBA. Twenty-seven percent of the personal monitoring measurements were 95 dBA or higher. Worker enclosures played a large role in reducing noise exposure. There were no significant differences between seasons in noise category distributions (P = 0.61). The planermen and planer infeed operators had the highest percentage of personal monitoring measurements 95 dBA or higher (62% and 82%, respectively). Conclusions Based on a conservative formula, a risk of excess noise exposure could exist even when wearing required hearing protection due to very high noise levels found in planing operations in sawmills. Am. J. Ind. Med. 43: 156–164, 2003. © 2003 Wiley-Liss, Inc.

*Author to whom correspondence should be addressed. Tel: +1-312-627-2004; fax: +1-312-627-1617; e-mail: phessel@exponent.com 1Department of Public Health Science, 13-103 Clinical Sciences Building, University of Alberta, Edmonton, AB, Canada T6G 2G3; 2Two North Riverside Plaza, Suite 1400, Chicago, IL 6060, USA; 3Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1; 42108 Urbana Road NW, Calgary, AB, Canada T2N 4B8

The study of near-fatal asthma (NFA) may provide a means to further our understanding of fatal asthma. Studies of NFA often are derived from a single ICU rather than from a defined population. We therefore aimed to identify factors distinguishing NFA patients (cases) from those persons treated in an emergency department (ED) [ED control subjects] and in the community (community control subjects [CCs]).This was a population-based case-control study conducted over 20 months of 45 NFA patients (age range, 5 to 50 years), 197 ED control subjects treated in an ED, and 303 CCs, all of whom were residents of Alberta.The age distribution was similar between NFA patients and control subjects, with the majority being22 years of age (NFA patients, 68.9%; ED control subjects, 71.3%; CCs, 60.7%). Those patients with NFA were significantly more likely to have received a diagnosis before 5 years of age (66.6%), compared to ED control subjects (39.6%) and CCs (28.7%). The NFA group was significantly more likely to report moderate-to-severe disease and more frequent symptoms than the other groups. Therapy with bronchodilators was used most frequently by the NFA group compared to the ED control subjects and CCs (p0.001), as was therapy with inhaled steroids (p0.001) and oral steroids (p0.001). NFA patients had higher scores for vulnerability and were most likely to admit to stress as an asthma trigger. All groups had high exposure to cigarette smoke and pets.NFA patients have many modifiable risk factors and many similarities to ED control subjects and CCs with asthma. General measures to improve asthma control and awareness of risks are required in all groups.

Schools are faced with the challenging mandate of addressing the learning needs of students while simultaneously managing a gamut of behavior and health problems. School health policies have been successfully used for many health-related issues. Although asthma is the most common chronic disease among children, schools receive only a small amount of support to manage asthma issues. This article describes our experiences in developing an asthma policy in schools. The problem of asthma in schools was assessed as part of a comprehensive community-based asthma intervention, and a plan was established to develop a school asthma policy. The goal of the policy was to facilitate a physical and social environment that enabled students with asthma to control optimally their condition, have a good quality of life, and learn effectively. Specific objectives included enhancing environmental control, educating staff, clarifying medication protocols, and responding appropriately to symptoms. Strategies in developing the policy included strengthening collaboration and networks among health, school, and community sectors; defining the role of the school and health sectors; designing the policy; refining the policy based on stakeholder feedback; and developing an evaluation plan.

Hearing acuity among electricians, plumbers and pipefitters, and boilermakers with > or = 20 years of union membership was compared with that of telephone workers. Automated pure tone audiometry was performed and a questionnaire was administered. Most construction workers were exposed to occupational noise and wore hearing protection. Median thresholds for electricians and telephone workers were comparable. Thresholds of plumbers and pipefitters were higher but comparable to expected values. Boilermakers had high levels of hearing loss. Thresholds at 4000 Hz among older workers were similar for all groups and were above expected values, suggesting a cohort effect. Audiometric screening seems to be warranted for some construction workers.

BACKGROUND: Asthma can usually be controlled through allergen avoidance and/or appropriate medication. An emergency department visit for an acute exacerbation of asthma often represents a breakdown in asthma management. Emergency department treatment results in significant health care expenditures and reflects a compromised quality of life.OBJECTIVES: To identify risk factors associated with an emergency department visit for asthma.METHODS: This case-control study compared 299 people (76% of 390 cases contacted) who attended one of two emergency departments in Alberta in 1992 and 1993 for an acute exacerbation of asthma (cases) with 212 unmatched community controls with asthma who were located by random digit dialing. Cases and controls were asked to complete a mailed questionnaire to obtain data regarding severity, visits to doctors and emergency departments, medication use, allergies and other triggers, and smoking history. Data analysis included bivariate analysis of risk factors and multivariate model development using logistic regression.RESULTS: The response rate was similar between cases and controls. Cases were younger than controls (odds ratio [OR] 2.16, 95% CI 1.34 to 3.48) and more often reported their asthma to be severe (OR 4.25, 95% CI 2.24 to 8.06), and had experienced nocturnal symptoms (stratified OR range 1.36 to 6.82). Cases used more health care services in the previous year, had been admitted to hospital at some time for asthma (OR 1.62, 95% CI 1.10 to 2.38) and used more medication than controls.CONCLUSIONS: Physicians and other health care workers should be sensitive to the risk factors and target interventions to high risk individuals.

The purpose of this analysis was to assess the validity of self-reported transfusion histories in dialysis patients. Using data from a cross-sectional study of a dialysis population being investigated for hepatitis C virus (HCV) infection, the correspondence between self-reported transfusion history and transfusion records was explored. Demographic data and dialysis histories were examined in relation to the accuracy of self-reports. Overall, the questionnaire data and the blood bank records agreed for 89% of participants. The Kappa statistic was 0.72 (95% CI: 0.61, 0.83) indicating an acceptable level of agreement. The effect of non-differential exposure misclassification on the risk estimates for transfusion history as a determinant of HCV infection is demonstrated. Exploring the discrepancies between self-reports and documented transfusion histories underlines the need to communicate clearly medical interventions in chronically ill patients. Additionally, it suggests that studies into transfusion-acquired blood-borne pathogens should use all available information sources to establish exposure.

Respiratory symptoms, lung function, and radiographic changes among 100 actively employed electricians in Edmonton, Alberta, Canada, with 20 or more years of union membership were compared with those of 100 telephone workers. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating films that were disagreed upon. Employment in a number of industrial sectors was compared for time and for time-weighted exposure to dust and fumes. Compared with telephone workers, electricians had more usual cough (odds ratio [OR] = 3.36; 95% confidence interval [CI], 1.36-8.31), usual phlegm (OR = 2.44; 95% CI, 1.01-5.86), chronic phlegm (OR = 2.74; 95% CI, 1.13-6.60), and shortness of breath (OR = 2.26; 95% CI, 1.10-4.67), but no differences in lung function. The prevalence of radiographic changes in both groups was low. The electricians had more radiographic changes, but only for the category "any change" was the difference statistically significant (OR = 5.2; 95% CI, 1.06-23.93). Only two electricians had small irregular opacities. Phlegm, chronic phlegm, and chest tightness were significantly associated with cumulative exposure to fumes in the gas and oil industry and to total industrial construction.

OBJECTIVES: A cross sectional study was undertaken to assess lung health among plumbers and pipefitters. Respiratory symptoms, lung function, and radiographic changes among 99 actively employed plumbers and pipefitters with > or = 20 years of union membership were compared with 100 telephone workers. METHODS: A respiratory symptom questionnaire was administered, including smoking and occupational histories. Spirometry was conducted according to standard criteria. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating disagreed films. Members of the union were categorised as pipefitters (n = 57), plumbers (n = 16), or welders (n = 26), based on longest service, and compared with the telephone workers and internally (between groups). Lung health was also compared with employment in several work sectors common to Alberta for time, and for time weighted by exposure to dust and fumes. RESULTS: Compared with the telephone workers, plumbers and pipefitters had more cough and phlegm, lower forced vital capacity, and more radiographic changes (20% with any change), including circumscribed (10%) and diffuse pleural thickening (9%). None of the plumbers and pipefitters had small radiographic opacities. Among the three subgroups of workers, plumbers had the highest prevalence of radiographic changes. Both plumbers and pipefitters showed higher odds ratios for cough and phlegm than the welders. No differences between groups were found for lung function. Indicators of lung health were not related to work in any sector. CONCLUSIONS: Plumbers and pipefitters had increased prevalence of symptoms suggestive of an irritant effect with no evidence of bronchial responsiveness. The chest radiographs showed evidence of asbestos exposure, especially in the plumbers, but at lower levels than previously reported. Health screening programmes for these workers should be considered, although the logistical problems associated with screening in this group would be considerable.

Workers exposed to a variety of wood dusts have been shown to exhibit occupational asthma, lung function deficits, and elevated levels of respiratory symptoms. Despite the popularity of pine and spruce, the health effects of exposures to these woods have not been extensively investigated. A study was undertaken to investigate the respiratory health of a group of sawmill workers processing pine and spruce (n = 94). Data collection included a respiratory symptom questionnaire, spirometry, and allergy skin testing. The sawmill workers were compared with a group of oil field workers from the same geographic area who underwent the same study protocol (n = 165). The results showed that the sawmill workers had significantly lower average values for FEV1 and FEV1/FVC (%), adjusted for age, height, and smoking. The largest differences were for current smokers. Significantly elevated age and smoking-adjusted odds ratios (OR) were detected for shortness of breath (2.83; 95% confidence interval [CI], 1.47 to 5.46) and wheeze with chest tightness (2.58; 95% CI, 1.18 to 5.62). Nonsignificant elevations were also seen for usual cough (1.47; 95% CI, 0.68 to 3.16), usual phlegm (1.94; 95% CI, 0.98 to 3.87), shortness of breath with exercise (1.45; 95% CI, 0.66 to 3.20), chest tightness (1.43; 95% CI, 0.80 to 2.57), and attacks of wheeze (1.70; 95% CI, 0.79 to 3.68). Sawmill workers were 2.5 times as likely as oil field workers to report current asthma (95% CI, 0.76 to 8.32). Workers employed more than 3 years showed significantly more asthma (OR = 3.67; 95% CI, 1.00 to 13.5) and bronchitis (OR = 2.14; 95% CI, 1.02 to 4.52). Sawmill workers were only 43% as likely to report a history of hay fever (95% CI, 0.20 to 0.94). These health effects were noted despite an average concentration of respirable dust of 1.35 mg/m3 (range, 0.1 to 2.2 mg/m3). These levels are below the present occupational standard.

The question of an association between occupational noise exposure and blood pressure has important public health implications. The harmful effects of hypertension are well known, and noise is considered the most pervasive of all occupational exposures. Most previous studies have looked cross-sectionally at blood pressure and noise exposures in workers. The present study examined historic medical and personnel records of 2,197 white male South African miners. At approximately 3-y intervals, the job title, diastolic and systolic blood pressures, height, weight, and use of medication for hypertension were recorded. Noise levels were estimated, based on noise measurements of individual jobs and work areas. In the cross-sectional analyses, multiple linear regression was used with blood pressure as the dependent variable; age, body mass index (BMI), and noise exposure were the independent variables. Longitudinal analyses were performed for those miners who had observations at four or more time periods, by calculating regression coefficients for individuals for blood pressure and noise, controlling for age and BMI. Additional longitudinal analyses compared blood pressure changes between two points in time for individual miners with changes in noise exposure, controlling for changes in age and BMI. The results of the cross-sectional and longitudinal analyses indicated no association between blood pressure and noise exposure. On the basis of these results, it does not appear that occupational noise exposure has an effect on blood pressure. Inconsistencies in the literature and shortcomings in the present study indicate that additional study is needed.

The tendency for readers of chest films of the pneumoconioses to place films in the middle of the International Labour Office (ILO) categories of profusion (eg, 1/1, 2/2) was described by Morgan et al [1974], who saw this tendency as a possible source of bias. The present study reexamines the middling tendency in relation to bias and variability by comparing duplicate readings of chest films for pneumoconiosis. Readings of trained lay persons were compared to professional readings of the same films and readings of professional readers were compared with each other. Reasons for the middling tendency, which include the use of standard middle films and the instructions given to users of the classification, are suggested and possible solutions are proposed.

The mother tongue of the majority of black workers in the industrial workforces of the Witwatersrand is either Zulu or S Sotho/Tswana, and these are also the main languages spoken in the area. However a substantial minority cite one of several other languages as their mother tongue. In consequence, in occupational surveys using a respiratory questionnaire, the accepted practice has been to use multilingual interviewers who administer the questionnaire in whichever of the two main languages the interviewee requests, but work from an English language version. To test the reproducibility of the information so gathered, a standardized questionnaire was administered to 56 subjects on two occasions approximately three weeks apart by each of two interviewers, one of whose mother tongue was Zulu and the other S Sotho. Reproducibility was little affected by whether the interviewer used her mother tongue or not, pointing to the multilingual competence of both interviewers. Reproducibility was, however, less in subjects not interviewed in their mother tongue compared to those who were. In general, reproducibility was also less for symptom than for history questions, though the phlegm question performed comparably to that reported for more homogeneous language/ethnic groups. Thus, even if internally valid, respiratory symptom information obtained by this method may have limited generalizability. However respiratory history information appears more reliable and may prove of value in the investigation of the natural history of chronic lung disease in this and similar communities.