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Background An exposure matrix (EM) for known and suspected carcinogens was required for a multicenter international cohort study of cancer risk and bitumen among asphalt workers. Methods Production characteristics in companies enrolled in the study were ascertained through use of a company questionnaire (CQ). Exposures to coal tar, bitumen fume, organic vapor, polycyclic aromatic hydrocarbons, diesel fume, silica, and asbestos were assessed semi‐quantitatively using information from CQs, expert judgment, and statistical models. Exposures of road paving workers to bitumen fume, organic vapor, and benzo(a)pyrene were estimated quantitatively by applying regression models, based on monitoring data, to exposure scenarios identified by the CQs. Results Exposures estimates were derived for 217 companies enrolled in the cohort, plus the Swedish asphalt paving industry in general. Most companies were engaged in road paving and asphalt mixing, but some also participated in general construction and roofing. Coal tar use was most common in Denmark and The Netherlands, but the practice is now obsolete. Quantitative estimates of exposure to bitumen fume, organic vapor, and benzo(a)pyrene for pavers, and semi‐quantitative estimates of exposure to these agents among all subjects were strongly correlated. Semi‐quantitative estimates of exposure to bitumen fume and coal tar exposures were only moderately correlated. EM assessed non‐monotonic historical decrease in exposures to all agents assessed except silica and diesel exhaust. Conclusions We produced a data‐driven EM using methodology that can be adapted for other multicenter studies. Am. J. Ind. Med. 43:3–17, 2003. © 2003 Wiley‐Liss, Inc.

Background An exposure matrix (EM) for known and suspected carcinogens was required for a multicenter international cohort study of cancer risk and bitumen among asphalt workers. Methods Production characteristics in companies enrolled in the study were ascertained through use of a company questionnaire (CQ). Exposures to coal tar, bitumen fume, organic vapor, polycyclic aromatic hydrocarbons, diesel fume, silica, and asbestos were assessed semi‐quantitatively using information from CQs, expert judgment, and statistical models. Exposures of road paving workers to bitumen fume, organic vapor, and benzo(a)pyrene were estimated quantitatively by applying regression models, based on monitoring data, to exposure scenarios identified by the CQs. Results Exposures estimates were derived for 217 companies enrolled in the cohort, plus the Swedish asphalt paving industry in general. Most companies were engaged in road paving and asphalt mixing, but some also participated in general construction and roofing. Coal tar use was most common in Denmark and The Netherlands, but the practice is now obsolete. Quantitative estimates of exposure to bitumen fume, organic vapor, and benzo(a)pyrene for pavers, and semi‐quantitative estimates of exposure to these agents among all subjects were strongly correlated. Semi‐quantitative estimates of exposure to bitumen fume and coal tar exposures were only moderately correlated. EM assessed non‐monotonic historical decrease in exposures to all agents assessed except silica and diesel exhaust. Conclusions We produced a data‐driven EM using methodology that can be adapted for other multicenter studies. Am. J. Ind. Med. 43:3–17, 2003. © 2003 Wiley‐Liss, Inc.

Hospital-based bloodborne infections are generally limited to viruses; hepatitis B virus, hepatitis C virus and the human immunodeficiency virus. The risk of infection by an infected patient to the health care worker is substantial. All preventable actions should be taken, including 3 injections of vaccine for hepatitis B, serological confirmation of protection, and further treatment if necessary. Since no preventable risk to a patient is acceptable, policies need to be set on the fitness-for-work of the infected surgeon. This article reviews the risks of bloodborne infections and preventive measures.

Periodic complete blood counts are not recommended for disease prevention in low-risk, non-pregnant adults. Consequently, there are few follow-up studies of the prevalence of incidentally detected anemia in asymptomatic subjects and its significance for their well-being. The objective of this survey is to determine the frequency of anemia and its predictive value for disease over a 15-yr annual follow-up of a cohort of asymptomatic young males, selected for physical fitness and intelligence.One thousand Israeli airmen aged 18-30 yr at entry into this historical-prospective study in 1968 were used as subjects. Hematocrit (Hct) levels were examined annually. On the average each subject had 13.2 tests in the course of the 15 yr follow-up. We arbitrarily defined anemia as a Hct of 40% or less on two or more tests, and compared the prevalence of diagnosed disorders in subjects with and without anemia.During follow-up, anemia was found in 125 (12.5%) of the subjects. On successive annual examinations of the same individual Hct levels varied by 3% or more in 3.5% of those without anemia, and in 10.5% of those with anemia. The frequency of diagnosed disorders, excluding inter-current infections and trauma, was 25.6%, and 10.9% among those with and without anemia, respectively (OR = 2.8, 95% CI 1.8-4.6). Anemia was associated with inflammatory bowel disease (OR = 12.1, 95% CI 2.3 78.6) and malignancy (OR = 3.6, 95% CI 1.1-10.7). It preceded diagnosis only in one case with Waldenstr 246 m's macroglobulinemia, in one case of inflammatory bowel disease and two cases of myocardial infarction.A finding of anemia doubled the likelihood of chronic disease. However, it had a limited predictive value for subsequent morbidity and did not lead to detection of treatable disorders or to disorders that might otherwise have endangered flight safety. Fluctuations of up to 3% in Hct over time may be viewed as normal in young males.

This quasi-experimental study tested the ambulatory blood pressure responsivity to daily variation in the work load of the same workers and examined whether this responsivity is moderated by perceived job control.The subjects were 79 nonshift, normotensive men who reported nearly almost equal occurrences of low and high work load in a typical workday. Job control was assessed by questionnaire. The workers recorded their situational work load and other parameters at each recording of ambulatory blood pressure.An analysis of covariance showed the main effects of both situational work load and job control on systolic ambulatory blood pressure, as well as a significant work load by job control interaction, even after control for clinic blood pressure, age, and body mass index. A blood pressure response to increased work load was observed only for workers with low job control. These workers also had a higher average systolic ambulatory blood pressure than workers reporting high control. The difference was 6.2 mm Hg (0.82 kPa) during the low workload periods and 10.2 mm Hg (1.36 kPa) during the high workload periods. A further multiple regression analysis confirmed the interaction and the main effect of job control but not that of work load, after control for work-related activities, body position, and hour of examination.This study showed that ambulatory blood pressure at work can fluctuate with variations in work load but only for workers with low job control. Low job control is independently associated with higher systolic ambulatory blood pressure.

Aviation ground personnel are subjected to a wide range of chemical and physical exposures that may lead the occupational physician to see a different spectrum of morbidity in the airport compared to other settings. It is essential to determine the most common medical problems in airport ground personnel in order to identify possible work-related conditions and in order to set the priorities for establishing health promotion programs and training occupational physicians. We compiled the diagnoses in 1000 consecutive visits of ground workers to the airport clinic for return-to-work examinations, and compared them to 7000 workers seen in general occupational clinics. The frequencies of the various categories of disease were similar in both type of clinics, except that low back pain was significantly more common in the ground personnel [251 (20.6%) vs. 1176 (15.2%), p0.003]. Over 80% of the diseases occurred in 10 diagnostic categories: cancer, fractures, hypertension, ischemic heart disease, knee pain, low back pain, neck pain, operations for various medical conditions, phonal trauma, and pregnancy. We conclude that, except for low back pain, the spectrum of disease seen in the airport clinic is not significantly different from that seen in general occupational medicine clinics. Focusing on the interaction of a limited number of diseases with the work environment will provide the occupational physician with a comprehensive training program, and the emphasis needed for establishing health promotion programs.

Work-related accidents at the airport are common, but the incidence and type of such events occurring in aviation ground personnel have not been reported previously. Information regarding the most common ground accidents at the airport is essential in order to implement prevention programs. The purpose of this study was to examine the descriptive epidemiology of injury-producing accidents among ground personnel at a modern airline. In this study we recorded all reported accidents occurring over a 5-year period (1988-92) to workers of a major airline in Israel that resulted in 3 d or more of absence from work. During the study period 523 work-related accidents occurred in 2000 ground workers. The most common accidents were due to slips, trips and falls (n = 211, 40.3%), lifting and carrying accidents (n = 107, 20.4%), and machinery accidents (n = 98, 18.7%). Work transport accidents and accidents from physical and chemical exposures were less common (n = 67, 12.8%, and n = 40, 7.5%, respectively). The accident rate decreased from 71 accidents/1,000 worker-years in 1988 to between 40-56 accidents/1,000 worker-years in the subsequent 4-year period (p = 0.0002). We conclude that slips, trips and falls are the most common cause of accidents in airport ground personnel. Further studies in other airports are warranted to confirm our findings.

The association of low back pain (LBP) with mechanical factors at the workplace is uncertain. Most of the studies on this subject did not examine multiple levels of symptoms and did not take into account both the type of work and the primary activity during work. We studied the annual prevalence, severity and duration of attacks of LBP recorded on a physician-administered questionnaire in 208 workers in a pharmaceutical factory. Symptoms were then cross-tabulated with job type, location, work requirements, gender, and years at the factory. LBP was reported by 138 (66.3%) of the workers. Although over 75% of jobs in the packing department, laboratories and offices required prolonged sitting, LBP was most prevalent among workers in the packing department, where the chairs were found to be ergonomically unfit (odds ratio 3.7, 95% confidence interval 1.5-9.1, P = 0.003). Logistic regression demonstrated a highly significant and independent association between LBP and work in the packing or production department (odds ratio 2.03), sitting or lifting (odds ratio 1.97) and 6 years seniority (odds ratio 1.64). Gender was not a significant variable. We conclude that among these pharmaceutical company employees, prolonged sitting and work in the packing or production departments were independently associated with LBP. Prospective studies are warranted to substantiate our findings.