Risk of Suicide and Accidental Death among Subjects Visiting a Doctor because of Mental Disorder: A Matched Case-Control Study in Finnish Farmers: Jyrki PENTTINEN. Kuopio Regional Institute of Occupational Health—Background: Various mental disorders, especially depression, precede suicide. According to some authors, also victims of accidental death in many cases have suffered from mental problems. In most former studies the study design has been retrospective. In this prospective study the risk of suicide or accidental death among patients visiting a primary health care doctor was evaluated. Subjects and methods: 20 suicides, 24 accidental deaths and 176 controls (four matched controls for each case) were included in a cohort comprising 3, 172 male farmers who were followed up for 13 yr. Results: Generally speaking, persons visiting a doctor because of some mental problem had a clearly increased risk of committing suicide: odds ratio (OR)=5.6; 95% confidence limit (CL): 1.7, 18.5. The corresponding OR for accidental deaths is 1.5 (95% CL: 1.1, 2.1) Alcohol abuse was the most usual mental disorder preceding suicide (OR=13.2, 95% CL: 1.4, 121) and accidental death (OR=10.9; 95% CL: 1.3, 91.4). Visits to the doctor because of depression preceded suicide in 5 of 20 cases. Not one of 80 controls of suicide cases had visited a doctor because of depression during the follow-up, so it was not possible to calculate the OR. Those having used psychotropical drugs during the follow-up had a 14.5fold risk (95% CL: 3.1, 68.3) of dying from suicide and 3.8-fold risk (95% CL: 1.3, 10.3) of dying accidentally. Conclusions: Alcohol abuse is the most usual mental disorder associated with accidental death. Suicide is often preceded by alcoholism or depression. (J Occup Health 2001; 43: 107-110)

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Gene Expression of Clara Cell Secretory Protein, Surfactant Protein-A and Thyroid Transcription Factor-1 in the Lungs of Rats Exposed to Potassium Octatitanate Whiskers in vivo: Li DING, et al. Institute of Industrial and Ecological Sciences, University of Occupational and Environmental Health, Japan—Inhalation studies have shown that exposure to potassium octatitanate whiskers (PT1), an asbestos substitute, produces pulmonary fibrotic changes, suggesting that PT1 might have fibrogenic potential. It has been theorized that Clara cell secretion protein (CCSP) and surfactant protein-A (SP-A) play a critical role in regulating the acute inflammatory response in the lung. The present study was conducted to investigate the time course (3 days, 1 wk, 1 month, 3 months, and 6 months) of the expression of mRNA of CCSP, SP-A and thyroid transcription factor1 (TTF-1), a common transcription factor of CCSP and SP-A, in lungs exposed to PT1 in vivo. PT1 suspended in saline was administered to male Wistar rats at a dose of 2 mg or 10 mg by single intratracheal instillation, and RNA was then extracted from the lungs. Expression of CCSP, SP-A and TTF-1 mRNA from the lungs was examined by reverse transcription-polymerase chain reaction. Exposure to 2 mg of PT1 did not increase levels of CCSP, SP-A or TTF-1 mRNA. The level of SPA mRNA in PT1 -exposed rats was decreased at 1, 3 and 6 months after a single instillation of 10 mg. Levels of CCSP and TTF-1 mRNA were also decreased at 3 days, 3 and 6 months after a single instillation. These findings suggest that CCSP and SP-A are involved not only in the acute inflammatory response but also in the chronic response of the lung exposed to PT1. (J Occup Health 2001; 43: 111-117)

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Characteristics of Exposure Profiles for Workers Exposed to Airborne Dusts and Polycyclic Aromatic Hydrocarbons (PAHs) in the Carbon Black Manufacturing Industry: Perng-Jy TSAI, et al. Department of Environmental and Occupational Health, Medical College, National Cheng Kung University—This study was aimed at characterizing the exposure profiles for carbon black manufacturing workers. Personal sampling was conducted on 8 wet pelletizing workers and 22 packaging workers. A sampling train consisted of an IOM personal inhalable aerosol sampler (to collect airborne dusts and their inherent particle-bound polycyclic aromatic hydrocarbons (PAHs)), and an XAD-2 sorbent tube (to collect gaseous PAHs) was used. For PAHs analyses, 21 PAH species were analyzed by using the gas chromatograph/mass technique. In addition, size segregating sampling was conducted at both workplaces, by using both the Micro-orifice Uniform Deposited Impactors (MOUDI) and the Noll Rotary Impactor (NRI) simultaneously to characterize the particle size distributions exposure to both exposure groups. Results show that the packaging workers had a higher dust exposure level (arithmetic mean=1.17 mg/m³) than the pelletizing workers (arithmetic mean=0.82 mg/m³). Although both levels were lower than the time-weighted-average threshold limit value (TLV-TWA) of 3.5 mg/m³ of ACGIH, about 7.48% of the packaging workers were estimated to be above the limit value. A significant amount of gaseous PAHs was also found in personal exposure, especially BaP and PER in the gaseous phase were similar to those found in the particle-bound phase. Exposure to particlebound PAHs was considered due to the releasing of carbon black dusts during the pelletizing and packaging processes, but for gaseous PAHs, it might be due to the emission of gaseous PAHs from the feedstock oil unloading process rather than the stack flue gas. The above findings suggest that both gaseous and particlebound PAHs are equally important in assessing exposure of carbon black industry workers. Size distributions, including both airborne dusts and particlebound PAHs, collected from both areas were found in the form of bimodality. No statistical difference could be found between the airborne dust size distribution and the corresponding particle-bound PAH size distribution in the two areas, which suggests that workers in both areas might be exposed to similar types of airborne dust that contain similar PAH compositions. (J Occup Health 2001; 43: 118-128)

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Mortality and Causes of Death among Japanese School Personnel between 1992 and 1996: Hideo TANAKA, et al. Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases—To examine mortality among Japanese school personnel working at primary and secondary schools, we studied mortality among members of the Mutual Aid Association of Public School Teachers (MAPST) aged 20 to 59 yr working at a primary or secondary school in six prefectures in Japan in 1992-1996 (membership, approximately 180, 000/yr). The observed number of deaths during the study period was obtained from the file of deceased members kept at the MAPST. The cause of death was determined by examining the death benefit application submitted by bereaved families. The sex-and-causespecific mortality was examined by using age-adjusted standardized mortality ratios (SMRs) in comparison with the general population, all workers, or professional and technical workers (peer group). During the study period, 719 deaths occurred. The male school personnel had a significantly lower risk of mortality from all causes than the general population [SMR: 0.45, 95% confidence interval (95%Cl)=0.41-0.49], all workers (SMR: 0.61, 95%CI=0.56-0.67), and the peer group (SMR: 0.70, 95%Cl=0.64-0.77). The female school personnel had a significantly lower risk of mortality from all causes than the general population (SMR: 0.46, 95%CI=0.40-0.53), and all workers (SMR: 0.81, 95%CI=0.71-0.93), but the difference from the peer group was not statistically significant (SMR: 0.93, 95%CI=0.82-1.07). Lower mortality in school personnel compared with the three populations was observed from all cancers (SMR: male, 0.54-0.68; female, 0.54-0.93), heart diseases (SMR: male, 0.600.94; female, 0.30-0.90), cerebrovascular diseases (SMR: male, 0.33-0.50; female, 0.31-0.61), and suicide (SMR: male, 0.36-0.68; female, 0.42-0.91). These findings indicate that Japanese school personnel working at a primary or secondary school had only half the mortality of the general population in both sexes. The causes of the low mortality among school personnel, including lifestyle factors and work environment, need to be studied to develop health promotion activities for other occupational employees in Japan. (J Occup Health 2001; 43: 129-135)

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Chronic Arsenic Poisoning and Respiratory Effects in Bangladesh: Abul Hasnat MILTON, et al. Arsenic Cell, NGO Forum for Drinking Water Supply & Sanitation, Bangladesh—A large population in Bangladesh have been exposed to naturally occurring inorganic arsenic through their drinking water. A prevalence comparison study of respiratory disorders among subjects with and without arsenic exposure through drinking water was conducted in Bangladesh. Characteristic skin lesions, keratoses and pigmentation alteration, and the water arsenic level confirmed the arsenic exposure. Three villages were selected from health awareness campaign programs. Participants in these courtyard meetings who had suspected skin lesions. i.e., keratosis, hyperpigmentation and hypopigmentation, were examined by a well-trained medical officer to confirm the diagnosis. Unexposed subjects were randomly selected from another village, where tubewells were not contaminated with arsenic. We interviewed and examined 218 individuals irrespective of age and sex from these villages. The arsenic level in their drinking water was measured and the mean arsenic level was 614 pg/l (ranging from 136 6mu;g/lto 1, 000 μg/l). Information regarding respiratory system signs and symptoms was also collected. There were few smokers, and analyses were therefore confined to nonsmokers. The overall crude prevalence (or risk) among the exposed subjects for chronic cough, and chronic bronchitis, was three times the prevalence in the control population. Age was a slightly negative confounding factor. The crude prevalence ratios were noticeably increased for female participants compared to male participants. A possible explanation for this noticeably increased occurrence of respiratory signs and symptoms in women is related to the presence of weakness. These results add to the evidence that long-term ingestion of arsenic can cause respiratory problems especially among females. (J Occup Health 2001; 43: 136-140)

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Exposure of Workers to Extremely Low Frequency Magnetic Fields and Electric Appliances: Yoon Shin KIM, et al. Institute of Environmental and Industrial Medicine, College of Medicine, Hanyang University, Korea—The purpose of this study was to investigate personal exposure to extremely low frequency magnetic fields. Subjects were randomly assigned to two groups. Thirty-seven subjects in occupational and 65 subjects in nonoccupational groups were measured for personal 24 h continual exposure, using EMDEX II (for 40-800 Hz, Enertech Consultant, Inc.), from March 1996 through December 1999. The mean personal exposure levels of the occupational group was 0.46 μT, whereas the value for the non-occupational group was 0.08 μT. Occupational groups were exposed more intensely while at work. Among the electric appliances examined, a massage unit showed the highest mean value of 247.07 μT, followed by an electric blanket with 5.24 μT. Finally, this study was expected to provide significant data for future study of exposure assessment of magnetic fields. A large scale study concerning more detailed exposure assessment should provide important information on health risk assessment of MFs. (J Occup Health 2001; 43: 141-149)

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Night-Shift Work Related Problems in Young Female Nurses in Japan: Takashi OHIDA, et al. Department of Public Health Administration, National Institute of Public Health—:Background: The relationship of night-shift work to sleep problems and work performance was examined in young female nurses in 11 hospitals in Japan. Methods: A crosssectional study was conducted by means of anonymous self-administered questionnaires, carried out in July 1999. Subjects were 620 female nurses (Average age: 23.9) who started their careers in April 1997 and continued working in the same hospitals for two years and three months until the time of the survey. A questionnaire consisting mainly of items concerning sleep disorders from the Japanese version of the Pittsburgh Sleep Quality Index was distributed to the subjects. Results: Significant associations were observed between working on night shift and the use of alcoholic beverages to help induce sleep, and between working on night shift and daytime drowsiness. Significant differences were also observed between two and three-shift systems with regard to subjective sleep quality. Moreover, average hours of sleep were significantly associated with three related sleep items: subjective sleep quality, difficulty in getting to sleep, and daytime drowsiness. Conclusion: Results suggest that in Japanese shift-work systems, sufficient sleep hours are needed for nurses who work night shift to ensure good quality of sleep and consequently better services for patients. (J Occup Health 2001; 43: 150-156)

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Changes in Cholinesterase Activity, Nerve Conduction Velocity, and Clinical Signs and Symptoms in Termite Control Operators Exposed to Chlorpyrifos: Masahiro GOTOH, et al. Asahi Rosai Hospital—We have surveyed periodical medical examinations for pest and termite control operators (n=64) exposed to chlorpyrifos and other organophosphate pesticides. Distribution of serum butyrylcholinesterase (BuChE) activities of all workers ranged 0.01-1.18 (ΔpH). Serum BuChE activities in 6 workers in one termite control company were severely depressed and ranged from 0.01 to 0.21 ΔpH. Erythrocyte acetylcholinesterase (AChE) activities in 3 workers were lower than the normal range. Erythrocyte AChE activities and serum BuChE acitivities in chlorpyrifos sprayers were significantly correlated (r=0.720). In other clinical signs, blood urine nitrogen (BUN) in 4 workers and white blood cell (WBC) counts in 4 workers were abnormal. Sensory nerve conduction velocities in the sural nerve of all 6 workers were significantly reduced to 18.8-26.6 m/s in the left leg and 19.2-27.2 m/s in the right leg. In the results of ophthalmic examinations, accommodation time (both eyes) in 4 workers extended over the normal range and electroretinography (ERG) in 2 workers showed abnormal ERG including disappearance of oscillatory potential. Chlorpyrifos residue in blood in 4 operators whose serum BuChE activities ranged from 0.01 to 0.03 ΔpH were detected in the range 2-8 ng/ml. They had sprayed chlorpyrifos daily for 5 d before every blood sampling. It is suggested that serum BuChE activity and sensory nerve conduction velocity are sensitive indicators to evaluate the effects of chlorpyrifos exposure, and may be used effectively to monitor exposure and the effects of chlorpyrifos on health. (J Occup Health 2001; 43: 157-164)

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Occupational Health Practice in Greece: Theodore BAZAS. Committee for Occupational Medicine, Central Council of Health, Greek Ministry of Health and Welfare—In Greece (a Member State of the European Union [EU]), where 57.7% of the four million economically active population are employed in the tertiary sector (mostly in Small and Medium Sized Enterprises [SMEs]), circa 20, 000 work accidents, but very few cases of occupational diseases are recorded annually. Nearly 10% of the 400 enterprise physicians are Specialists in Occupational Medicine. In several large companies Occupational Health (Medicine and Hygiene) and Safety [OHS] practice is of a high standard. However, the provision of work-specific or general preventive medical examinations for workers, and of occupational hygiene services needs to be extended to SMEs. OHS legislation has advanced markedly, having been harmonized to that of the EU, whereas its enforcement (a legal responsibility of the employer) has frequently been inadequate, partly due to the long-standing shortage of State Technical Work Inspectors; in December 2000 their number rose from 120 to approximately 300. By and large, education and training in OHS for University level students, physicians, engineers, managers, foremen and workers varies from sufficient to basic, stagnant or even lacking, but has recently been making some progress; several Greek books and information material on Occupational Health have lately been published. Virtually no pertinent scientific field research is carried out. Public awareness of the importance of OHS needs to be tackled more effectively. (J Occup Health 2001; 43: 165-167)

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Acute Methemoglobinemia—A Common Occupational Hazard in an Industrial City in Western India: Aruna DEWAN, et al. Poison Information Centre, National Institute of Occupational Health (NIOH)—Cases of acute methemoglobinemia reported to the Poison Information Centre at NIOH over a period of six years from 1993 to 1999 were analyzed. Of 1067 acute poisonings, there were 30 cases of acute methemoglobinemia, the majority of which were due to occupational exposures. The causative agents were mostly aromatic nitro amino compounds used as intermediates in the manufacture of dyes. Diagnosis of acute methemoglobinemia was made on the basis of clinical presentation and occupational history. A particular occupation viz. washing chemical contaminated plastic bags was responsible for many cases of methemoglobinemia. This report highlights the risk of acute poisoning among workers in the small scale chemical industry and also among self employed workers handling toxic chemicals. (J Occup Health 2001; 43: 168-171)

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