Although the health care costs and the number of disability cases across all medical illnesses have increased, disability management programs implementing stress management interventions have been found to improve physical and mental health, reduce costs to employers, and facilitate the reintegration of injured individuals into the work environment. Stress management programs limit the impact and chronicity of disabilities and can be used to reduce and control the cost of disability in the workplace. Providing the most efficacious behavioral interventions thereby allows employers, employees and health professionals to work cooperatively to achieve optimum health and cost effectiveness. This review presents a variety of group and individual interventions, which have been utilized to aid disabled employees in coping with work-related injuries and medical illness. The implementation of stress management interventions in the workplace is described in detail, with special emphasis on the use of cognitive behavioral stress management. Finally, this review outlines a team approach to the application of a workplace stress management intervention aimed at reducing the overall impact of disability.
The literature was reviewed to study cases of intoxication with systemic dermatitis associated with exposure to trichloroethylene. The average age of patients in the reports reviewed to date was twenty-nine; these diseases were found in relatively young persons and no difference was found according to gender. Many cases occurred within one month after the onset of exposure to trichloroethylene, and were accompanied by hepatitis, jaundice, hepatomegaly or hepatosplenomegaly. Most of the patients had no history of drug abuse or herpes infection. The level of exposure to trichloroethylene was not recorded in many cases, but ranged from less than 9 ppm to 800 ppm. In the severest cases, the lesions involved mucous membranes such as the conjunctiva and oral cavity, and the patients were diagnosed with Stevens-Johnson syndrome, but the etiology of the disease after trichloroethylene exposure remains unclear. Since several drugs have also been shown to cause systemic dermatitis with hepatitis, susceptibility factors are discussed. Many patients were found to have the slow acetylator genotype of N-acetyltransferase (NAT) 2, suggesting that the NAT2 genotype is a susceptibility factor. This hypothesis may also be applicable to trichloroethylene because NAT is involved in the glutathione-mediated metabolism.
To understand how psychological characteristics influence adoption and maintenance of physical activity/exercise, we conducted a cross-sectional study among Japanese employees based upon the idea of stages of behavior modification. The study population consisted of 719 employees (male, 396, female, 323) from five medium-sized manufacturing companies (50-200 employees) in Okayama Prefecture, Japan. The female response rate was 67.5% (n=218), among which 201 eligible female subjects (62.2%) were analyzed. The study questionnaire included demographic characteristics, physical activity/exercise measures, self-efficacy measures, and perceived benefit and barriers scales. Participants were asked to select the items that best described their current physical activity/exercise level from an 8-item questionnaire, and we converted their answers to the 5 stages of change according to a transtheoretical model of behavior change. Perceived benefit and barrier scales were classified into 7 factors (4 benefits and 3 barriers) by factor analyses. The relationship between psychological determinants and the stage of physical activity/exercise was examined by one-way analysis of variance. Only 10% of the subjects had moderate physical activity (in the action and maintenance stages) regularly. We found that self-efficacy, "weight control benefit", "physical barrier" and "time barrier" were psychological determinants of physical activity/exercise stages in female employees, and especially there was a consistent relationship between self-efficacy and the stage of physical activity/exercise. Our data suggest that health education for Japanese female employees requires that health professionals should provide support for strengthening self-efficacy, show practical ways to increase physical activity in daily life, and provide broad and accurate information showing that physical activity/exercise have a good effect on health.
A comparison was made of the bronchoalveolar lavage fluid (BALF) response to ultrafine nickel (Uf-Ni) and standard-sized nickel (Std-Ni). Rats were intratracheally instilled with 0, 0.1, 0.5, 1 and 5 mg Uf-Ni and Std-Ni, respectively. At 3 d after instillation, the body weight and wet lung weight were determined. At the same time, BALF was analyzed for lactate dehydrogenase (LDH), total protein (TP), tumor necrosis factor-alpha (TNF-alpha), and total cell and differential cell counts. The results showed that indicators of lung injury and inflammation in BALF were markedly raised with increased Uf-Ni and Std-Ni for each from 0 to 1 mg, and there were no differences in the indices between instillation of Uf-Ni at 1 mg and 5 mg. The results also showed that the effects of Uf-Ni on the indices were significantly higher than those of Std-Ni. Additional groups of rats were intratracheally instilled with 1 mg of Uf-Ni or Std-Ni, and wet lung weight and BALF profiles were analyzed at 1, 3, 7, 15 and 30 d later. The effect of Uf-Ni and Std-Ni on indices that can be presumed to reflect epithelial injury and permeability (LDH or TP), and release of proinflammatory cytokine (TNF-alpha) were increased throughout the 30 d post-exposure and the effects of Uf-Ni on these indices were significantly higher than those of Std-Ni from 1 to 30 d after instillation. Moreover, the number of neutrophils and LDH activity in BALF of rats after exposure to Uf-Ni were significantly greater than those of Std-Ni-exposed rats up to 30 d after instillation. Our findings suggest that Uf-Ni has a much more toxic effect on the lung than St-Ni, but the mechanism remains to be elucidated.
Pulmonary deposition and the clearance of deposited fiber particles from lungs are key determinant factors in assessing potential carcinogenicity and fibrogenicity. Forty-two Wistar male rats (9 wk old) were exposed to silicon carbide whisker (SiCW) for 6 h/d, 5 d/wk for 4 wk. The mass median aerodynamic diameter was 2.5 μm as detected by an Andersen sampler, and the geometric mean fiber diameter and length determined by a scanning electron microscope were 0.4 and 2.2 μm, respectively. The daily average exposure concentrations were 10.4 0.5 mg/m3 (214 ± 31 fibers/ml ) during the exposure period. The rats were sacrificed after 3 d, 2 wk, 1, 2, 3, 6 and 12 months after 4-wk exposure. At the time of sacrifice, the wet lung weights and the deposited SiCW amounts in the lungs were measured by an X ray reference method. The amount of SiCW deposited was 0.60 ± 0.09 mg 3 d after a 4-wk exposure. The apparent deposition fraction was 4.8 ± 0.7 (%). During the clearance period, the amount of SiCW deposited in the rat lungs decreased exponentially with the increasing duration of the clearance period. The biological half time in the one-compartment model was determined to be 4.0 months which is similar to the values for glass fiber, potassium titanate whisker and aluminium-silicate ceramic fiber under similar exposure conditions.
This study examined the mortality among shipbreaking workers from 1985 to 1997, after the shipbreaking industry was banned in 1985-1986. The study cohort consisted of men including 2,850 flame cutters, 871 lifters, 240 odd-jobbers and 225 other workers registered in 1985 at Kaohsiung Shipbreaking Workers Union. Mortality (n=336) data examined were obtained from the Vital Statistics Registry from January 1985 to December 1997. The standardized mortality ratio (SMR) and logistic regression were used to estimate the risk of mortality from neoplasms, injuries and other causes. Compared to the local reference population, the deaths that were significantly higher than the expected numbers among all workers included deaths from all cumulative causes (SMR=1.11, 95% confidence interval (CI)=1.00-1.23), and deaths from external causes of injury and poisoning (SMR=1.75, 95% CI =1.47-2.09). Flame cutters in the youngest group, on the other hand, had very significant excess deaths from nasopharynx neoplasm (SMR=5.2, 95% CI=1.7-16.2) and pleural neoplasm (SMR=104.1, 95% CI=14.0-739.0). Based on logistic regression analysis controlling for age, lifters was about 5.1 more likely times than flame cutters to die from accidental falls. This study suggests that former shipbreaking workers are more likely to be at higher risk of injuries and the young flame cutters are at higher risk from neoplasms.
-Objectives-To estimate rates of cadmium (Cd) uptake from the digestive tract and changes in Cd in biological specimens after intake of Cd mainly in rice. Methods-Twenty-five young non-smoking Japanese female volunteers (20-23 in age) were recruited and a 20-d experimental study was conducted. With polished rice containing 0.004 ppm and 0.340 ppm of Cd, Meal L and Meal H were prepared. Approximately 12% of total Cd in Meal L and 92% of total Cd in Meal H originated in rice. The volunteers ate Meal L for 11 d to achieve a stable intake-output balance of Cd. Fifteen of the 25 volunteers ate Meal H on the 12th day (Group D1), and the remaining 10 ate Meal H on the 12th, 13th and 14th day (Group D3). All 25 subjects then resumed the consumption of Meal L to the end of the study (20th day). All meals, feces and urine were collected during the study, and Cd intake from the daily meals (Cd-I), Cd in feces (Cd-F) and Cd in urine (Cd-U) were determined. For measurement of Cd in blood (Cd-B), venous blood was collected from all volunteers on the day before the study and again on the 12th and 20th day; venous blood was also collected from 4-8 volunteers at additional time points. Results-Mean Cd-I was 4.51 μg/d (range: 1.85-6.93) or 48.48 μg/d (range: 27.98-56.27) when they ate Meal L or Meal H. Cd-F and Cd-B exhibited faster responses to the change in Cd-I than did Cd-U. The Cduptake rate, defined as (1-Cd-Fexcess /Cd-Iexcess) (Fig. 1), was 47.2% (range: -9.4-83.3%) in Group D1 and 36.6% (range: -9.2-73.5%) in Group D3, and the Cdbalance rate, defined as (1-Cd-Foutput /Cd-Iintake), was 23.9% (range: -4.0-37.7%) in Group D1 and 23.7% (range: -8.2-56.9%) in Group D3. Conclusions-Cd-F and Cd-B are better biological monitoring parameters for assessing change in Cd-I than Cd-U. The Cduptake and Cdbalance rates appeared to be higher than those in previous papers when ingested Cd mainly originated in rice.
A study was conducted in a glass bottle manufacturing plant in Pondicherry, India, to assess the magnitude and identify the risk factors of work-related injuries between January and December 1998. Three hundred and seventy-seven injuries were reported among 341 permanent workers followed up for one year (incidence=1,105.5/1,000 workers/yr). A higher load of injuries was noted in the first half of the night shifts and the second half of the other three shifts. Injuries were higher in the second half of the week and during the first half of the year. Hands and wrists were the most common sites of injury (40.6%), whereas the eye, foot, ankles and other body parts had 30%, 14.6%, 10.6% and 4.2% of injuries respectively. The commonest type of injury was cuts and lacerations (50.1%); injuries to the eye (due to foreign bodies, chemicals and welding sparks) accounted for 30%, sprains 8% and burns 7.1% of the injuries. A cohort of 75 workers chosen from the 341 permanent workers were followed up for the one year for identification of risk factors. Significant risk factors were age (less than 30 yr) and experience (less than 2 yr). Technical factors responsible for injury were a hazardous worksite in 37 (38.5%) cases, inadequate protection with safety wear in 32 (33%) cases and proximity to machines in 14 (14.6%) cases. Human factors identified were non-use of protective wear in 43 (45%), overconfidence in 18 (18.7%) and timing error while working with machines in 11 (11.4%) episodes.
Occupational accident rates are high in the developing world and they are among the crucial indicators of work life. The data on serious occupational accidents in three years from the Aegean Region of Turkey were analyzed in order to define the working life situation. The data for 1995-97 were obtained from The Social Insurance Institution. Variables were defined for workers, work environment and working conditions for descriptive analysis. The relationships between these variables and outcomes of the occupational accidents were analyzed. The fatality risk was 2.6 times higher for mining and construction than for the production sector (p<0.001), and 1.6 times higher for evening and night shifts than for day shifts (p<0.01). Mortality from being struck by something, falls, motor vehicle accidents and electrocutions were significantly higher than being cut or in, under or between objects (OR 3.5, 8.7, 23.1, 26.1 respectively and p<0.01). As a conclusion, it was suggested that within the globalization picture, occupational health problems in the developing world should be explored intensively in order to establish effective prevention programs.