Symptom screening in detection of occupational solvent-related encephalopathy.

OBJECTIVES: Sensitive and easily applicable methods are needed for early detection of central nervous system adverse effects related to occupational solvent exposure. The present study evaluates how symptom screening works in practice. METHODS: A cross-sectional questionnaire survey was conducted on 2,000 construction workers, including painters and carpenters, in Finland. Scores were calculated for symptoms relevant for chronic solvent encephalopathy (CSE). Responses on exposure and health were compared between subjects with high score (N = 28) and all other respondents. The respondents with the highest scores, regardless of their occupation and exposure, were invited for clinical examination to investigate the aetiologies of the symptoms. If the examination resulted in a suspicion of CSE, a multidisciplinary differential diagnostic follow-up procedure was performed. RESULTS: The respondents with highest symptom scores were more exposed to solvents than those with lower scores (P < 0.001) and reported more often physician-diagnosed diseases, especially psychiatric disorders (P < 0.001). They also consumed more alcohol (P = 0.005) and were more often unemployed or unable to work (P < 0.001). In the clinical examination, sleep disturbances, somatic disorders, depression, unemployment, and alcohol use were commonly found in addition to considerable solvent exposure history and clinical neurological findings. Further examinations and a diagnostic follow-up verified three cases of encephalopathy. One case was a CSE, an occupational disease. The other two encephalopathy cases had multifactorial aetiology including solvents. CONCLUSIONS: Screening in active workforce for symptoms of cognitive dysfunction identifies highly solvent-exposed workers and also reveals occupational and non-occupational cases of encephalopathy. Evaluation of differential diagnostic conditions is essential in the detection of CSE. A stepwise model is proposed.

Asthma incidence in wood-processing industries in Finland in a register-based population study.

OBJECTIVES: This register-based population study determined incidence rates of clinically verified asthma among woodworkers, other blue-collar workers, and administrative personnel employed in wood-processing industries in Finland. Exposure to wood dust was under special scrutiny. METHODS: All Finns employed in wood-processing industries were followed for asthma incidence via record linkage in the years 1986-1998. Incident cases included people with asthma reimbursed for medication by the national health insurance or registered as having occupational asthma. Age-adjusted incidence rates and relative risks (RR) by gender were estimated for wood workers, other blue-collar workers, and administrative employees (referents) in wood industries. RESULTS: The relative risk of asthma was increased for all woodworkers among both genders [men: RR 1.5, 95% confidence interval (95% CI) 1.2-1.8; women: RR 1.5, 95% Cl 1.2-1.7]; a similarly elevated risk was also found for other blue-collar workers (men: RR 1.5, 95% Cl 1.2-1.8; women: RR 1.4, 95% Cl 1.2-1.6) in the same wood industries. Statistically increased relative risks were found for low and medium exposure to wood dust, but not for high exposure. Altogether 217 of the 4074 clinically verified asthma cases were reported as occupational asthma in the Finnish Register on Occupational Diseases. CONCLUSIONS: The incidence rates for asthma were significantly increased both among the woodworkers and the other blue-collar workers in wood industries but without a clear dose-response. Cases recognized as occupational asthma accounted for only a small part of the total asthma excess, indicating that much of the work-related asthma excess remains unrecognized in these industries.

Work tasks, chemical exposure and respiratory health in construction painting.

BACKGROUND: There is insufficient knowledge about the role of house painting tasks and chemical exposure in the respiratory health of construction workers. METHODS: A cross-sectional questionnaire survey was conducted of 1,000 Finnish male construction painters and 1,000 carpenters (response rates 60.6% and 60.4%, respectively). Multivariate logistic regression models were adjusted for age, smoking, and atopy. RESULTS: Outdoor painting, more than indoor painting, was associated with asthma-like respiratory symptoms [odds ratios (OR) 2.7-6.5], rhinitis symptoms [OR 2.4, 95% confidence interval (CI) 1.1-5.2], asthma (OR 4.7, 95% CI: 1.4-16.1), and chronic bronchitis (OR 2.9, 95% CI: 1.0-8.4) when compared to carpentry work. Risk factors for respiratory symptoms and chronic bronchitis were the use of epoxy/urethane paints, putties, and plasters and the use of glues or traditional paints. Water-based paints were not a common cause of symptoms. CONCLUSIONS: Special attention should be paid to work methods and personal protection, not only in outdoor painting, but also in all filling, plastering, and sanding tasks. The shift from epoxy/urethane and other solvent-based paints to water-based products should be further encouraged.

Comparative study of work ability between cancer survivors and their referents.

Even though cancer survivors are often able to continue working after they have been diagnosed, they may have health impairments resulting in reduced work ability. We studied the current work ability of 591 employed people with an early-stage of breast cancer, lymphoma, testicular or prostate cancer, and 757 referents. We also investigated whether the survivors perceived that cancer had impaired their work ability, and which disease-related, socio-demographic and social factors at work had an impact on their work ability. The work ability of the cancer survivors did not differ from that of their referents. Among the survivors, 26% reported that their physical work ability, and 19% that their mental work ability had deteriorated due to cancer. The survivors who had other diseases or had had chemotherapy, most often reported impaired work ability, whereas survivors with a strong commitment to their work organisation, or a good social climate at work, reported impairment less frequently.

Activity, functional capacity and well-being in ageing Finnish workers.

BACKGROUND: The ageing of the labour force and falling employment rates have forced policy makers in industrialized countries to find means of increasing the well-being of older workers and of lengthening their work careers. AIMS: To longitudinally study the relationship between activity and functional capacity and the well-being of ageing workers. METHODS: Follow-up study to that carried out by the Finnish Institute of Occupational Health in 1981-97 (n = 3817). Activity level was measured using various free-time activities, and functional capacity was measured through daily-life activities. The measure of well-being included items with both positive and negative affects. The associations between activity, functional capacity and well-being were analysed by general linear models with repeated measures. RESULTS: Activity level and functional capacity had a strong positive effect (the effects of one unit increase were 0.32 and 0.30, respectively) on well-being. They were also interdependent. The impact of activity level in maintaining well-being became 31% greater during the follow-up, whereas the effect of functional capacity diminished by 17%. CONCLUSION: The results of the study indicate that both involvement in activities and functional capacity have an important, partly compensatory role in maintaining the well-being of ageing workers.

Cancer survivors' received and needed social support from their work place and the occupational health services.

GOALS OF WORK: Even though a lot of studies have been conducted concerning cancer patients' social support, the importance of social support from the work life is unclear. We examined the amount of emotional and practical support that cancer survivors needed and had actually received from their coworkers, supervisors, and the occupational health personnel. We also examined whether disease-related or sociodemographic background variables were associated with needed or received support. Finally, we investigated whether there were differences between various sources in received or needed support. PATIENTS AND METHODS: The data consisted of a total of 640 cancer survivors with breast cancer, lymphoma, testicular or prostate cancer, aged 25-57 years at the time of diagnosis. Information on social support was collected with a mailed questionnaire using an adapted version of the Structural-Functional Social Support Scale (SFSS). MAIN RESULTS: The cancer survivors had received most support from their coworkers and they hoped for more support especially from the occupational health care personnel (39% of women and 29% of men). The men who had lymphoma, had received chemotherapy, or had low education level needed more support. The need for practical support from the occupational health personnel was fivefold between the chemotherapy-treated and those not treated. The women both received and needed more support than the men did. CONCLUSIONS: There is a clear need for additional social support from work life among the cancer survivors especially from the occupational health personnel.

Chemical exposure and symptoms of hand dermatitis in construction painters.

Studies on the prevalence of hand dermatitis in construction painting are rare. Our aim was to study the painters' chemical exposure and the prevalence of self-reported skin symptoms on hands and forearms. A cross-sectional questionnaire survey was conducted on 1000 Finnish male construction painters and 1000 carpenters (response rates 60.6% and 60.4%, respectively). We used 2 definitions for symptom-based hand dermatitis (liberal > or = 2 symptoms and strict criteria > or = 3) and logistic regression analysis, adjusted with age and atopy. Painters reported more symptoms of hand dermatitis than carpenters (12-month prevalence 22.5% and 14.2%, P < 0.05; strict criteria 13.3% and 6.4%, P < 0.05). A dose-response relationship was found for reporting symptoms and exposure to several solvent-based (SB) and water-based (WB) products. When exposure was combined into 1 variable, daily use of SB epoxy/urethane paints (OR 5.3, 95% CI 2.2-12.9; strict criteria 6.8, 2.3-19.9) and WB putties/plasters (1.9, 1.2-3.0; strict criteria 2.0, 1.1-3.9) were associated with hand dermatitis, whereas using only WB paints was not a risk factor. In conclusion, painters reported significantly more symptoms of hand dermatitis than carpenters. Putties/plasters emerged as a risk factor for dermatitis in construction painting.

Respiratory symptoms and diseases among construction painters.

OBJECTIVE: To study the self-reported prevalence of respiratory symptoms and diseases among construction painters and estimate the potential risk for this group compared with a representative group of carpenters sharing the construction work environment but without significant exposure to paint. METHODS: A questionnaire study was conducted on 1,000 male Finnish construction painters and 1,000 carpenters (mean response rate 60.5%). Symptoms and diseases of the respiratory tract were studied, by logistic regression modelling, in relation to occupation and duration of painting experience. Age, atopy and smoking habits were taken into account. RESULTS: The painters reported more asthma-like, rhinitis, laryngeal and eye symptoms than the carpenters [odds ratio (OR) 1.4-1.8]. The difference in the prevalence of asthma between the occupations was not statistically significant, but the painters with 1-10 years of painting experience had a threefold risk of asthma compared with the carpenters. Chronic bronchitis was linked to painting occupation [OR 1.9, 95% confidence interval (CI) 1.2-3.0] and to the duration of exposure; OR (CI) for over 30 years of painting was 2.2 (1.2-4.0). Occupation was not associated with allergic rhinitis or conjunctivitis. CONCLUSIONS: The results indicate a higher risk for respiratory symptoms and chronic bronchitis among construction painters than among carpenters.

Employment status of Finnish cancer patients in 1997.

We explored the impact of cancer diagnosis on the employment status of 46 312 working-aged people with cancer, alive on 31 December 1997 in Finland, and an equal number of age- and gender-matched referents. In general, 50% of the cancer patients were employed, in comparison to 55% of their referents. People with cancer were slightly less often employed, mainly because of their higher retirement rate: 34% of the cancer patients and 27% of the referents had retired. People with lung cancer as well as those with cancer of the nervous system were less likely to be employed. Our results suggest that cancer diagnosis does not usually lead to unemployment or early retirement, even though the employment rate of the people with cancer varied greatly according to the cancer site. Early retirement is common among people with highly disabling cancer or poor prognosis, but in general, the employment of cancer survivors seems optimistic.

Solvent-related health effects among construction painters with decreasing exposure.

BACKGROUND: The prevalence of solvent-related symptoms among construction painters is unclear due to their declining exposure. METHODS: A questionnaire study was conducted on 1000 male Finnish construction painters and 1000 carpenters. Symptom questions were combined with exposure parameters, medical history, and health behavior. RESULTS: Highly significant associations were found between cumulative intensity of long-term solvent exposure (CE-LT) and symptoms of memory and concentration, and mood. CE-LT was a better measure of solvent exposure than the number of years as a painter. Exposure was also associated with diagnosed psychiatric disorders, hypertension and arrhythmia. Recent exposure in the 1990s had no major effect on symptoms. CONCLUSIONS: The results strengthen the dose-response relationship of exposure and long-term neurotoxic effects. No clear association was found between recent exposure and symptoms. Cardiovascular effects in solvent-exposed construction painters is further suggested.

The impact of education and occupation on the employment status of cancer survivors.

We explored the effect of a diagnosis of cancer on employment according to cancer type, education, occupation, age, gender, mother tongue (Swedish or Finnish), calendar time and hospital district. All 12,542 new cancer cases diagnosed in 1987-1988 and 1992-1993, aged 15-60 years at the time of the diagnosis were identified from the Finnish Cancer Registry. The employment rate of the cancer survivors 2-3 years after the diagnosis was only 9% lower than their gender- and age-matched referents. However, we found that education and occupation modified the effect of cancer on the employment; the difference between cancer survivors and their referents in the probability of being employed was greater in the lower than in the higher educational groups. A modifying effect of education on the probability of employment was found among people with cancer of the lung, stomach, rectum and cervix uteri and those with cancers of the nervous system.

Results of common laboratory tests in solvent-exposed workers.

OBJECTIVES: The screening and identification of occupational liver or other organ-system injury related to long-term, low-level solvent exposure are difficult in clinical practice. We studied the feasibility of the use of common laboratory tests combined with a detailed exposure history. METHODS: The relationships between laboratory tests and exposure to organic solvents were studied in regression modelling adjusted to age, alcohol consumption, gender and body mass index (BMI). The subjects were 29 solvent-exposed workers and 19 referents. Laboratory tests included serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), carbohydrate-deficient transferrin (CDT), alkaline phosphatase (ALP), creatinine, cholesterol, HDL-cholesterol, triglycerides, blood glucose and total and conjugated bilirubin. Positive hepatitis serology, systemic diseases or medications with known hepatic effects and current pregnancy were exclusion criteria. The main exposures of each subject were identified. Current solvent exposure status, exposure during the past 3 months, exposure during the past 5 and 10 years, and total life-time exposure were recorded. RESULTS: AST (P=0.0031), ALT (P=0.0015) and cholesterol (P=0.0110) correlated positively with cumulative solvent exposure in the past 5 years, total bilirubin with current exposure (P=0.0380), and glucose with exposure in the past 5 (P<0.0001) and 10 (P=0.0003) years. Triglycerides correlated positively with exposure in the past 5 (P=0.0025) and 10 (P=0.0059) years and with life-time exposure (P=0.0005). Creatinine correlated negatively with exposure in the past 10 years (P=0.0300) and life-time exposure (P=0.0005). Most laboratory values were within the normal range. CONCLUSIONS: These results suggest a multi-system health effect of solvents. The laboratory data had some similarities with those in the metabolic syndrome. The screening and diagnostics of solvent-related conditions should be based on a thorough work history and a set of carefully selected laboratory tests. No single test seems sufficient for this purpose.

Risk of asthma among Finnish patients with occupational rhinitis.

STUDY OBJECTIVES: To determine the risk of asthma among patients with occupationally induced rhinitis. DESIGN: Patients with confirmed occupational rhinitis were followed for asthma incidence through register linkage. Patients with other occupational diseases were used as a reference population. SUBJECTS: Patients entered into the Finnish Register of Occupational Diseases in from 1988 to 1999 for occupational rhinitis (n = 3,637) or other occupational disease (n = 31,457) were observed until December 31, 2000, through two national registers of individuals who were eligible for the reimbursement of asthma medication and the Population Register Center. METHODS: Incidence rates of asthma were calculated, and a log-linear model, adjusted for age, gender, and occupation, was used to estimate the relative risks (RRs) of asthma among those with occupational rhinitis compared to those with other occupational diseases. RESULTS: There were 420 and 972 incident cases of asthma, respectively, among those with occupational rhinitis and the reference population. The crude RR of asthma was 4.8 (95% confidence interval [CI], 4.3 to 5.4) for all patients with occupational rhinitis, 5.4 (95% CI, 4.8 to 6.2) for those with occupational rhinitis accepted for compensation, and 3.7 (95% CI, 3.1 to 4.5) for patients with unaccepted occupational rhinitis. The RR varied according to occupation and was the highest among farmers and wood workers, both groups having a sevenfold risk. The risk was especially high during the year following notification, but a roughly threefold risk persisted several years thereafter. CONCLUSIONS: Patients with occupationally induced rhinitis have a high risk of asthma, but further studies are needed to establish the effect of preventive interventions.

Different measures of asbestos exposure in estimating risk of lung cancer and mesothelioma among construction workers.

To analyze occupation, expert-evaluated cumulative exposure, and radiographic abnormalities as indicators of asbestos-related cancer risk we followed 16,696 male construction workers for cancer in 1990-2000. We calculated standardized incidence ratios (SIR) in comparison to the Finnish population and relative risks (RR) in a multivariate analysis in comparison to the internal low-exposure category of each indicator. Overall, the risk was increased for mesothelioma (SIR 2.0, 95% CI = 1.0-3.3), but not for lung cancer (SIR 1.1, 95% CI = 0.9-1.2). Radiographic lung fibrosis indicated a 2-fold and a high value of the exposure index a 3-fold RR of lung cancer, while there was no risk among those with pleural plaques. The risk of lung cancer was the highest in insulators (RR 3.7, 95% CI = 1.4-9.9). Occupation, expert-evaluated cumulative exposure, and lung fibrosis are useful indicators of lung cancer risk among construction workers.

The risk of asthma among Finnish patients with farmer's lung.

OBJECTIVES: To assess the incidence and risk of asthma in patients with farmer's lung in comparison with farm workers without farmer's lung. METHODS: The details of farmers and animal-husbandry workers notified in 1988-1999 for farmer's lung ( n=1,272) or other occupational disease ( n=5,045) to the Finnish Register of Occupational Diseases were followed until 31 December 2000 through two national registries of individuals eligible for reimbursement of the cost of asthma medication and the Population Register Center. Incidence rates of asthma were calculated, and a log-linear model adjusted for age, gender and occupation was used to estimate relative risks of asthma among those with farmer's lung compared to those with other occupational disease. RESULTS: Of the patients with farmer's lung, 109 (8.6%) were diagnosed with asthma during the follow-up compared with 202 (4.0%) incident cases of asthma among those in the reference population. The crude relative risk of asthma was 2.1 (95% CI 1.6-2.6) among those with farmer's lung compared with the reference population. The age- and occupation-adjusted relative risk of asthma among patients with farmer's lung was 2.5 (1.8-3.5) in men and 1.4 (1.0-1.9) in women. The rate of asthma was especially high during the first 2 years after notification of farmer's lung. CONCLUSIONS: Patients with farmer's lung have an increased risk of developing asthma in comparison to farm workers in general. Most of the cases of asthma occur relatively shortly after the diagnosis of farmer's lung, which should be taken into account in medical follow-up of patients with farmer's lung.

Incidence of asthma among Finnish construction workers.

We wanted to explore the risk of asthma among male workers of the construction industry. All Finnish male construction industry workers and all those employed in administrative work were followed for asthma incidence through a register linkage in 1986 through 1998. Age-adjusted relative risks (RR) were estimated for 24 construction occupations. The risk was increased in nearly all construction occupations studied, but it was highest among welders and flame cutters (RR 2.34), asphalt roofing workers (RR 2.04), plumbers (RR 1.90), and brick layers and tile setters (RR 1.83). Only 45 (2%) of the cases of asthma among construction workers had been recognized as occupational asthma. Construction industry workers have an increased risk of adult-onset persistent asthma and cases of occupational asthma caused by well-established causative agents have only a minor contribution to this overall asthma excess.

Individual factors, occupational loading, and physical exercise as predictors of sciatic pain.

STUDY DESIGN: In this prospective study, a cohort of 2077 workers free of sciatic pain and another cohort of 327 workers with severe sciatic pain were followed up for 1 year. OBJECTIVE: To evaluate the effects of different risk factors on the incidence and persistence of sciatic pain. SUMMARY OF BACKGROUND DATA: Sciatic pain seems to differ from other types of low back pain in terms of etiology, occurrence, and prognosis. Yet only a few studies of sciatic pain exist. The role of individual characteristics, occupational loading, and participation in different sports has rarely been assessed in a study with a prospective design among a working population. METHODS: The subjects of this study, Finnish forest industry workers, replied to a modified version of the Nordic Questionnaire at the baseline of this study and after 1 year. The effects of the predictors on the 1-year incidence and persistence of sciatic pain were studied with multivariable logistic regression modeling. RESULTS: Greater age, mental stress, smoking of long duration, and work-related twisting of the trunk increased the risk of incidental sciatic pain. Joggers had a lower risk for incidental sciatic pain, but a higher risk for persistent symptoms. Walking was positively associated with the risk of incidental pain. Greater age, mental stress, former smoking, jogging, and poor job satisfaction increased the risk for persistent severe sciatic pain. CONCLUSIONS: The findings from this study suggest that mental stress and smoking are independent risk factors for incidental sciatic pain. Overall physical exercise and most of the sports activities, except jogging and walking, had no effect on sciatic pain. Physical workload factors seemed to be more involved in the onset of sciatic pain, whereas psychosocial factors were related to the persistence of symptoms.

Exploration of asthma risk by occupation--extended analysis of an incidence study of the Finnish population.

OBJECTIVES: The objective of the study was to determine asthma risks at the most-detailed level of occupational classification in a previously described nationwide follow-up study that included the entire employed workforce of Finland. METHODS: In Finland, persons with clinically verified persistent asthma are registered for medication reimbursement within the national health insurance scheme. Data were combined from three national registers, and all 25- to 59-year-old employed Finns were followed for asthma incidence in 1986-1998. Altogether 49,575 cases were detected. A log-linear model was used to estimate the relative risks of asthma for 275 nonadministrative occupations in comparison with administrative work (33 occupations). RESULTS: A significantly increased risk was found for either men or women in 125 occupations. For the men, the risk was highest among bakers, laundry workers, shoemakers and repairers, tanners, fell mongers and pelt dressers, and metal plating and coating workers. For the women, the risk was highest among shoemakers and repairers, railway and station personnel, jewelry engravers, engineroom crew, molders, round-timber workers. and bakers. CONCLUSIONS: The results suggest that the work-related excess of asthma incidence is much more widely spread across the labor force than has been previously thought. A great number of occupations deserves to be targeted for in-depth studies focusing on the determinants of asthma excess and on possibilities for better asthma control among asthmatics working in these occupations. The large work-relatedness of asthma incidence should also raise public health interest because of the economic losses incurred and the potential for prevention.