The preplacement evaluation.

Over the past 25 years, the preplacement evaluation has undergone considerable evolution under the influence of regulatory and economic pressures. Formally used by some employers to screen out applicants who might have represented the mere possibility of a future work-related injury, the modern-day preplacement evaluation is legally restricted to only two determinations: (1) whether the individual can perform essential job functions with or without accommodation and (2) whether the individual represents a direct threat to himself or herself or others. Truly enlightened companies also recognize that other benefits accrue from a properly designed, conscientiously performed preplacement evaluation, perhaps the most important of which is to promote worker health, in the certain recognition that healthy employees are more productive ones. This benefit may be the true purpose of the preplacement evaluation and its most enduring, tangible benefit.

An industry-wide pulmonary study of men and women manufacturing refractory ceramic fibers.

An industry-wide pulmonary morbidity study was undertaken to evaluate the respiratory health of employees manufacturing refractory ceramic fibers at five US sites between 1987 and 1989. Refractory ceramic fibers are man-made vitreous fibers used for high temperature insulation. Of the 753 eligible current employees, 742 provided occupational histories and also completed the American Thoracic Society respiratory symptom questionnaire; 736 also performed pulmonary function tests. Exposure to refractory ceramic fibers was characterized by classifying workers as production or nonproduction employees and calculating the duration of time spent in production employment. The risk of working in the production of refractory ceramic fibers and having one or more respiratory symptoms was estimated by adjusted odds ratios and found to be 2.9 (95 percent confidence interval 1.4-6.2) for men and 2.4 (95 percent confidence interval 1.1-5.3) for women. The effect of exposure to refractory ceramic fibers on forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), the ratio of the two (FEV1/FVC), and forced expiratory flow (liters/second) between 25 percent and 75 percent of the FVC curve (FEF(25-75)) was evaluated by multiple regression analysis using transformed values adjusted for height, by dividing by the square of each individual's height. For men, there was a significant decline in FVC for current and past smokers of 165.4 ml (p < 0.01) and 155.5 ml (p = 0.04), respectively, per 10 years of work in the production of refractory ceramic fibers. For FEV1, the decline was significant (p < 0.01) only for current smokers at 134.9 ml. For women, the decline was greater and significant for FVC among nonsmokers, who showed a decrease of 350.3 ml (p = 0.05) per 10 years of employment in the production of refractory ceramic fibers. These findings indicate that there may be important sex differences in response to occupational and/or environmental exposure.

Building-related illness and sick building syndrome: from the specific to the vague.

When a primary-care physician encounters a patient with a possible building-related illness, common sense applies. Does the patient have a potentially serious condition? Does he or she need a referral to a specialist? This paper explores the topics of building-related illness and sick building syndrome.

Effects of formaldehyde on the mucous membranes and lungs. A study of an industrial population.

One hundred nine workers and 254 control subjects were studied to evaluate the effects of formaldehyde on the mucous membranes and lungs. A modified, respiratory symptom questionnaire and spirometry were administered to all study participants before and after their work shift, and formaldehyde levels were determined for each test subject. Over the course of the monitored work shift, test subjects demonstrated a dose-dependent excess of irritant symptoms and a statistically significant decline in certain lung function parameters. Analysis of test and control subject data combined revealed a correlation between formaldehyde exposure and these pulmonary changes. Baseline spirometry values were not significantly different between test and control groups, and formaldehyde-exposed workers did not report an excess of respiratory symptoms. Formaldehyde is a dose-dependent irritant of the eyes and mucous membranes at low-level exposures. It can exert a small, across-shift effect on airways but after a mean exposure of ten years does not appear to cause permanent respiratory impairment.

Evaluation of the neurophysiologic effects of 1,2-propylene glycol dinitrate by quantitative ataxia and oculomotor function tests.

1,2-Propylene glycol dinitrate (PGDN), a nitrated ester found in the torpedo propellant Otto Fuel II, has been suspected of causing neurologic and cardiovascular effects. This study evaluated the possible acute and chronic neurophysiologic toxicity of PGDN in U.S. Navy torpedo facilities. The test procedures included a medical and occupational history, neuro-ophthalmologic examination, and quantitative tests of both oculomotor function and ataxia. A study population of 87 workers chronically exposed (CE) to PGDN during torpedo maintenance procedures was compared to a group of 21 controls (CON). Although workers often complained of vascular effects (headaches, nasal congestion), no evidence of chronic neurotoxicity was found, even among a subgroup of workers (CEsub) with the longest total duration of exposure. To detect possible acute effects, 29 subjects from the study group were tested before and immediately after PGDN exposure during a torpedo maintenance procedure or turnaround (TA). These personnel had a statistically significant decline in saccade velocity and a prolongation of saccade delay time, even though most peak airborne concentrations of PGDN were well below 0.2 ppm.

Nitrogen dioxide-induced pulmonary disease: five new cases and a review of the leterature.

Twenty-three patients exposed to nitrogen dioxide in agriculture or industry were referred to the University of Wisconsin Medical Center. Eighteen experienced a transient upper respiratory tract syndrome; five developed pulmonary edema or bronchiolitis obliterans. This latter group responded to steroid therapy but all demonstrated evidence of persistent pulmonary dysfunction on follow-up studies. Combining our findings with those in the literature we concluded: (1) exposure to NO2 is more common than generally appreciated; (2) case fatality is high--29% for silo-filler's disease; (3) steroids are effective therapy and should be continued for at least eight weeks; (4) although the majority recover without significant sequelae, some individuals may develop persistent functional abnormalities; (5) there is no evidence that long-term exposure to low concentrations of NO2 leads to chronic airway obstruction; and, (6) NO2-induced pulmonary disease could be elminated with appropriate preventive measures.