The impact of occupational health service network and reporting system in Taiwan.

BACKGROUND: Underreporting occupational disease cases has been a long-standing problem in Taiwan, which hinders the progress in occupational health and safety. To address this problem, the government has founded the Network of Occupational Diseases and Injuries Service (NODIS) for occupational disease and injury services and established a new Internet-based reporting system. OBJECTIVES: The aims of this study are to analyze the possible influence of the NODIS, comprised of Center for Occupational Disease and Injury Services and their local network hospitals, on compensable occupational diseases and describe the distribution of occupational diseases across occupations and industries from 2005 to 2010 in Taiwan. METHODS: We conducted a secondary analysis of two datasets, including the NODIS reporting dataset and the National Labor Insurance scheme's dataset of compensated cases. For the NODIS dataset, demographics, disease distribution, and the time trends of occupational diseases were analyzed. The data of the Labor Insurance dataset was used to calculate the annual incidence of compensated cases. Furthermore, the annual incidence of reported occupational diseases from the NODIS was further compared with the annual incidence of compensable occupational diseases from the compensated dataset during the same period. RESULTS: After the establishment of the NODIS, the two annual incidence rates of reported and compensable occupational disease cases have increased by 1.2 and 2.0 folds from 2007 to 2010, respectively. The reason for this increased reporting may be the implementation of the new government-funded Internet-based system. The reason for the increased compensable cases may be the increasing availability of hospitals and clinics to provide occupational health services. During the 2008-2010 period, the most frequently reported occupational diseases were carpal tunnel syndrome, lumbar disc disorder, upper limb musculoskeletal disorders, and contact dermatitis. CONCLUSIONS: The new network and reporting system was successful in providing more occupational health services, providing more workers with compensation for occupational diseases, and reducing underreporting of occupational diseases. Therefore, the experience in Taiwan could serve as an example for other newly developed countries in a similar situation.

Air-polluted environmental heavy metal exposure increase lung cancer incidence and mortality: A population-based longitudinal cohort study.

BACKGROUND: An increased risk of lung cancer has been observed due to exposure to certain environmental heavy metals. This study elucidated the role of air-polluted heavy metals in the development of lung cancer. METHODS: A longitudinal cohort study involving the general population was conducted to compare heavy metal content among lung cancer patients. The urine concentrations of heavy metals were measured. Questionnaire surveys were designed to collect exposure-related demographic and lifestyle data of the study subjects. RESULTS: Participants residing near the petrochemical industrial area with higher air Cd concentration had relatively higher urinary concentration of Cd. After adjusting for sociodemographic and behavioral factors, tobacco smoking and air pollution remained as potential sources of Cd exposure. An increased prevalence of lung cancer was observed in the highly polluted zone. The risk of lung cancer incidence increased 1.25-fold for each 1 µg/g-creatinine increase in urine Cd level. Patients with lung cancer had significantly higher urinary Cd concentrations. Lung cancer patients with higher urinary Cd level had significantly poor survival (urine Cd level ≥ 1.58 vs <1.58 µg/g-creatinine; survival, medium, 192.0 vs 342.5 days, p < 0.001). At the longitudinal follow-up, participants with higher urinary Cd level had a higher risk of lung cancer incidence (urine Cd level ≥ 1.58 vs <1.58 µg/g-creatinine: 3.91% v.s. 0.87%, hazard ratio: 4.65, p < 0.001). CONCLUSIONS: Accumulation of Cd could be a risk of lung cancer occurrence. High exposure to Cd may result in poor prognosis in lung cancer patients.

Mortality from liver cancer and leukaemia among polyvinyl chloride workers in Taiwan: an updated study.

OBJECTIVES: To investigate types of cancer caused by occupational exposure to vinyl chloride monomer (VCM) and the temporal mortality trends of these cancers in workers from polyvinyl chloride (PVC) manufacturing factories in Taiwan, with follow-up of the cohort extended by 15 years, from 1980 to 2007. Methods A retrospective cohort study of workers from six PVC factories in Taiwan was conducted. 3336 male PVC workers were enrolled and further linked with the National Mortality Registry and National Household Registry databases. Standardised mortality ratios (SMR) with 95% CIs were calculated and compared to the general Taiwanese male population. Cause-specific mortality between two study periods, 1980-1997 and 1998-2007, was compared. Six-year moving averages of the SMRs were calculated to examine mortality trends. RESULTS: Liver cancer mortality increased during 1989-1994 (SMR 1.90, 95% CI 1.01 to 3.25), reached a peak during 1991-1996 (SMR 2.31, 95% CI 1.39 to 3.61) and became non-significant during 1994-1999 (SMR 1.42, 95% CI 0.80 to 2.34). Leukaemia mortality significantly increased during 1984-1989 (SMR 6.06, 95% CI 1.24 to 17.53), reached a peak during 1985-1990 (SMR 7.56, 95% CI 2.06 to 19.35) and became non-significant during 1991-1996 (SMR 3.24, 95% CI 0.39 to 11.69). The mortality trend for haemolymphopoietic cancer showed a similar pattern to that of leukaemia. CONCLUSIONS: VCM may increase the risk of liver cancer and leukaemia. When VCM exposure was controlled at worksites, mortality from these cancers returned to background levels.

Physical therapy utilization in subjects with work-related musculoskeletal disorders: Taiwan experience.

INTRODUCTION: This study aimed to investigate the use of physical therapy (PT) services by subjects with work-related musculoskeletal disorders (WMSDs) and to identify factors associated with long-term use of PT in Taiwan. METHODS: Data including demographic characteristics, work history, pain and disability ratings, and psychosocial status were collected by questionnaire. Subjects who were referred to PT were interviewed weekly by telephone to obtain information about use of PT. RESULTS: A total of 160 subjects participated in this study. Of these, 85 subjects (53.1%) did not receive PT. Of the 75 subjects who received PT, 53 (70.7%) received short-term treatment (<30 days) and 22 (29.3%) received long-term treatment (> or =30 days). The number of treatment sessions for the treatment groups was 7.8 sessions +/- 9.0. Logistic regression analysis identified age (odds ratio [OR] = 1.074, P = 0.007) and the subject's confidence that the disorder would be diagnosed as an occupational injury ("yes" and "not sure" vs. "no"; OR = 4.288, P = 0.012) as significant factors affecting the duration of treatment. CONCLUSIONS: Almost 30% of the subjects referred to PT received long-term treatment (> or =30 days), the significant factors affecting this classification were subject's age and confidence in a diagnosis of WMSD.

Worker's compensation and return-to-work following orthopaedic injury to extremities.

OBJECTIVE: To explore the influence of workers' compensation coverage on injury patterns and return-to-work outcome in orthopaedic injuries of the extremities. DESIGN: Prospective and follow-up study. SUBJECTS: A total of 154 subjects were recruited and 37.7% of the injuries were covered by workers' compensation. METHODS: Baseline data were obtained by questionnaire and chart review. The main outcome variable was time of first return to work. Subjects were followed up at 1, 3 and 6 months after initial interview. Cox proportional hazards model was used to analyse associations between potential predictors and return-to-work. RESULTS: The workers' compensation group were most likely to be men employed in labour occupations and were most likely to sustain crushing injuries, or injuries from being struck by objects. The 6-month return-to-work rates for the workers' compensation and non-workers' compensation groups were 70.7% and 71.9%. Early return-to-work was associated with more years in higher education, and increased self-efficacy in both groups. Moreover, age older than 45 years and hospitalization less than 14 days were associated with early return-to-work in the non-workers' compensation group. CONCLUSION: The injury patterns of workers' compensation and non-workers' compensation groups differed, but the likelihood of return-to-work at 6-month follow-up was similar. More years of education and self-efficacy were positive predictors of return-to-work.

Delayed return-to-work in workers after non-severe occupational upper extremity fracture in Taiwan.

BACKGROUND/PURPOSE: Occupational injury of the upper extremities account for 24% of occupational injuries in Taiwan. However, studies on the timing and factors influencing return-to-work are lacking. METHODS: A total of 102 hospitalized workers with non-severe upper extremity fractures, defined as without avulsion, amputation and nerve damage, were interviewed over the telephone using a structured questionnaire at 45, 90 and 180 days after injury. RESULTS: After controlling other factors, cases with other-than-digit fracture presented three-fold more difficulty than those with digit fracture on returning to work (OR, 0.32; 95% CI, 0.17-0.63). Male workers (OR, 2.70; 95% CI, 1.16-6.25) and those with financial help from their employer (OR, 2.32; 95% CI, 1.17-4.60) found it easier to return to work 90 days after injury. There were 32% who were still unable to return to work 180 days after injury. CONCLUSION: Women workers and workers without financial help from employers are at a disadvantage with regard to early return-to-work. Other assistance besides medical treatment could be of significant help but should be cautiously exercised in extrapolating to workers who are not the main breadwinner in their household.

Reduced epidermal nerve density among hand-transmitted vibration-exposed workers.

OBJECTIVE: The objective of this study was to evaluate ultrastructural changes of epidermal nerve density (END) in workers exposed to hand-transmitted vibration. METHODS: Ten male subjects with occupational exposure to hand-transmitted tools for 46.9 hours weekly for an average of 6.5 years were included in this study. We performed a skin biopsy from the forearms and compared the END with 10 age- and gender-matched healthy control subjects. RESULTS: Nine of the 10 subjects had abnormally low END. The END of the exposed workers was significantly lower than the control group (4.1 +/- 2.8 vs 9.0 +/- 4.3 fibers/mm, P = 0.005). The difference remained even after one subject with possible undiagnosed diabetes was not included (4.3 +/- 2.9 vs 9.6 +/- 4.2 fibers/mm, P = 0.005). The reduction of END did not correlate with the abnormality of nerve conduction studies or quantitative sensory testing. CONCLUSIONS: The reduction of END suggested the involvement of small-diameter nerve fibers among this population, and such a histologic change might either be independent or precede changes of large myelinated nerve fibers.

XRCC1 and CYP2E1 polymorphisms as susceptibility factors of plasma mutant p53 protein and anti-p53 antibody expression in vinyl chloride monomer-exposed polyvinyl chloride workers.

Mutant p53 protein and anti-p53 antibody in circulating blood can be detectedamong individuals with mutations of the p53 tumor suppressor gene. Plasma mutant p53 protein and anti-p53 antibody have also been associated with vinyl chloride monomer (VCM) exposure, although the mechanism of VCM-related carcinogenesis remains unclear. Polymorphisms of metabolic and DNA repair genes have been implicated in chemical exposure-related carcinogenesis. The aim of this study is to explore the association between polymorphisms of metabolic and DNA repair genes with mutant p53 protein and anti-p53 antibody expression induced by VCM. Study subjects comprised 333 male workers occupationally exposed to VCM. Plasma mutant p53 protein and anti-p53 antibody detected with ELISA were grouped together as p53 overexpression. Genotypes of cytochrome P450 2E1 (CYP2E1), aldehyde dehydrogenase 2 (ALDH2), glutathione S-transferase T1 (GSTT1), and X-ray repair cross-complementing group 1 (XRCC1, exon 10) genes were identified by the PCR. High VCM exposure group had significantly higher p53 overexpression as compared with low exposure group [odds ratio (OR), 2.1; 95% confidence interval (CI), 1.1-3.8]. Individuals having experienced a high VCM exposure and displaying a XRCC1 Gln-Gln genotype had a highest risk of p53 overexpression among those having different combinations of VCM exposure and XRCC1 genotypes (OR, 6.5; 95% CI, 1.7-24.2). Interestingly, those subjects reflecting a CYP2E1 c2c2 genotype among the low VCM-exposure group demonstrated a greater risk of p53 overexpression (OR, 9.8; 95% CI, 1.2-81.6) as compared with those experiencing a low VCM exposure and CYP2E1 c1c1/c1c2 genotypes. Additional analysis revealed that individuals possessing more susceptible XRCC1 Gln-Gln, CYP2E1 c2c2, ALDH2 1-2/2-2, and non-null GSTT1 genotypes were more likely to reveal p53 overexpression. Our results suggest that susceptible XRCC1 and CYP2E1 genotypes may modulate the mutation of the p53 gene among VCM-exposed workers.

Interaction of vinyl chloride monomer exposure and hepatitis B viral infection on liver cancer.

Vinyl-chloride monomer (VCM), a human carcinogen, has caused angiosarcoma of the liver. Recent studies have shown that VCM exposure is associated with hepatocellular cancer. In Taiwanese studies, the majority of VCM-exposed workers with liver cancer had history of hepatitis B virus (HBV) infection. To determine the role of HBV on the development of liver cancer in the VCM-exposed workers, we conducted a case-control study from a previously established polyvinyl chloride (PVC) cohort consisting of 4096 male workers from six PVC polymerization plants. A total of 18 patients with liver cancer, and 68 control subjects matched for age and specific plant of employment were selected. Detailed history of the participants that included alcohol consumption status, cigarette use, occupation, and family history of chronic liver disease were obtained using an interviewer-administered questionnaire. When the HBV surface antigen (HBsAg)-negative subjects without history of tank-cleaning were used as the reference, the HBsAg-negative subjects with history of tank-cleaning demonstrated a 4.0-fold greater risk of liver cancer (95% confidence interval: 95% CI = 0.2-69.1). The HBsAg carriers without history of tank-cleaning revealed a 25.7-fold greater risk of liver cancer (95% CI = 2.9-229.4). Whereas the HBsAg carriers with history of tank-cleaning revealed the greatest risk (matched odds ratio (ORm) 396.0, 95% CI = 22.6 -infinity) of developing liver cancer among subjects with different VCM-exposure status and HBsAg status categories. Further analysis showed the interaction term was significant (P < .01). Therefore, our results suggest an interaction between occupational VCM exposure and HBV infection for the development of liver cancer.

Working hours, sleep duration and the risk of acute coronary heart disease: a case-control study of middle-aged men in Taiwan.

BACKGROUND: This study aimed to examine whether long working hours and short sleep duration were associated with an increased risk of acute myocardial infarction (AMI) or severe coronary heart diseases (SCHD), independent of established psychosocial work-related factors. METHODS: A case-control study was conducted. Cases were 322 men, aged <60 years and economically active, who were admitted to hospital with a first diagnosed AMI or SCHD during 2008-2011, of whom 134 were confirmed AMI and the other 188 were angiography-confirmed SCHD. Controls were 644 men who were drawn from a national survey and were matched to the cases on age, education and area of residence. Odds ratios of total CHD and confirmed AMI in relation to average weekly working hours and daily hours of sleep were calculated. RESULTS: Men with average working hours longer than 60 h/week were found to have significantly increased risks for total CHD (OR=2.2) as compared to those with weekly working hours in 40-48 h, and those with daily hours of sleep fewer than 6 h were found to have increased risks for CHD (OR=3.0) as compared to those with sleeping hours in 6-9 h. Restriction to confirmed AMI yielded a greater risk and these associations remained consistent with adjustment of smoking status, body mass index and psychosocial work factors including job demands, job control, workplace justice, job insecurity and shift work. CONCLUSION: The results support the hypothesis that long working hours and short sleep duration contribute independently to the risk of cardiovascular diseases in men.

Correlation of Occupational Stress Index with 24-hour Urine Cortisol and Serum DHEA Sulfate among City Bus Drivers: A Cross-sectional Study.

OBJECTIVES: The questionnaire of occupational stress index (OSI) has been popular in the workplace, and it has been tailored for bus drivers in Taiwan. Nevertheless, its outcomes for participants are based on self-evaluations, thus validation by their physiological stress biomarker is warranted and this is the main goal of this study. METHODS: A cross-sectional study of sixty-three city bus drivers and fifty-four supporting staffs for comparison was conducted. Questionnaire surveys, 24-hour urine cortisol testing, and blood draws for dehydroepiandrosterone-sulfate (DHEA-S) testing were performed. The measured concentrations of these biological measures were logarithmically transformed before the statistical analysis where various scores of stressor factors, moderators, and stress effects of each OSI domain were analyzed by applying multiple linear regression models. RESULTS: For drivers, the elevated 24-hour urine cortisol level was associated with a worker's relationship with their supervisor and any life change events in the most recent 3 months. The DHEA-S level was higher in drivers of younger age as well as drivers with more concerns relating to their salary and bonuses. Non-drivers showed no association between any stressor or satisfaction and urine cortisol and blood DHEA-S levels. CONCLUSION: Measurements of biomarkers may offer additional stress evaluations with OSI questionnaires for bus drivers. Increased DHEA-S and cortisol levels may result from stressors like income security. Prevention efforts towards occupational stress and life events and health promotional efforts for aged driver were important anti-stress remedies.

Acute expanded perlite exposure with persistent reactive airway dysfunction syndrome.

Expanded perlite has been assumed as simple nuisance, however during an accidental spill out in Taiwan, among 24 exposed workers followed for more than 6 months, three developed persisted respiratory symptoms and positive provocation tests were compatible with reactive airway dysfunction syndrome. During simulation experiment expanded perlite is shown to be very dusty and greatly exceed current exposure permission level. Review of literature and evidence, though exposure of expanded perlite below permission level may be generally safe, precautionary protection of short term heavy exposure is warranted.

Incidence and risk factors of neck discomfort: a 6-month sedentary-worker cohort study.

INTRODUCTION: This study aimed to evaluate the six-month incidence and possible risk factors of neck discomfort among sedentary workers. METHODS: Data, including demographic characteristics, work history, psychological characteristics and prevalent neck discomfort of 157 sedentary workers was collected by a questionnaire. A follow-up questionnaire was administered six months later to calculate the incidence of symptoms and related disability. RESULTS: The six-month incidence of neck discomfort was 23.5% (12/51). The two groups of prevalent and non-prevalent subjects showed no difference in demographic data and work characteristics except for work load (p<0.05) and score in "job control" in the Job Content Questionnaire (JCQ) (p<0.05). In logistic regression, light-load work (versus no-load work, OR = 0.10, p = 0.023) and higher score of 'job control' in JCQ (OR = 0.86, p = 0.031) were significant protecting factors. CONCLUSION: The six-month incidence rates of neck discomfort in our subjects were high. Light-load work and a higher score of 'job control' were important preventive factors. The results provide an epidemiological basis for prevention of neck discomfort in different working populations.

Saved by a material safety data sheet.

BACKGROUND: We present the case of a young female laboratory worker who developed acute hepatic encephalopathy. OBJECTIVE: To show that knowledge of occupational exposures to causative agents can alter therapeutic management. METHODS: Although the patient was in a deep coma, her family members examined the workplace material safety data sheet, revealing exposure to chloroform. Since most chemical-induced hepatitis is self-limiting, a scheduled liver transplantation was postponed. RESULTS: The patient recovered. Subsequent air sampling suggested that the patient had been exposed to chloroform at a concentration of more than 15 ppm for 2 weeks. CONCLUSION: Our case report demonstrates the importance of obtaining an occupational history and how the patient's family can be important in this process.

Musculoskeletal disorders in hotel restaurant workers.

BACKGROUND: A variety of occupational groups have been shown to experience elevated risks of work-related musculoskeletal disorders (WMSD). Little information on WMSD is available in hotel restaurant workers. OBJECTIVE: To document the profile of WMSD in a sample of hotel restaurant workers in Taiwan. METHODS: A self-administered questionnaire was used to gather information regarding body site specific WMSD, pain intensity and strategies for pain relief amongst a sample of hotel restaurant workers. RESULTS: Among 905 restaurant workers, 785 (84%) reported experience of WMSD in the previous month, with the highest prevalence rate found for the shoulder (58%). The highest mean score for perceived pain intensity was found for the lower back/waist (2.50 points). Despite a high prevalence rate, only a small portion of those reporting WMSD (12%) considered their work capacity or activities of daily living to be affected by WMSD, and only <5% of workers with WMSD sought medical treatment. CONCLUSION: WMSD related pain is common among hotel restaurant workers in Taiwan, but it does not appear to interfere with job performance or daily living. Self-treatment and alternative therapies that have not been evaluated for effectiveness are commonly employed by hotel restaurant workers.

Molecular epidemiology of plasma oncoproteins in vinyl chloride monomer workers in Taiwan.

AIMS: To determine the presence of Asp13-p21-ki-ras oncoprotein and p53 oncoprotein in the plasma of vinyl chloride monomer (VCM)-workers in Taiwan. METHODS: We used enhanced chemiluminescence (ECL) western blotting to detect Asp13-p21-ki-ras and ELISA to detect mutant p53 protein (p53-Ag) and anti-p53 antibodies (p53-Ab) in the plasma of VCM-exposed workers. RESULTS: Twenty-five out of 251 (10%) VCM-workers were positive for Asp13-p21-ki-ras in plasma, but 0 out of 36 controls were positive. There were 15 out of 95 (15.8%) plasma-positives among the more highly exposed (> 480 ppm-month) workers and 10 out of 156 (6.4%) plasma-positives among the lesser exposed (< or = 480 ppm-month). Compared to the unexposed controls, age and drinking adjusted odds ratios (95% CI) were 1.2 (0.1, 9.8) in the lower exposed workers, and 4.8 (0.8, 28) in the higher exposed workers, and there was a significant linear trend between exposure and plasma positivity (P=0.001). Thirty-three out of 251 (13.2%) VCM-workers were positive for the p53 over-expression (10% with positive p53-Ag and 2.8% with positive p53-Ab). There was a significant association between cumulative VCM exposure concentration and positive p53 expression (P=0.032) among VCM-workers after adjusting for age, hepatitis, drinking and smoking status. CONCLUSIONS: Asp13-p21-ki-ras oncoprotein and p53 over-expression (p53-Ag or p53-Ab) can be found in the plasma of VCM-workers in Taiwan, and a significant dose-response relationship exists between plasma oncoproteins expression and VCM exposure.