[Predictors of return to work after occupational injury in a locomotive enterprise].

OBJECTIVE: To identify the potential determinants of return to work (RTW) following work-related injury. METHODS: A historical cohort of workers with occupational injury in a state-owned locomotive vehicle company in central China was followed up for RTW. Demographic, employment and medical information was retrieved from the company archival documents; and post-injury information was interviewed by questionnaires. Univariate analysis and Cox Regression Model were used to examine the associations between potential determinants and outcomes of RTW. RESULTS: Three hundred of the 323 included cases (92.9%) eventually returned to work after the median absence of 43 days (average of 49.2 days). Factors from socio-demographic, clinical, economic and psychological domains were found affecting RTW in the univariate analyses. The multivariate analysis indicated that age, injury severity, injury locus, injury nature, pain in the injury locus, self-reported health status and pre-injury monthly salary were significant determinants of RTW. CONCLUSIONS: There are multidimensional factors affecting RTW after occupational injury. Proper clinical treatment and rehabilitation, as well as economic and social support to facilitate workers' RTW would be the priorities for intervention. Future studies should be conducted in a larger representative sample to confirm the findings and to develop a multidisciplinary intervention strategy towards promoting RTW.

[Synergistic interaction between MMP-3, VDR gene polymorphisms and occupational risk factors on lumbar disc degeneration].

OBJECTIVE: To explore the synergistic interaction between MMP-3,VDR gene polymorphisms and occupational risk factors on lumbar disc degeneration. METHODS: A case-control study including 178 cases of lumbar disc degeneration and 284 controls was carried out through questionnaire and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technology. Additive model was used to analyze the synergistic interaction between gene polymorphisms and occupational risk factors. RESULTS: The non-conditional logistic regression analysis showed that bending/twisting, whole-body vibration, heavy physical workload, alleles 5A of MMP-3 (6A5A/5A5A) and A of VDR-Apa (AA/Aa) were significantly associated with lumbar disc degeneration(OR = 4.06, 8.96, 5.46, 1.96 and 1.70, respectively, P < 0.05). There were synergistic interactions between the mutation genotype 5A of MMP-3 and whole-body vibration exposure, between the mutation genotype 5A of MMP-3 and bending/twisting, and between the mutation genotype A of VDR-Apa and whole-body vibration exposure (SI: 13.27, 2.91 and 2.35 respectively, P < 0.05). CONCLUSION: People with the mutation genotypes 5A of MMP-3 and/or A of VDR-Apa may have the increased risk of developing lumbar disc degeneration if they are exposed to whole-body vibration and/or bending/twisting.

Matrix metalloproteinase-3 and vitamin d receptor genetic polymorphisms, and their interactions with occupational exposure in lumbar disc degeneration.

OBJECTIVES: To investigate the occupational and genetic risk factors inducing lumbar disc degeneration in a Chinese population, and to explore their synergistic interactions. METHODS: A case-control study involving 178 low back pain patients with lumbar disc degeneration and 284 controls was carried out. Five types of work-related factors were investigated using questionnaires. Polymerase chain reaction and restriction fragments length polymorphism was used to detect the polymorphisms of MMP-3 (matrix metalloproteinase-3)(rs731236), VDR-Taq (vitamin D receptor-Taq) and VDR-Apa (vitamin D receptor-Apa)(rs35068180). Rothman's synergy index was used to measure the synergistic interactions between gene polymorphisms and occupational risk factors. RESULTS: Family history of lumbar disc diseases, back injury history, whole-body vibration, bending/twisting, heavy physical workload, age, mutation alleles 5A of MMP-3 and A of VDR-Apa were significantly associated with lumbar disc degeneration (OR=12.70, 11.79, 8.96, 5.46, 1.05, 1.96 and 1.70, respectively, p<0.05). Synergistic interactions existed between the mutation allele 5A of MMP-3 and whole-body vibration exposure, the mutation allele 5A of MMP-3 and bending/twisting, and the mutation allele A of VDR-Apa and bending/twisting (SI=13.27, 2.91, 2.35, respectively, p<0.05). CONCLUSIONS: The results of this study suggest that gene-occupation interaction might play a certain role in exaggerating lumbar disc degeneration. There is a possibility that subjects who carry mutation alleles 5A of MMP-3 and/or A of VDR-Apa are more vulnerable to lumbar disc degeneration when they are exposed to whole-body vibration and/or bending/twisting under ergonomic loads.

[A psychophysical evaluation of NIOSH Lifting Equation in a Chinese young male population: a pilot study].

OBJECTIVE: To determine the maximum acceptable weight of lift (MAWL) in a Chinese young male population, and examine whether the revised weight limit recommended by the US. National Institute for Occupational Safety and Health can be used for Chinese workers. METHODS: Eleven young male college students participated in the experiment. The psychophysical approach was used to determine the MAWL with the different frequencies of lift, the heart rate and the self-evaluation. The weight was lifted from the floor to the work-table (760 mm). The results were compared with the recommended weight limit (RWL) and the MAWL by Snook. RESULTS: The MAWL of young male was 34.1 kg while the MAWL with frequency of 1, 4 and 8/min was 17.4, 14.7 and 12.2 kg respectively. The overall MAWL were lower than RWL of NIOSH and the results of Snook. CONCLUSION: The NIOSH 1991 equation such as load constant and frequency multiple should be revised when the NIOSH limits is used in Chinese population.

[Effects of dusts on workers' health in enzyme production plants].

OBJECTIVE: To assess the health effects of dusts in enzyme production plants. METHODS: The concentration of enzyme-containing dusts, the enzyme and the wheat-containing dusts and their health effects on workers were investigated in three enzyme production plants. Air samples were collected by high volume sampler and personal sampler. Total dust was weighed and its content of enzyme was analyzed by enzyme activity method. Health effects were assessed by the questionnaire, the pulmonary function and the skin prick test. RESULTS: It was found that the geometric mean of enzyme-containing dust was 8.91 mg/m(3), the industrial enzyme was 1.68 mg/m(3), and the wheat-containing dust was 6.93 mg/m(3). The enzyme-containing dust higher than 20 mg/m(3) caused eye symptoms. The wheat-containing dust at 6.93 mg/m(3) might result in skin and nose symptoms. The sensitization could be observed in enzyme and wheat exposed workers. CONCLUSION: Adverse effects may arise for the health of the workers if the concentration of enzyme-containing dusts and the wheat-containing dusts is up to a certain limit and it is necessary to make the limit of these indexes.

An overview of published benzene exposure data by industry in China, 1960-2003.

This article presents an overview of occupational benzene exposures in China based on data published in Chinese medical journals. The data were derived from 384 reports of benzene poisoning or industrial hygiene surveys published in Chinese medical journals between 1960 and 2003. The following information was extracted whenever available: industry, occupation, task, date, benzene levels, sampling location, workplace descriptions and, for case reports, medical diagnosis. Each paper provided one or more sets of benzene data, each set representing a sampling location or job title with one to several measurements including, mainly, breathing zone area concentration measurements, and much less frequently personal monitoring. Two criteria based on data quality were applied to select suitable data for analyses. The selected exposure data were analyzed by industry and time period. Nine hundred five sets of benzene measurements from 72 industries were reported in the 384 papers selected for this review, and 621 sets (68.6%) presented average benzene concentrations, which covered 55 industries. The distribution of the reported average benzene exposures was skewed with a median of 51.5 mg/m3. The average benzene concentrations were below 100 mg/m3 for 406 (65%) of the 621 reported average concentrations. The medians of the reported averages in mg/m3 for the five industries with the highest exposures were: 124.8 for leather products, 98.7 for electronic devices, 75.4 for machinery, 50.4 for shoes, and 50.3 for office supplies and sports equipment manufacturing. These data describe the concentrations and changing patterns of occupational benzene exposure by industry and time period in China.

[Isometric muscle strength measurements and assessment: a pilot study].

OBJECTIVE: To determine the anthropometric parameters and the isometric muscle strength in a working population sample in China, and to investigate the relationship between muscle strength and individual attributes, such as age, gender, height and weight. METHODS: The study population consisted of 146 male and 47 female people including workers, administrators and college students. Four types of muscle strength, i.e., handgrip, arm lift, shoulder lift, and torso pull, were measured. RESULTS: Left handgrip, right handgrip, arm lift, shoulder lift and torso pull of male workers were (42.07 +/- 7.20), (43.92 +/- 7.14), (26.79 +/- 4.64), (33.79 +/- 6.88), (88.56 +/- 17.98) kg, respectively while those of female workers were (21.29 +/- 5.09), (23.26 +/- 5.47), (13.29 +/- 3.37), (18.52 +/- 4.01), (41.06 +/- 12.04) kg, respectively. The female's strength was about 50% lower than the male's. The strength in the 40 approximately years old group was higher than that in other age groups. There were significant positive correlation between the gender and the isometric strength as well as between the body weight and the isometric strength. If the body weight served as the corrected parameter, there was no significant difference in the handgrip among the groups (P < 0.05), but the torso pull of male workers > college students > administrators. All relative muscle strengths except the torso pull were similar for all age groups. CONCLUSION: The body weight as the independent variable can be used for establishing the predictive equation of the muscle strength. Calculation of the relative muscle strength can relieve the interference of the body weight for the muscle strength.

[Study on the application of benchmark dose and biological monitoring indexes of fluorides in drinking water].

OBJECTIVE: By using Benchmark Dose (BMD) approach to explore the relations among drinking water fluoride, urine fluoride, serum fluoride and dental fluorosis; and to evaluate the significance of urine fluoride and serum fluoride in control and prevention of endemic fluorosis. METHODS: 512 children (290 in Xinhuai Village, 222 in Wamiao Village) aged 8-13 years were recruited in the study. Epidemiological methods were used to investigate the prevalence of dental fluorosis, and the levels of urine fluoride, serum fluoride, and drinking water fluoride in superficial well. The children were divided into six subgroups by the concentration of fluoride in drinking water: < 0.5 mg/L, 0.5-mg/L, 1.0-mg/L, 2.0-mg/L, 3.0-mg/L and > or = 4.0 mg/L. RESULTS: There was significant dose-response relationship between the drinking water fluoride and the prevalence of dental fluorosis or the prevalence of defect dental fluorosis. The BMDLs (Benchmark Dose Lower Bound) were 1.01 and 1.30 mg/L, respectively. Urine fluoride and serum fluoride also had significant dose-response relationship to the prevalence of dental fluorosis or defect dental fluorosis. The correlation coefficient between drinking water fluoride and urine fluoride was 0.717, and it was 0.855 between drinking water fluoride and serum fluoride, and 0.617 between urine fluoride and serum fluoride. CONCLUSIONS: The currently national standard of fluoride in drinking water in China is safe and reasonable. As a biological monitoring index, the levels of fluoride in serum may be more useful than that in urine in the control and prevention of endemic fluorosis.

[Study on lifting-related musculoskeletal disorders among workers in metal processing].

OBJECTIVE: To investigate lifting-related musculoskeletal disorders in metal processing, to analyze the risk factors, and to study the validity and feasibility of using NIOSH lifting equation in China. METHODS: The questionnaires of semi-structured interview, the Ovako Working Posture Analysing System (OWAS) postural analysis and variables of the NIOSH equation were applied to the study. The study population consisted of 69 workers mainly involved in manual materials handling (MMH), categorized as Job A; and 51 machinery workers, served as controls, that were less MMH task involved, as Job B. RESULTS: The prevalence of low back pain (LBP), which was defined at least one episode lasting for more than 24 hours in the past 12 months, were 63.8% and 37.3% for Job A and Job B, respectively. However, the prevalence of LBP lasting for more than a week due to lifting were 26.09% and 5.88% for Job A and B, respectively. The proportion of awkward back postures were found higher in Job A than that of Job B (66% vs 63%, P < 0.05). The NIOSH Lifting Index (LI) was estimated to be 2.4 for Job A, and 0 < LI < 1 for Job B. The analysis of multiple regressions revealed that the repetitiveness of lifting and length of service had greatly attributed to the occurrence of LBP. The "composite load" (object weight x activity repetitiveness) had a significant adverse effect on lower back meaning that the objective weight remains an ingredient part of the risk. CONCLUSION: The occurrence of LBP is not only related to the force load, but the repetitiveness of lifting and awkward postures. The method of OWAS observation and US-NIOSH equation are important tools in assessing characteristics and risk factors of LBP for MMH tasks. Further study aimed at developing an integral scheme for the assessment system is needed.

Study on musculoskeletal disorders in a machinery manufacturing plant.

Musculoskeletal disorders and related risk factors in machinery manufacturing were investigated using interviews, postural analysis, and the revised National Institute for Occupational Safety & Health lifting equation. Sixty-nine workers involved in manual materials handling (Job A) and 51 machinery workers less involved with manual material-handling tasks (Job B) were studied. Low back pain (LBP) (at least one episode lasting for 24 hours or more in past 12 months) prevalence rates were 63.8% and 37.3% for Jobs A and B, respectively. Prevalence rates of LBP every day for a week or more attributed to lifting were 26.09% and 5.88% for Jobs A and B, respectively. Multiple regression analysis revealed that lifting repetitiveness and work age contributed to the occurrence of LBP. The "composite load" (object weight x activity repetitiveness) had a significant adverse effect on LBP.

New trends in the development of occupational exposure limits for airborne chemicals in China.

Occupational exposure limits (OELs) are well established in many countries, which serve occupational professionals as benchmarks of industrial hygiene practice at workplaces worldwide. Starting in the mid-1950s, the central government of China began promulgating OELs for hazardous substances at workplaces. This paper discusses the historical basis, philosophical principles and schematic protocols of developing and setting OELs in China. The underlying principles include: (1) protection of human health being the first and the most important criterion; (2) the use of quantitative epidemiological studies in humans being given top priority; (3) integration and full use of all information sources, including animal experimental data for new chemicals or chemicals with new toxicity concerns; (4) considerations of socioeconomic and technological feasibilities in the country; and (5) amending existing standards based on new evidence. The strategy of the World Health Organization's "Two-step Procedure" is applied to convert health-based recommendations to law-based operational OELs, with considerations for national technological and socioeconomic conditions and priorities. As a result of the recent passage of the new law Occupational Diseases Prevention and Control Act of the People's Republic of China (ODPCAct), an official document Occupational Exposure Limits for Hazardous Agents in the Workplace containing a comprehensive list of new and amended OELs has been issued, which has now become one of the most essential regulations affiliated with the ODPCAct. This paper provides a brief summary of the salient features of the new law ODPCAct and the principles and processes of developing or amending OELs. This paper also discusses the challenges that lie ahead in enforcing the new regulations in China.