Disparities in occupational health services: an international comparative study.

BACKGROUND: Occupational Health Services (OHS) are comprehensive, multidisciplinary services supplied by various trained workers, including occupational physicians (OP), whose specialty is focused on workers' health. AIMS: Our study questions are whether the OP/worker ratio may reflect the scope and availability of OHS. METHODS: This comparative study, conducted on globally different OHS, was based on literature analysis of peer-reviewed articles published in journals covering topics of occupational medicine and public health that addressed parameters on the type and scope of OHS provision. RESULTS: We described the number of OP/worker ratio, and the correlation to economic parameters (Gross domestic product-GDP, health expenditure, Gini Index-GI) by country. We found that among countries with a GDP per capita higher than US$30,000, only three (US, South Korea and Israel) had a very low OP/worker ratio (about 1:50,000 compared to 1:5,000 in other countries). Looking at all the countries together, there was a statistically significant negative correlation between health expenditure percentage of GDP per capita and OP/worker ratio (rs = -0.54, p = 0.01) and a significant positive correlation between GI and OP/worker ratio (rs = 0.47, p = 0.04). CONCLUSIONS: The lesser the percentage of health expenditure of GDP and the subsequent greater general inequality as reflected by the GI, the lower the OP/worker ratio. The data collected in our comparative study show that the OP/worker ratio is a parameter both easy to define and obtain which best represents the status and disparity of OHS in each country.

Occupational Silica Exposure and Dose-Response for Related Disorders-Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance.

BACKGROUND: The exposure patterns of respirable crystalline silica based on environmental records, as well as the link to different diseases, are not well described. AIMS AND OBJECTIVES: In this study, we evaluated the risk for various diseases in relation to occupational silica exposure, including Silicosis, pulmonary tuberculosis (TB), Autoimmune disorders (AIDs) and Renal diseases. METHODS: We assessed the relationship between silica exposure and the rate of various diseases such as silicosis, pulmonary TB, AIDs and renal diseases in a cross-sectional study. We reviewed the medical records and exposure level of workers exposed to silica during the past two decades. RESULTS: 261 workers were included in the study, total duration of exposure 15.6 years (±SD 8.74); 42.15% of them were employed in the artificial marble industry and 29.5% in manufacturing and construction industries. The average yearly silica exposure levels were 0.23 mg/m3 (±0.34). The average cumulative silica concentration was 3.59 mg/m3/y (±4.80). We found 25 (9.58%) incident cases of silicosis, 10 cases of chronic obstructive pulmonary disease (COPD) and emphysema (3.83%), six cases of several AIDs (2.30%), five cases of pulmonary TB (1.92%), three cases of renal diseases (1.15%), two cases of sarcoidosis (0.77%) and no lung cancer cases. When compared to studies with the same endpoint we found excess risk of silicosis (RR = 2.67/0.13 = 20.5, 95% CI 9.85 to 42.86)), pulmonary TB (RR = 30.70, CI 3.43-274.49, p = 0.002) and AIDs (RR = 2.87, 95% CI = 1.27 to 6.48 p = 0.01). CONCLUSIONS: Silica exposure was a significant risk factor for silicosis, pulmonary TB and AIDs. Our findings are important given persistent worldwide silica-related epidemics in low and high-income countries.

The Correlation between Clinical and Demographic Parameters and Sickness Absence in Diabetic Employees.

Objectives: Diabetes mellitus is one of the most significant and prevalent chronic diseases. Individuals with diabetes can still encounter substantial difficulties in finding and keeping their job because of their condition. The purpose of this study was to examine the scope of diabetes-related absence from work and its relationship with variables such as type of employer, workload, the severity of illness, and type of treatment. Materials and Methods: We conducted a case-control study, including 220 diabetic patients and 230 controls. Information regarding absence from work was obtained by reviewing medical records, and general patient information was retrieved by conducting telephone interviews. Results: Patients with diabetes had, annually, more days of absence than non-diabetic patients (8.5 vs. 2.7, respectively p and lt; 0.001). Among diabetic patients, public-sector employees were absent more than private-sector employees (9.0 vs. 7.2 days, respectively, p and lt; 0.05). A positive correlation was found between workload (measured by stamina) and absence (Pearson correlation = 0.098, p = 0.04). Concerning the clinical variables, we found that employees suffering from diabetic complications exhibited higher absence rates (15.5 vs. 5.7 days, respectively, p and lt; 0.003). Parameters like HbA1c levels, patient age, disease duration, and type of treatment did not differ significantly amongst the groups with regards to absence rates. Conclusions: The main variables affecting absence from work were not medical but rather sociodemographic: education, workload, and type of employer. The results of this study reinforce the perception that well-controlled diabetic employees can be combined in most types of occupations without fear of increased absence from work.

Residential proximity to agricultural fumigant use and respiratory health in 7-year old children.

OBJECTIVES: To examine the relationship between residential proximity to agricultural fumigant use and respiratory symptoms and lung function in 7-year old children. METHODS: Participants were 294 children living in the agricultural Salinas Valley, California and enrolled in the Center for the Health Assessment of Mothers and Children Of Salinas (CHAMACOS) study. We obtained information on respiratory symptoms and asthma medication use from maternal questionnaires and children performed spirometry to determine the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and forced expiratory flow 25-75% (FEF25-75) at 7-years of age. We estimated agricultural fumigant use within 3, 5 and 8 km of residences during pregnancy and from birth to age 7 using California's Pesticide Use Report data. We evaluated the association between prenatal and postnatal residential proximity to agricultural use of methyl bromide, chloropicrin, metam sodium and 1,3-dichloropropene with respiratory symptoms and use of asthma medication with logistic regression models and continuous lung function measurements with linear regression models adjusted for confounders. RESULTS: There were no significant associations between residential proximity to use of fumigants and respiratory symptoms or use of asthma medication. We did not observe any adverse relationships between residential proximity to fumigant use and lung function measurements. Unexpectedly, we observed suggestive evidence of improved FEV1 and FEF25-75 with higher use of methyl bromide and chloropicrin during the prenatal period. For example, for each 10-fold increase in methyl bromide use during the prenatal development period we observed higher FEV1 (ß = 0.06 L/s; 95% CI: 0.00, 0.12) and higher FEF25-75 (ß = 0.15 L/s; 95% CI: 0.03, 0.27). Maternal report of child allergies (runny nose without a cold during the previous year) modified the relationship between FEV1 and prenatal proximity to methyl bromide use (p = .07) and we only observed higher FEV1 among children without allergies (ß = 0.08 L/s; 95% CI: 0.02, 0.14 for a 10-fold increase in methyl bromide use during the prenatal period). CONCLUSIONS: Residential proximity to agricultural fumigant use during pregnancy and childhood did not adversely affect respiratory health in the children through 7 years of age. These findings should be explored in larger studies.

Elemental Sulfur Use and Associations with Pediatric Lung Function and Respiratory Symptoms in an Agricultural Community (California, USA).

BACKGROUND: Elemental sulfur, "the oldest of all pesticides," is the most heavily used agricultural pesticide in California and Europe. Sulfur is considered relatively safe and is used in both conventional and organic farming systems. Adverse respiratory effects have been reported in applicators and animals, but the effect on residential populations, and especially on children living in proximity to fields treated with elemental sulfur, is not known. OBJECTIVES: We evaluated associations between residential proximity to elemental sulfur applications and respiratory symptoms and spirometry of children living in an agricultural community. METHODS: Participants were enrolled in the CHAMACOS longitudinal birth cohort. We collected respiratory symptomatology for 347 children at 7 y of age and measured spirometry on a subset of 279. Of these, estimations of proximity to sulfur application and relevant covariate data were available for 237 and 205 children for whom we had symptomatology information and FEV1 measurements, respectively. Data from the California Pesticide Use Reporting System were used to estimate the amount of elemental sulfur applied within 0.5, 1, and 3km of a child's residence during the week, month, and 12 mo prior to pulmonary evaluation. Regression models controlled for maternal smoking during pregnancy; season of birth; PM2.5 (particulate matter ≤2.5mm in aerodynamic diameter); breast feeding duration; child's sex, age, and height; technician; and other covariates. RESULTS: Adverse associations with respiratory outcomes were found for sulfur applications within 0.5- and 1-km radii. Specifically, asthma medication usage and respiratory symptoms increased [OR=3.51; 95% confidence interval (CI): 1.50, 8.23, p=0.004; OR=2.09; 95% CI: 1.27, 3.46, p=0.004, respectively] and FEV1 decreased (ß=−0.143; 95% CI: −0.248, −0.039, p=0.008) per 10-fold increase in the estimated amount of sulfur used within 1 km of child residence during the year prior to pulmonary evaluation. CONCLUSIONS: This study suggests that elemental sulfur use, allowed in both organic and conventional farming, in close proximity to residential areas, may adversely affect children's respiratory health. https://doi.org/10.1289/EHP528.

Decreased lung function in 7-year-old children with early-life organophosphate exposure.

BACKGROUND: Organophosphate pesticides are heavily used in agriculture, and adverse associations with respiratory health in occupational settings have been reported. However, most of the evidence comes from studies where there were no biomarkers of exposure and no objective outcome measurement. Non-occupational chronic effects among residents living in agricultural communities are less well described. OBJECTIVE: To evaluate associations between early-life organophosphate exposure and lung function of children living in an agricultural community. METHODS: Participants were 279 children from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) longitudinal birth cohort. The area under the curve for organophosphate exposure was determined by urinary diethyl and dimethyl dialkylphosphate metabolites of organophosphate pesticides, which were measured five times during childhood (6-60 months). Spirometry was performed at age 7 years. Regression models controlled for maternal smoking during pregnancy, season of birth, particulate matter concentrations with aerodynamic diameter ≤2.5 µm (PM2.5), breast feeding duration, mould and pets at home, distance of home from a highway, food insecurity, maternal education, season of spirometry, sex, height and technician. RESULTS: Childhood diethyl, dimethyl and total dialkylphosphate concentrations were associated with significant decreases in lung function at age 7. Specifically, we found lower FEV1, (L/s) (ß=-0.16, 95% CI -0.30 to -0.02, p=0.03) and FVC (L) (ß=-0.17, 95% CI -0.34 to 0.01, p=0.06) per 10-fold increase of total dialkylphosphate levels. CONCLUSIONS: Early-life organophosphate exposure as assessed by dialkylphosphate concentrations was adversely associated with 7-year-old children's lung function.

Early-life exposure to organophosphate pesticides and pediatric respiratory symptoms in the CHAMACOS cohort.

BACKGROUND: Although pesticide use is widespread, the possible effect of early-life exposure to organophosphate (OP) on pediatric respiratory health is not well described. OBJECTIVES: We investigated the relationship between early-life exposure to OPs and respiratory outcomes. METHODS: Participants included 359 mothers and children from the CHAMACOS birth cohort. Dialkyl phosphate (DAP) metabolites of OP pesticides, specifically diethyl (DE) and dimethyl (DM) phosphate metabolites, were measured in urine from mothers twice during pregnancy (mean = 13 and 26 weeks gestation) and from children five times during childhood (0.5-5 years). Childhood DAP concentrations were estimated by the area under curve (AUC). Mothers reported their child's respiratory symptoms at 5 and 7 years of age. We used generalized estimating equations (GEE) to examine associations of prenatal and childhood DAP concentrations with repeated measures of respiratory symptoms and exercise-induced coughing at 5 and 7 years of age, adjusting for child's sex and age, maternal smoking during pregnancy, secondhand tobacco smoke, season of birth, PM2.5, breastfeeding, mold and cockroaches in home, and distance from highway. RESULTS: Higher prenatal DAP concentrations, particularly DE, were nonsignificantly associated with respiratory symptoms in the previous 12 months at 5 or 7 years of age [adjusted odds ratio (aOR) per 10-fold increase = 1.44; 95% CI: 0.98, 2.12]. This association was strongest with total DAP and DE from the second half of pregnancy (aOR per 10-fold increase = 1.77; 95% CI: 1.06, 2.95; and 1.61; 95% CI: 1.08, 2.39, respectively). Childhood DAP, DE, and DM concentrations were associated with respiratory symptoms and exercise-induced coughing in the previous 12 months at 5 or 7 years of age (total DAPs: aOR per 10-fold increase = 2.53; 95% CI: 1.32, 4.86; and aOR = 5.40; 95% CI: 2.10, 13.91, respectively). CONCLUSIONS: Early-life exposure to OP pesticides was associated with respiratory symptoms consistent with possible asthma in childhood.

[The rationale for promotion of bicycle helmet legislation for children up to 18 years].

BACKGROUND: Each year, many children suffer from injuries caused by bicycles, scooters, skateboards, and roller skates accidents. Head injury is the most common cause of death and serious disability in bicycle-related crashes. In various studies the use of bicycle helmets has been proven to be the most effective measure in preventing head injury: the use of bicycle helmets reduced the risk of head and brain injury by 85-88%. Legislation that mandates the use of helmets has been shown to effectively increase helmet use and, therefore, significantly decrease head injuries among riders. COST-BENEFIT: Legislation requiring helmets will save $44.2 million (direct benefit) to society over a 5-year period, and save approximately 57 lives, 2,544 hospitalizations, and 13,355 emergency room visits. BICYCLE-RELATED DEATHS AND INJURIES IN ISRAEL: Data from trauma registry of 10 hospitals of the Israeli Center for Trauma and Emergency Medicine research indicate that 649 children ages 17 years and under were injured in a bicycle-related accidents (58-serious, 77-medium injury). Bicycle-related injuries accounted for approximately 33% of motor vehicle accidents among children ages 17 years and under. LEGISLATION: Many countries have legislation requiring helmets for riders. In Israel, there is no law requiring helmets. On a telephone survey, conducted by 'Beterem', a high support rate for a law requiring bicycle helmets (89%) was found among parents to children up to 15 years of age. Based on the evidence of the effectiveness of helmets as a means for reducing head injuries in cyclists, and the importance of a law to this effect, the medical community in Israel should act to promote the legislation requiring helmets for children on bicycles, scooters, skateboards, roller skates, and rollerblades.

[Parents' risk perception and analysis of children's injuries scenarios from cold fat removers].

BACKGROUND: Cold fat removers cause serious injuries to children. OBJECTIVES: (1) To examine the knowledge, awareness and reported behaviors of parents concerning cold fat removers and to follow trends over time, before and after an intervention program. (2) To learn the common scenarios of injuries from cold fat removers in order to deepen the understanding of their occurrence and to promote prevention activities. METHODOLOGY: (1) Three telephone surveys of a representative sample of parents of children under the age of 15 years in the Jewish population were conducted during the period January 2004-June 2006. The sampling was performed in two stages: a stratified sample and a random sample in each layer. Results were analyzed in accordance with the children's age and the socio-demographic characteristics of the families. (2) Analysis of the children's injuries scenarios from cold fat removers of hospitalized children was conducted. The scenarios were collected from seven hospitals in Israel during January 2004-June 2006. RESULTS: The percentage of parents that were aware of the danger of ingestion of cold fat removers was significantly higher in June 2005 (40%) in comparison to January 2004 (22%). Only half of the sampled parents in January 2005 (53%) were aware of the fact that body contact with cold fat removers is more dangerous than bleach. About two thirds of sampled parents in June 2005 stated that they store their detergents in a safe place: 46.5% of parents store their detergents on a high shelf and 18% store them in a locked place. Thirteen scenarios of children's injuries due to cold fat removers were analyzed. The results showed that most injuries were at home, and that the main failures were due to human factors, underestimation of danger and a combination of these factors. Most of the injuries occurred both to infants and toddlers under 4 years of age and also in young children (6-8 years old); half of the scenarios occurred in the Arab population. CONCLUSIONS: A positive trend in parents' awareness of the danger of cold fat removers was observed. This trend was noted over the same period of time that the intervention program conducted by Beterem and the Israeli Ministry of Health took place. Yet, we cannot determine in certainty that this positive trend was due to the intervention program. Intervention programs implemented through health professionals, changes in the product and research and evaluation should be continued and promoted.