Eight-week, placebo-controlled, double-blind comparison of the antidepressant efficacy and tolerability of bupropion XR and venlafaxine XR.

The efficacy, safety and tolerability of bupropion XR and venlafaxine XR was assessed and compared with placebo in adult outpatients with major depressive disorder (MDD). Adults meeting DSM-IV criteria for MDD with a minimum Hamilton Depression Rating Scale (HAMD) 17-Item total score of > or =18 were randomized to eight weeks of double-blind treatment with either bupropion XR (150 mg/day), venlafaxine XR (75 mg/day) or placebo. At the end of the fourth week of treatment, a dosage increase to bupropion XR 300 mg/day or venlafaxine XR 150 mg/day was allowed if, in the opinion of the investigator, response was inadequate. The primary efficacy endpoint was mean change from baseline at week 8 in the Montgomery-Asberg Depression Rating Scale (MADRS) total score last observation carried forward (LOCF). Mean changes from baseline at week 8 (LOCF) in MADRS total score were statistically significant for bupropion XR and venlafaxine XR patients compared to the placebo group: -16.0 for bupropion XR (P = 0.006 vs placebo), -17.1 for venlafaxine XR (P < 0.001 vs placebo) and -13.5 for placebo. Secondary outcomes (including CGI-S, HAM-A, MEI, Q-LES-Q-SF, responder and remitter analyses) also improved significantly for both active treatment groups compared with placebo. The most frequently reported adverse events were dry mouth and insomnia for bupropion XR, and nausea, hyperhidrosis, fatigue, and insomnia for venlafaxine XR. In this double-blind, placebo-controlled trial, bupropion XR at doses up to 300 mg/day and venlafaxine XR at doses up to 150 mg/day demonstrated comparable antidepressant efficacy.

Incidence rates of occupational allergic contact dermatitis caused by metals.

BACKGROUND: Data on the incidence rates (IR) of occupational dermatoses are scarce. MATERIAL AND METHODS: We calculated the IR of occupational allergic contact dermatitis (ACD) caused by chromium, nickel and cobalt by occupation, during a 7-year period (1991-1997) from the data of the Finnish Register of Occupational Diseases and from the statistics on the working population in different occupations. RESULTS: A total of 2543 cases of occupational ACD were reported during 1991-1997. Cr caused 143 (5.6%) cases of ACD, Ni 176 cases (6.9%) and Co 41 cases (1.6%) of ACD. Women had greater number of occupational ACD from nickel, whereas occupational ACD from chromate and cobalt was more frequent in men. The ranking list of the IR of occupational ACD caused by Cr per 10,000 working years was (incidence rate in parenthesis) (1) tanners, fellmongers, and pelt dressers (12.20); (2) cast concrete product workers (6.94); (3) leather goods workers (4.71), (4) metal plating and coating workers (3.66); (5) bricklayers (3.44); (6) reinforcement concreters (2.79); and (7) building workers (1.32). The corresponding ranking list for Ni was (1) footwear workers (2.55); (2) machine and metal product assemblers (2.40); (3) electrical and teletechnical equipment assemblers (2.03); (4) precision instrument mechanics (1.73); (5) postal officials (1.48); (6) hairdressers, beauticians, and bath attendants (1.24); (7) industrial tailors and seamstresses (1.08); and (8) waiters in cafes and snack bars (1.04). The corresponding ranking list for Co was (1) printers (0.80); (2) turners, machinists, and toolmakers (0.36); and (3) machine and engine mechanics (0.17). CONCLUSION: The Finnish Register of Occupational Diseases forms a good basis for calculating IR. As IR illustrates the risk to become sensitized, preventive measures should be directed at occupations with the highest IR.

International data base of exposure measurements in the pulp, paper and paper product industries.

An international data base of exposure measurements in the pulp, paper and paper product industries was constructed to be used in exposure assessment for epidemiology studies and hazard control. Industrial hygiene and biological monitoring data were collected from countries participating in the multicentric study of the International Agency for Research on Cancer. Each measurement was characterized by country, mill type and number, department, job, agent measured, sampling method, measurement result in the standard unit, duration and date of sampling, assessment of representativeness, measurer, purpose of measurements, and remarks (e.g. on measurement sites and biases). Over 31,000 measurement results on 246 different chemical agents from 13 countries were available from pulp (45% of measurements), paper/paperboard/recycling (12%) and paper product (11%) mills or from their non-production departments (23%). Most measurements (82%) were carried out after 1980. The most frequently measured group of agents was inorganic gases (35%), followed by organic compounds (25%), solvents (18%), mineral dusts (12%), metals (6%) and bioaerosols (3%). Over 90% of the measurements were without an obvious bias, but their true representativeness is difficult to assess. Concentrations of various agents, including sulfur dioxide, chlorine dioxide, carbon monoxide, nitrogen dioxide, ozone, ammonia, formaldehyde and some solvents, often exceeded current occupational exposure limits. This data base summarizes a great deal of previously unpublished exposure data, provides a unique opportunity to study exposure patterns at the international level and identifies exposure situations that require further attention and investigation.

Occupational exposure to carcinogens in the European Union.

OBJECTIVES: To construct a computer assisted information system for the estimation of the numbers of workers exposed to established and suspected human carcinogens in the member states of the European Union (EU). METHODS: A database called CAREX (carcinogen exposure) was designed to provide selected exposure data and documented estimates of the number of workers exposed to carcinogens by country, carcinogen, and industry. CAREX includes data on agents evaluated by the International Agency for Research on Cancer (IARC) (all agents in groups 1 and 2A as of February 1995, and selected agents in group 2B) and on ionising radiation, displayed across the 55 industrial classes. The 1990-3 occupational exposure was estimated in two phases. Firstly, estimates were generated by the CAREX system on the basis of national labour force data and exposure prevalence estimates from two reference countries (Finland and the United States) which had the most comprehensive data available on exposures to these agents. For selected countries, these estimates were then refined by national experts in view of the perceived exposure patterns in their own countries compared with those of the reference countries. RESULTS: About 32 million workers (23% of those employed) in the EU were exposed to agents covered by CAREX. At least 22 million workers were exposed to IARC group 1 carcinogens. The exposed workers had altogether 42 million exposures (1.3 mean exposures for each exposed worker). The most common exposures were solar radiation (9.1 million workers exposed at least 75% of working time), environmental tobacco smoke (7.5 million workers exposed at least 75% of working time), crystalline silica (3.2 million exposed), diesel exhaust (3.0 million), radon (2.7 million), and wood dust (2.6 million). CONCLUSION: These preliminary estimates indicate that in the early 1990s, a substantial proportion of workers in the EU were exposed to carcinogens.

Occupational exposure to chemical and biological agents in the nonproduction departments of pulp, paper, and paper product mills: an international study.

As part of an international epidemiological study of workers in the pulp and paper industry, previously unpublished exposure measurements were assembled in a database. This article describes 7293 measurements in nonproduction departments from 147 mills in 11 countries. The greatest variety of agents was measured in the maintenance, construction, and cleaning department, where high exposures to asbestos, chromium [VI] compounds, copper, mercury in urine, nitrogen dioxide, ozone, styrene, sulfur dioxide, trichloroethylene, and welding fumes were observed. Measurements in the storage, yard, loading, and shipping department indicated high exposures to asbestos, carbon monoxide, fungal spores, nitrogen oxides, sulfur dioxide, and total dust. The steam and power generation department had high exposures to methyl mercaptan, silica, and total dust. Measurements in process and effluent water treatment, laboratory and research, engineering, and office, administration, and cafeteria areas had few elevated exposures. Throughout the nonproduction departments, measurements of pulp-production chemicals such as chlorine and sulfur compounds tended to be low, with many below detection limits. There were some problems with the available data; in particular, detection limits were often not specified, and the data tended to be clustered in such a way that sources of exposure variability could not be distinguished. Despite these problems, the data provide new insight into the exposures of nonproduction pulp and paper industry personnel.