bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community based universal neonatal hearing screening by health visitors using otoacoustic emissions
Authors: Owen M , Webb M , Evans K 
Published: July 2002

OBJECTIVESTo carry out a pilot study to test the feasibility of health visitors (HVs) performing neonatal otoacoustic emissions (OAE) hearing screening in the community using Echoport ILO288 and to evaluate its acceptability to parents and HVs.DESIGNProspective cohort study.SETTINGLocal health centres and babies' homes in urban and rural settings in West Gloucestershire.PARTICIPANTSTwelve HVs, 683 babies, and their parents.MAIN OUTCOME MEASURESCoverage rate, age at testing, referral rate for formal audiology testing, and parental anxiety scores.RESULTSOf the 683 babies registered with the study HVs, 99% (675) were tested, with a median age at first test of 18 days. Parental consent for the study was refused for six of the eight not tested. Taking a unilateral pass as a screening pass (for comparison with other studies), 4% (27/675) failed the first OAE test, and 1.9% (13/675) failed a second OAE test performed by the HV within a further two weeks and were referred for formal audiology testing. One baby (0.15%) was found to have a moderate sensorineural hearing loss on brain stem auditory evoked responses, giving a false positive rate of 1.7% (12/675). Some 18% (120/675) were tested at home, of which 80% (96/120) were combined with another planned reason for HV contact. In all, 82% (555/675) of tests were carried out in health centre clinics, of which 47% (260/555) were combined purpose visits. Mean parental anxiety scores (possible range 0–5) were 0.86, 2.27, and 3.45 before the first test, first retest, and audiology test respectively. The median time taken for one HV to complete testing was 12.2 minutes (range 3–65), compared with the 15 minutes currently allocated for two HVs to perform distraction testing. Based on the results of questionnaires, the test was very well received by parents and HVs alike.CONCLUSIONHVs are able to perform OAE testing in the neonatal period at home and in local health centre clinics. They achieve high population coverage rates and low false positive rates. Universal neonatal hearing screening by HVs using OAE testing is feasible, well received, and could be less demanding of HV time than the current distraction testing. This model of universal neonatal hearing screening should be considered by the National Screening Committee.
Decisions to treat or not to treat pneumonia in demented psychogeriatric nursing home patients: development of a guideline
Authors: van der Steen Jenny T , Muller Martien T , Ooms Marcel E , van der Wal Gerrit , Ribbe Miel W 
Published: July 2002

Non-treatment decisions concerning demented patients are complex: in addition to issues concerning the health of patients, ethical and legal issues are involved. This paper describes a method for the development of a guideline that clarifies the steps to be taken in the decision making process whether to forgo curative treatment of pneumonia in psychogeriatric nursing home patients.The method of development consisted of seven steps. Step 1 was a literature study from which ethical, juridical and medical factors concerning the patient's health and prognosis were identified. In step 2, a questionnaire was sent to 26 nursing home physicians to determine the relative importance of these factors in clinical practice. In a meeting of nine experienced physicians (step 3), the factors identified in step 2 were confirmed by most of these professionals. To prevent the final guideline being too directive, a concept guideline that included ethical and legal aspects was designed in the form of a “checklist of considerations” (step 4). Experts in the fields of nursing home medicine, ethics and law reviewed and commented on the concept guideline (step 5). The accordingly adapted “checklist of considerations” was tested in a pilot study (step 6), after which all experts endorsed the checklist (step 7).The resulting “checklist of considerations” structures the decision making process according to three primary domains: medical aspects, patient's autonomy, and patient's best interest (see annex at end of paper).
Study of two cohorts of workers exposed to methyl methacrylate in acrylic sheet production
Authors: Tomenson J A , Bonner S M , Edwards J C , Pemberton M A , Cummings T F , Paddle G M 
Published: July 2002

OBJECTIVESTo study mortality among 4324 workers at two United Kingdom factories, Darwen, Lancashire and Wilton, Cleveland, producing polymethyl methacrylate (PMMA) sheet. The Darwen factory is still active, but the Wilton one was closed in 1970. Also, to investigate patterns of mortality after exposure to methyl methacrylate; in particular, mortality from colon and rectal cancer.METHODSAll male employees at the Darwen factory with a record of employment in 1949–88 and all men ever employed at the Wilton factory (1949–70) were investigated. The vital status of both cohorts was ascertained on 31 December 1995. The exposure of 1526 subjects at the Darwen plant who were engaged from 1949 onwards could be characterised. The mean duration of exposure was 7.6 years at 13.2 ppm (8 hour time weighted average), although exposures in some work groups were as high as 100 ppm. It was not possible to calculate the cumulative exposure of workers first employed at the Darwen plant before 1949 or workers at the Wilton factory.RESULTSIn the Darwen cohort, 622 deaths were identified and a further 700 deaths in the Wilton cohort. Mortalities for the cohort were compared with national and local rates and expressed as standardised mortality ratios (SMRs). In the subcohort of Darwen workers with more than minimal exposure to MMA, reduced mortalities compared with national and local rates, were found for all causes (SMR 94), and colorectal cancer (SMR 92), but mortality from all cancers was slightly increased (SMR 104). No relations were found with cumulative exposure to MMA. In the subcohort of Wilton workers, mortality from all causes of death was significantly reduced (SMR 89), but mortality from all cancers (SMR 103) and colorectal cancer (SMR 124) were increased. The excess of colorectal cancer was confined to employees with less than 1 year of employment.CONCLUSIONThe study provided no clear evidence that employment at the factories or exposure to MMA had adversely affected the mortalities of workers.
Epidemiological response to a suspected excess of cancer among a group of workers exposed to multiple radiological and chemical hazards
Authors: Baysson H , Laurier D , Tirmarche M , Valenty M , Giraud J M 
Published: July 2002

OBJECTIVEAn excess of cancer was suspected by workers of the metallurgy department at the French Atomic Energy Commissariat (CEA) after several deaths from cancer were reported in 1983 and 1984. After a descriptive study performed by the CEA in 1985 the results of which were not conclusive enough to put an end to the controversy, the present cohort study was undertaken in 1989.METHODSAs no specific exposure, or a precise cancer site was suspected, it was decided to include all subjects who had worked at the metallurgy department for at least 1 year between 1950 and 1968. The cohort was followed up to 31 December 1990. Individual occupational exposures were determined retrospectively for each year from 1950 to 1990, both qualitatively (annual job, and hazard records, and assistance from former workers) and quantitatively (for external radiation). On the basis of these exposures, three types of occupational tasks were identified: handling of chemicals, radionuclides, and external radiation. Standardised mortality ratios (SMRs) were calculated to estimate the risk of death, and the existence of an association between risk of cancer and each of the three tasks was tested.RESULTSThe cohort included 356 workers, followed up for an average of 30 years (total of 10 820 person-years). The number of deaths from all causes and from all cancer sites were respectively 44 and 21. No excess of cancer deaths was found for the study period (SMR 0.77), nor was there a peak in 1983–4. The risk of death from all cancer sites increased with the duration of exposure to chemicals.CONCLUSIONThe results do not justify the workers' impression of an excess of cancer. They suggest, however, that the duration of work at some tasks that involved handling chemicals may be an indicator of risk of cancer. Communication to the workers during the study played an important part in reducing their concern, contributing to their better understanding of the results.
Polychlorinated dibenzo-p-dioxin and dibenzofuran concentrations in the serum samples of workers at continuously burning municipal waste incinerators in Japan
Authors: Kumagai Shinji , Koda Shigeki , Miyakita Takashi , Yamaguchi Hideki , Katagi Kenichi , Yasuda Nobufumi 
Published: July 2002

OBJECTIVESTo find whether concentrations of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) in serum increased in workers at municipal incinerators that burn continuously.METHODS30 Workers employed at three municipal waste incineration plants (incinerator workers) and 30 control workers were studied. The incinerator workers had worn dust masks or airline masks during the periodic repair work inside the incinerators. Previous job, dietary habit, smoking habit, distance from residence to the incineration plant, and body weight and height were obtained from a questionnaire survey. Concentrations of PCDDs/PCDFs were measured in the serum of the workers and the dust deposited in the plants. The influence of various factors on serum concentrations of PCDDs/PCDFs was examined by multiple regression analysis.RESULTSDust analysis showed the greatest amount of octachlorodibenzo-p-dioxin (OCDD), followed by 1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin (HpCDD), 1,2,3,4,6,7,8-heptachlorodibenzofuran (HpCDF), and octachlorodibenzofuran (OCDF). The toxicity equivalents (TEQs) of PCDDs and PCDFs in the deposited dust were 4.8, 1.0, and 6.4 ng TEQs/g, respectively, for plants A, B, and C. The mean serum TEQs of PCDDs and PCDFs in the incinerator workers and control workers were 19.2 and 22.9 pg TEQs/g lipid, respectively, for area A, 28.8 and 24.5 pg TEQs/g lipid for area B, and 23.4 and 23.6 pg TEQs/g lipid for area C. No significant differences were found between the incinerator workers and the controls for TEQs of PCDDs and PCDFs separately, and TEQs of PCDDs and PCDFs together. However, the serum 1,2,3,4,6,7,8-HpCDF concentration was significantly higher in the incinerator workers than in the controls for all the three areas. When the exposure index to 1,2,3,4,6,7,8-HpCDF is defined as the product of the concentration of 1,2,3,4,6,7,8-HpCDF in the deposited dust and duration of employment, the concentration of 1,2,3,4,6,7,8-HpCDF in serum increased as the exposure index increased. Multivariate analysis suggested that the serum concentration of HpCDF increased with duration of employment at the incineration plants and OCDF increased with employment of ⩾21 years. The other significant variables (p<0.01 or p<0.001) were area for hexachlorodibenzo-p-dioxin (HxCDD) and tetrachlorodibenzofuran (TCDF), Brinkman index for HpCDD, and body mass index (BMI) for tetrachlorodibenzo-p-dioxin (TCDD), HpCDD, and TEQs of PCDDs.CONCLUSIONThe serum TEQs of PCDDs and PCDFs was not significantly higher among the incinerator workers, but the serum concentration of 1,2,3,4,6,7,8-HpCDF was. This suggests that the incinerator workers had inhaled dust containing PCDDs and PCDFs while working in plants equipped with incinerators that burn continuously.
Fatigue among working people: validity of a questionnaire measure
Authors: Beurskens Anna J H M , Bültmann Ute , Kant IJmert , Vercoulen Jan H M M , Bleijenberg Gijs , Swaen Gerard M H 
Published: July 2002

OBJECTIVESTo evaluate the validity of the checklist individual strength questionnaire (CIS) in the working population. This 20 item self reported questionnaire has often been used in patients with chronic fatigue. To date, no research has focused on the validity of the CIS in occupational groups.METHODSTo evaluate the discriminant validity the CIS was filled out by five groups of employees with expected differences in fatigue. The convergent validity was evaluated by comparing the results of the CIS with the results of three related measures: measured unidimensional fatigue, burnout, and need for recovery.RESULTSThe CIS was able to discriminate between fatigued and non-fatigued employees in occupational groups. The expected agreement between the results of the CIS and related measures was confirmed.CONCLUSIONSThe CIS seems to be an appropriate instrument for measuring fatigue in the working population.
Strategy for prevention and control of the risks due to noise
Authors: Malchaire J 
Published: July 2002

OBJECTIVESTo propose a strategy for progressively controlling the exposure to noise in industry as much as possible. To propose a method that could, in the first stage, be used by the workers and management themselves to control exposures to noise as much as possible, and then, in later stages, when necessary, progressively call in the assistance of specialists and experts to identify more complex solutions and organise personal protection and medical surveillance.METHODSThe strategy includes three stages. Stage 1 is observation, simple and easy to use by the workers to recognise the problems, identify straightforward solutions, and call for assistance when needed. Stage 2 is analysis, more complex but more costly, performed with the assistance of occupational health specialists to identify more technical control measures and set up a programme to conserve hearing. Stage 3 is expertise, performed with the assistance of acoustic experts for special measurements and control measures.CONCLUSIONSThe proposed strategy enriches the assessment procedure that is usually recommended, by providing for one preliminary stage used by the people directly concerned. It explicitly recognises (a) the competence of the workers and management about their working conditions and (b) that knowledge and measurements of acoustics are not an absolute prerequisite for solving—at least partly—noise problems. It attempts to organise in sequence and optimise the cooperation between the workers, the occupational health specialists, and the experts in acoustics.
Lung function over the first 3 years of a professional diving career
Authors: Skogstad Marit , Thorsen Einar , Haldorsen Tor 
Published: July 2002

OBJECTIVESTo characterise diving exposure and pulmonary function in professional divers at the start of their formal education and during the first 3 years of their professional career.METHODSThe study included 87 men at the start of their education as professional divers. At follow up 1 and 3 years after the school 83 and 81 divers respectively were re-examined. Assessment of lung function included dynamic lung volumes and flows and transfer factor for carbon monoxide (TlCO).RESULTS69 Divers had preschool SCUBA diving experience and had a median number of 70 dives (range 2–3000) to a median maximal depth of 40 (range 10–73) metres. During the 15 week introductory diving course, they had 44 dives (range 38–50) in the depth range 10–50 metres. The median number of dives over the follow up period was 95 (range 0–722) to a maximal median depth of 38 (range 0–98) metres. At the start of the diving course there were no differences in forced vital capacity (FVC), forced expired volume in 1 second (FEV1), and in TlCObetween the 69 pre-exposed divers and the 18 never exposed divers. The FVC was significantly larger than predicted in both groups. At follow up at 3 years there was a significant reduction in mean (SD) FEV1of 1.8% (6.5), in forced mid-expiratory flow rate (FEF25–75%) of 6.5% (11.7) and in forced expiratory flow at 75% of FVC expired (FEF75%) of 10.4% (16.8). There was no change in FVC. The TlCOwas significantly decreased by 4.6% (8.8). No significant effects were found of cumulative diving exposure, including the number of dives, on the relative changes of any of the lung function variables.CONCLUSIONSThe results indicate that divers initially belong to a selected group with large FVC. Exposure to diving may contribute to changes in pulmonary function, mostly affecting small airways conductance.
Mortality from cancer and chronic respiratory diseases among workers who manufacture carbon electrodes
Authors: Donato F , Monarca S , Marchionna G , Rossi A , Cicioni C , Chiesa R , Colin D , Boffetta P 
Published: July 2002

OBJECTIVESTo investigate the risk of cancer and non-neoplastic respiratory diseases among workers who manufacture carbon electrodes, as this industry entails exposure to mixtures of polycyclic aromatic hydrocarbons.METHODSA historical cohort study was carried out of 1006 male workers employed for at least 1 year between 1945 and 1971 in a carbon (graphite) electrode production plant in central Italy, who were followed up for mortality between 1955 and 1996. The ratio of observed to expected deaths (standardised mortality ratios, SMRs) was computed from both national and (for the period 1964–96) regional age and period specific mortalities. A multivariate Poisson regression analysis was performed to investigate the relative risk (RR) of death according to duration of employment and time since first employment in the factory.RESULTSA total of 424 workers had died, 538 were still alive, and 44 were lost to follow up. Mortalities from all causes, all cancers, and respiratory tract cancer were in line with the regional figure. An excess was found over the expected deaths from skin cancer including melanoma (SMR 3.16, 95% confidence interval (95% CI) 0.65 to 9.23) and from non-neoplastic respiratory diseases (SMR 1.58, 95% CI 1.16 to 2.11). Poisson regression analysis including age as a covariate showed an increased risk of dying from gastric cancer with increasing duration of employment, and an increase in the RR of dying from lung cancer and from non-neoplastic respiratory diseases with increasing time since first employment, although the linear trend was not significant.CONCLUSIONThis study supports previous findings that working in the carbon electrode manufacturing industry may not increase the risk of dying from respiratory cancer. However, a possible association with non-malignant respiratory diseases cannot be excluded.
Occupational exposure to magnetic fields relative to mortality from brain tumours: updated and revised findings from a study of United Kingdom electricity generation and transmission workers, 1973–97
Authors: Sorahan T , Nichols L , van Tongeren M , Harrington J M 
Published: July 2002

OBJECTIVETo investigate whether risk of brain tumour is related to occupational exposure to magnetic fields.METHODSThe mortality experienced by a cohort of 83 997 employees of the former Central Electricity Generating Board of England and Wales was investigated for the period 1973–97. All workers were employed for at least 6 months with some employment in the period 1973–82. Computerised work histories were available for 79 972 study subjects for the period 1971–93. Detailed calculations had been performed by others to enable a novel assessment to be made of exposures to magnetic fields. Two analytical approaches were used, indirect standardisation (n=83 997) and Poisson regression (n=79 972).RESULTSBased on serial mortalities for England and Wales, deaths from brain cancer were close to expectation (observed 158, expected 146.4). No significant positive trends were shown for risks of brain tumours either with lifetime cumulative exposure to magnetic fields or with such exposures received in the most recent 5 years.CONCLUSIONSThere are no discernible excess risks of brain tumours as a consequence of occupational exposure to magnetic fields in United Kingdom electricity generation and transmission workers.
Neurobehavioural changes and persistence of complaints in workers exposed to styrene in a polyester boat building plant: influence of exposure characteristics and microsomal epoxide hydrolase phenotype
Authors: Viaene M K , Pauwels W , Veulemans H , Roels H A , Masschelein R 
Published: July 2002

OBJECTIVESTo investigate neurobehavioural effects and the persistence of complaints in workers exposed to styrene relative to exposure characteristics and the enzyme microsomal epoxide hydrolase (mEH) activity.METHODSA cross sectional study was performed in a retrospective cohort of workers of a polyester boat building plant 3 years after the main activity shut down in 1989. Workers still currently exposed to a much lower concentration of styrene in air than before (n=27) and formerly exposed workers (n=90) were compared with matched control workers (n=64). Currently and formerly exposed workers laminated 4700 and 3610 hours on average at mean exposure to styrene concentrations of 148 and 157 mg/m3respectively. A structured neurological anamnesis into former and present complaints, the NSC-60 questionnaire, and computer assisted neurobehavioural tests (NES) were administered. The mEH phenotype activity was measured in lymphocytes with a novel gas chromatography-mass spectroscopy (GC-MS) method.RESULTSFor the period before 1989, currently and formerly exposed workers reported more complaints than control workers which related well with the mean exposure to airborn styrene concentration (p=0.03). Most complaints disappeared after the end of exposure, although the chest, equilibrium, and somatic category scores of NSC-60 and the number of workers reporting diminished sense of smell remained increased in formerly exposed workers (p⩽0.05). Symbol-digit substitution and digit span forwards test results were worse in currently and formerly exposed workers (p⩽0.01). In the combined group of currently and formerly exposed workers, the symbol-digit substitution and colour-word vigilance results related well to duration of exposure (p<0.01 and p=0.03) and mEH phenotype activity (p=0.01 and p=0.05), whereas the digit span forwards results only showed associations of borderline significance (duration of exposure (p=0.08) and mEH phenotype activity (p=0.08)).CONCLUSIONMost subjective symptoms were reversible but some persisted after the end of exposure to styrene, whereas dysfunction of visuomotor performance and perceptual speed seemed to persist. Duration of exposure at lamination tasks and the interaction, duration of exposure×concentration of exposure, were found to be the best predictors of worsening visuomotor and perceptual speed performances. Activity of the mEH phenotype may play a modulating part in styrene neurotoxicity. The results suggested that less than 10 years of exposure to atmospheric styrene at an average concentration of 155 mg/m3may result in persistent neurotoxic effects.
A case-referent study of cancer mortality among sulfate mill workers in Sweden
Authors: Andersson E , Hagberg S , Nilsson T , Persson B , Wingren G , Torén K 
Published: July 2002

OBJECTIVESTo investigate whether workers in Swedish sulfate mills have an increased risk of death from certain malignancies that have previously been linked to the pulping process.METHODSSubjects of the study (n=2480) were men aged 40–75 at death during 1960–89 in the parishes surrounding four sulfate mills. Exposure assessment was based on information from the personnel files in the mills— 35% of the subjects were recognised there, and work categories were created.RESULTSAmong all sulfate mill workers, the odds ratio (OR) (90% confidence interval (90% CI)) for death from lung cancer was 1.6 (1.1 to 2.3), pleural mesotheliomas 9.5 (1.9 to 48), brain tumours 2.6 (1.2 to 5.3), and liver or biliary tract cancer 2.3 (1.0 to 5.2). There was an increased mortality from leukaemia among workers in the soda recovery plant (5.9 (2.6 to 13)) and bleaching plant and digester house (2.8 (1.0 to 7.5)).CONCLUSIONSSulfate mill workers were at increased risk of dying from lung cancer and pleural mesotheliomas, probably due to exposure to asbestos. Increased risks of brain tumours and cancers of the liver or biliary tract were also found but the aetiology is not obvious.