A historical prospective study of cancer in lamp manufacturing workers in one plant was conducted. All men and women who worked for a total of at least 6 months and were employed at some time between 1960 and 1975 were included. Work histories were abstracted and subjects were divided according to whether they had worked in the coiling and wire drawing area (CWD). Cancer morbidity from 1964 to 1982 was ascertained via the provincial registry, and was compared with the site-specific incidence in Ontario, adjusting for age, sex and calendar period. Of particular interest were primary breast and gynecological cancers in women. The cancers of a priori concern were significantly increased in women in CWD, but not elsewhere in the plant. The excess was greatest in those with more than 5 yr exposure (in CWD) and more than 15 yr since first working in CWD, with eight cases of breast and gynecological cancers observed in this category compared with 2.67 expected. Only three cancers occurred in men in CWD. Environmental measurements had not been made in the past and little information was available on substances used in the 1940s and 1950s, the period when the women with the highest excess began employment. It is known that methylene chloride and trichlorethylene have been used, but not enough is known about the dates and patterns of use to draw any conclusions about their relationship with the increase in disease.
An historical prospective mortality study of INCO's Ontario work-force has been conducted. A cohort of approximately 54 000 men, employed in all aspects of the extraction and refining of copper and nickel from the Sudbury ore deposit, have been followed for mortality between 1950 and 1976. A total of 5 283 deaths were identified by computerized record-linkage to the Canadian Mortality Data Base of death certificates. The analysis focuses on mortality from cancer of the nasal sinuses, larynx, lung, and kidney. Little evidence was found for increased mortality from laryngeal or kidney cancer, but lung and nasal cancer deaths were clearly elevated in men exposed to the two Sudbury area sinter plants and at Port Colborne in the leaching, calcining, and sintering department. The standardized mortality ratio (SMR) for lung cancer increases linearly with increasing duration of exposure and there is no evidence of a threshold. The nasal cancer mortality rate also rises linearly with duration of exposure. While lung cancer has a greater excess in the Sudbury sinter plant than at Port Colborne, the reverse is true for mortality from nasal cancer, which is ten times more frequent at Port Colborne than at Sudbury.
This article aimed to examine changes in general health and time with back pain and neck pain and to identify predictors of any such changes. Hospital workers were studied longitudinally with surveys in 1995, 1996, and 1997 (N = 712). Back and neck pain were reported only at the 2nd and 3rd surveys. There was a significant decline in general health and significant increases in time with neck pain and back pain. Predictors of changes in these outcomes were mainly work-related variables (initial or change values), such as job interference with family, job influence, work psychological demands, and hours worked.
This paper examines the performance of 4 different methods of estimating peak spinal loading and their relationship with the reporting of low-back pain.
The data used for this comparison was a subset of subjects from a case-referent study of low-back-pain reporting in the automotive industry, in which 130 random referents and 105 cases (or job-matched proxies) were studied. The peak load on the lumbar spine was determined using a biomechanical model with model inputs coming from a detailed self-report questionnaire, a task-based check list, a video digitization method, and a posture and load sampling technique.
The methods were directly comparable through a common metric of newtons or newton meters of spinal loading in compression, shear, or moment modes. All the methods showed significant and substantial associations with low-back pain in all modes (odds ratios 1.6-2.3). The intraclass correlation coefficients (ICC) showed strong similarities between the checklist and video digitized techniques (ICC 0.84-0.91), moderate similarities between these techniques and the work sampling method (ICC 0.49-0.52), and poor correlations (ICC 0.16-0.40) between the self-report questionnaire and the observer recorded measures.
While all the methods detected significant odds ratios, they cannot all be used interchangeably for risk assessment at the individual level. Peak spinal compression, moment, and shear are important risk factors for low-back pain reporting, no matter which measurement method is used. Questionnaires can be used for large-scale studies. At the individual level a task-based checklist provides biomechanical model inputs at lower cost and equal performance compared with the criterion video digitization system.
This article explores the extent to which hospital workers at a large teaching hospital at different managerial/supervisory levels (designated and non-designated supervisors, and non-supervisory staff), experienced job stress and job satisfaction prior to the re-engineering of hospital services. For all groups, increased levels of job demands were associated with higher levels of stress. Lower levels of decision latitude were associated with increased job stress for designated supervisors. Increasing levels of decision latitude were associated with both job stress and satisfaction for the other two groups. Co-worker support and teamwork contributed to increased job satisfaction for all groups.
To determine whether prehospital outcome of patients who receive care from emergency medical technicians-paramedic (EMT-Ps) differs from that of patients who receive care from emergency medical technicians-defibrillation (EMT-Ds), as rated by the treating EMTs using standardized scales, and to determine whether the patient's seriousness of illness is relevant to any differential benefit of one level of care over the other.
Historical (retrospective) cohort.
An urban and semiurban region of southwest Ontario comprising an area of 1,136 square kilometers (438 square miles) with a population of more than 445,000.
Patients (10,291) who were transported by the Hamilton-Wentworth EMS system between January 1, 1991, and December 31, 1991.
EMTs rated the prehospital outcome of their own patients, using scales that had been tested in a previous study. Comparisons between EMT-P- and EMT-D-treated patients were made by chi 2, chi 2 by trend, and Fisher's exact test as appropriate.
More seriously ill or injured EMT-P-treated patients were rated as improved and fewer EMT-P-treated patients were rated as worsened compared with similar patients who were cared for and rated by EMT-Ds. The differential benefit from EMT-P to EMT-D care ranged from 8% to 25% for patients rated as "severe" and from 27% to 49% for patients rated as "life-threatened."
According to the ratings of prehospital care providers, patients classified as "severe" or "life-threatened" had their conditions "improve" by the time they arrived at the hospital more often when care was provided by an EMT-P team than when it was provided by an EMT-D team.
PURPOSE: To determine the clinical effectiveness of Haemophilus influenzae type b (Hib) vaccines. STUDY IDENTIFICATION AND SELECTION: Computerized searches of MEDLINE, EMBASE and SCISEARCH databases were performed, and the reference list of each retrieved article was reviewed. Two prospective clinical trials of Hib polyribosyl ribitol phosphate conjugated with diphtheria toxoid (PRP-D) were identified. In addition, one cohort study of the PRP-D vaccine, two trials of the PRP vaccine, five case-control studies of the PRP vaccine and 10 randomized controlled trials of the immunogenicity of the PRP-D vaccine were identified. DATA EXTRACTION: Study quality was assessed and descriptive information concerning the study populations, the interventions and the outcome measurements was extracted. RESULTS: The difference in the effectiveness of the PRP-D vaccine between the prospective trials, in which a three-dose schedule had been used beginning at 2 to 3 months of age, was clinically important (37% v. 83%) but not statistically significant. The PRP vaccine, which induces lower antibody responses than the PRP-D vaccine does, was clinically effective only in a subgroup of one prospective trial; 90% effectiveness was reported among children 18 to 60 months of age. CONCLUSIONS: Hib vaccine appears to be less effective in high-risk populations. None the less, because of the large variation in baseline risk, the number of children who would have to be vaccinated to prevent one case of invasive Hib disease is substantially less for high-risk than for low-risk populations. The vaccination of children at high risk, such as native children, with the PRP-D vaccine using a four-dose schedule (at 2, 4, 6 and 14 months of age) seems warranted. The currently available evidence does not strongly support a policy of universal vaccination with either a one-dose or a four-dose schedule.
We examined 470 fatal occupational accidents in Ontario, 1986-1989, that met eligibility criteria. Homicides and most accidents on public roads were excluded. Information was obtained from coroners' files and records of the provincial Ministry of Labour. Levels of alcohol likely to produce impairment were found in six subjects (2% of the two-thirds of fatalities tested). Cannabis was detected in 3.9% of cases (17% of those tested), but other illegal drugs were not found. Recommendations of coroner's juries showed that organizational factors were considered relevant on many occasions, although language and literacy were rarely mentioned. The incidence rate rose steadily with age. Other data items were examined, although, because of missing information and/or lack of denominator data for many of them, the conclusions that can be drawn are limited. Among these tentative findings was that more fatal accidents occurred in the first half of the shift than in the second half.
There is growing evidence that occupational injuries influence workers' emotional and physical wellbeing, extending healthcare use beyond what is covered by the Workers' Compensation Board (WCB).
The authors used an administrative database that links individual publicly funded healthcare and WCB data for the population of British Columbia (BC), Canada. They examined change in service use, relative to one year before the injury, for workers who required time off for their injuries (lost time = LT) and compared them to other injured workers (no lost time = NLT) and individuals in the population who were not injured (non-injured = NI).
LT workers increased physician visits (22%), hospital days (50%), and mental healthcare use (43% physician visits; and 70% hospital days) five years after the injury, relative to the year before the injury, at a higher rate than the NI group. For the NLT workers, the level of increased use following the injury was between that of these two groups. These patterns persisted when adjusting for registration in the BC Medical Service Plan (MSP) and several workplace characteristics.
Although the WCB system is the primary mechanism for processing claims and providing information about workplace injury, it is clear that the consequences of workplace injury extend beyond what is covered by the WCB into the publicly funded healthcare system.
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