This informative article on the occupational wood dust exposure in
Italy requests a monitoring method for received personal doses. Such a
method exists exploiting samples obtained by nasal lavage (1). It is based
on the the chemical analysis for wood polyphenols. Although they are
species specific they are good quantitative indicators of hardwood dust
particles coarse enough to be retained in the na...
This informative article on the occupational wood dust exposure in
Italy requests a monitoring method for received personal doses. Such a
method exists exploiting samples obtained by nasal lavage (1). It is based
on the the chemical analysis for wood polyphenols. Although they are
species specific they are good quantitative indicators of hardwood dust
particles coarse enough to be retained in the nasal passages.
The wood tannins can also be analysed in the suspended dust in the
work room air. This provides the advantage that it gives an idea of
current dusts and previous materials which may not have been properly
cleaned away (2).
References
1 Mämmelä P, Tuomainen A, Vartiainen T, Lindroos L, Kangas J,
Savolainen H. Biological monitoring of wood dust exposure in nasal lavage
by high-performance liquid chromatography. J environ Monit, 2002; 4: 187-
189
2 Bianco M-A, Savolainen H. Woodworkers´ exposure to tannins. J appl
Toxicol, 1994; 14: 293-295
As described in this investigation only a minority workers with an
occupational asthma due to a diisocyanate exposure have specific IgE
antibodies towards the monomers (1).
Therefore, it is likely the host factors play an important role (2).
However, their significance may not be so firm so as to be used as
predictors of a disease. The concept is, however, important in the
workers´ compen...
As described in this investigation only a minority workers with an
occupational asthma due to a diisocyanate exposure have specific IgE
antibodies towards the monomers (1).
Therefore, it is likely the host factors play an important role (2).
However, their significance may not be so firm so as to be used as
predictors of a disease. The concept is, however, important in the
workers´ compensation cases if only those with specific antibodies or
positive provocation test results outside the work place are accepted as
valid cases.
1 Savolainen H. New mechanistic model for organic diisocyanate-
induced respiratory disease. Schweiz Med Wochenschr 1999; 129: 465-7.
2 Berode M, Jost M, Ruegger M, Savolainen H. Host factors in
occupational diisocyanate asthma: a Swiss longitudinal study. Int Arch
Occup Environ Health 2005; 158-163.
Comments on Koppelaar et al, 'Determinants of implementation of
primary preventive interventions on patient handling in healthcare: a
systematic review'. OEM 2009;66:353-360
Koppelaar et al put forward an interesting view on implementation in
their article. They state that the results of interventions will depend
not only on the effectiveness of the intervention itself but also on
appropriate implementation in...
Comments on Koppelaar et al, 'Determinants of implementation of
primary preventive interventions on patient handling in healthcare: a
systematic review'. OEM 2009;66:353-360
Koppelaar et al put forward an interesting view on implementation in
their article. They state that the results of interventions will depend
not only on the effectiveness of the intervention itself but also on
appropriate implementation in the actual work situation. However, the term
implementation and the use of the supportive reference by Groll and
Grimshaw are not used in their proper context here. The idea is that once
an intervention has been shown to be effective, it should be implemented
into health care, meaning that it should be used in 100% of the situations
in which it is appropriate. Koppelaar et al confuse this with the actual
process of the intervention in an evaluative trial. I think that these are
two different processes with different determinants. Since there is no
evidence of effectiveness of interventions that aim at preventing adverse
health effects of handling patients by healthcare workers, these
interventions should not be implemented in practice. If one would like to
improve these types of interventions in research projects, there should be
a clear idea of how the intervention works. Based on these ideas a
maximum powerful intervention can be developed and evaluated. Once proven
effective, the intervention should be implemented in health care. Also in
their review the majority of the studies cited does not have a
statistically significant positive outcome, neither is there a relation
with the outcome of the study and the 'barriers and facilitators' for
implementation.
Moreover, we would like to point out that the review does not deserve
the adjective systematic. The inclusion criteria are unclear because
there is no definition of the study designs to be included. Arbitrarily,
qualitative studies are excluded. The search is limited only to Medline
and Web of Science and it is unclear why important databases such as
Embase, Cinahl and OSHrom are not searched. There is language bias because
only studies written in English are included. Especially for
implementation, one could expect to find studies to be published in
national languages. Even though it is an objective to assess the influence
of barriers and facilitators on the effectiveness of interventions, there
are no methods or results for this objective. The lack of an assessment of
study quality in combination with the inclusion of any study type makes
that the reader has no idea what the validity of the results of the
included studies is. The authors acknowledge this as a limitation of their
study in the discussion section. However, in my view, all these problems
together make it impossible to interpret the results of the review.
"The Corresponding Author has the right to grant on behalf of all
authors and does grant on behalf of all authors, an exclusive license (or
non exclusive for government employees) on a worldwide basis to the BMJ
Publishing Group Ltd and its Licensees to permit this article (if
accepted) to be published in Occupational and Environmental Medicine
editions and any other BMJPG products to exploit all subsidiary rights, as
set out in our licence
Jos Verbeek, MD PhD
Finnish Institute of Occupational Health
Cochrane Occupational Health Field
Kuopio
Finland
1. E Koppelaar, J J Knibbe, H S Miedema, A Burdorf. Determinants of
implementation of primary preventive interventions on patient handling in
healthcare: a systematic review. Occup Environ Med 2009;66:353–360.
2. Grol R, Grimshaw J. From best evidence to best practice: effective
implementation of change in patients’ care. Lancet 2003;362:1225-29.
3. Campbell M, Fitzpatrick R, Haines A, Kinmonth A, Sandercock P,
Spiegelhalter D, Tyrer P. Framework for design and evaluation of complex
interventions to improve health. BMJ 2000;321:694–6
4. Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG. Epidemiology and
reporting characteristics of systematic reviews. PLoS Med 4(3);2007:e78.
doi:10.1371/journal.pmed.0040078
We are writing to respond to Dr.Kalman in regard to our article
entitled “Maternal Occupational Exposure and Risk of Spontaneous Abortion
in Veterinary Practice”.
Regarding the risk relating to radiation, we presented data
separately for those with 1-4 x-rays a week in Table 2. Readers are able
to use these analyses rather than those in Table 3 if they prefer. The
results for exposure...
We are writing to respond to Dr.Kalman in regard to our article
entitled “Maternal Occupational Exposure and Risk of Spontaneous Abortion
in Veterinary Practice”.
Regarding the risk relating to radiation, we presented data
separately for those with 1-4 x-rays a week in Table 2. Readers are able
to use these analyses rather than those in Table 3 if they prefer. The
results for exposure to radiation as a continuous variable are also
presented in the text for readers who require more detail (results
section, page 3, column 1, line 16).
In regard to the way data were presented, particularly regarding
exposure to waste anaesthetic gases, we suggest that this is a different
situation to the dose-response variable describing x-rays a week. We
categorized the variable surgery/gas scavenging using both two and three
categories, but in the table we used three categories in order to
disentangle the effects of surgery and waste anaesthetic gases. The
results for the variable surgery/gas scavenger using two categories were
reported in the text (results section, page 3, column 1, line 6).
This study, as documented in the abstract, only reports an increased
risk of spontaneous abortion in veterinarians who performed more than five
radiographic examinations per week. However, we suggest that it would be
wise to advise veterinarians of the possible risk due to radiation even at
low doses, particularly for young females. It has long been established
that x-rays can have harmful effects, including sterility, miscarriage,
mutagenesis and carcinogenesis and, while empirical evidence of harm is
difficult to measure at low doses, the theories of radiation and cancer
biology have to led to widespread adoption of the ALARA principle (as low
as reasonably achievable).
I am grateful for the speedy response from Dr Shirangi and her
colleagues to my original letter. I regret the delay in my further
response.
Importantly, the authors justify the combination of the ‘no exposure’
and ‘one to 5 films per week’ categories (ie the elimination of an
exposure category) on the identification that the crude relative risk data
did not indicate any adverse outcome for t...
I am grateful for the speedy response from Dr Shirangi and her
colleagues to my original letter. I regret the delay in my further
response.
Importantly, the authors justify the combination of the ‘no exposure’
and ‘one to 5 films per week’ categories (ie the elimination of an
exposure category) on the identification that the crude relative risk data
did not indicate any adverse outcome for the taking of one to 5 films. I
would, of course, agree that had there been such an adverse outcome, it
would have been inappropriate to carry out this combination. The question
however centres around the justification of this action when, in fact,
there is demonstrated beneficial outcome which reaches statistical
significance. There is, of course, significant publication around
considerations of low dose radiation effects, including hormesis, so that
lack of biological plausibility would not appear to offer such
justification.
In addition, it appears that this treatment of the data is not
standardised in the paper. It is noted, for example, that in the category
dealing with surgery/gas scavenging, the crude data is in 3 exposure
categories, and there is no adverse outcome between the first 2
categories. Notwithstanding this, there appears to have been no move to
amalgamate these 2 groups in the multiple logistic regression.
I think an important role of Occupational Physicians is to be able to
comment on and advise workers in relation to research. This appears a
difficult task to do in relation to a study which shows the greatest risk
of spontaneous abortion to be in those who are not subject to any x-ray
exposure, with a statistically significant reduction in risk for those
taking one to 5 films but, nevertheless, produces an abstract and
conclusion based around an apparently demonstrated radiation risk and
advice to warn workers.
Yours sincerely
Dr Chris Kalman MBChB FRCP (Glas) FFOM
Director/Consultant Occupational Physician
Reply to Kolstad and Bondes regarding “objective” exposure
measurements of psychosocial working conditions
We agree with Kolstad and Bonde that it is important to identify
measures of “psychosocial” working conditions that are less dependent of
the individual appraisal than pure self-report. This was the intention of
our two studies published in OEM (1-2). The studies were based on an
exposure protocol to asses...
Reply to Kolstad and Bondes regarding “objective” exposure
measurements of psychosocial working conditions
We agree with Kolstad and Bonde that it is important to identify
measures of “psychosocial” working conditions that are less dependent of
the individual appraisal than pure self-report. This was the intention of
our two studies published in OEM (1-2). The studies were based on an
exposure protocol to assess different psychosocial working conditions
through a description of the actual work content according to
predetermined criteria (1,2). We asked the interviewee to provide concrete
examples of such exposure.
Kolstad and Bonde are concerned to what extent these measures are
independent of the individual. They refer to our first study (1) where we
found no systematic difference in the relationship between self-reported
and externally-assessed demands and control among psychologically
distressed and non-distressed subjects. Our best interpretation of these
findings was that self-reported and externally-assessed work demands and
control were equally valid for distressed and for non-distressed subjects.
This also implies that it is reasonable to expect accordance between
individual perception and external assessments. However, the levels of
distress were probably low.
In the second study (2), the outcome was diagnosis of depression and
exposure assessment was performed singularly with the interview protocol
from the first study (1). Kolstad and Bonde suspect that the depressed
participants described their working conditions as worse than would have
been obtained by an assessment truly independent of the affective state of
the interviewee. As we stated in the paper, this is possible, but we
believe that “overreporting of inappropriate work characteristics among
those with psychiatric disorders is likely to be notably smaller than in
self-report questionnaires.
As a remedy for these potential biases Kolstad and Bonde suggest
aggregated, average exposure measures obtained among colleagues with
common working conditions. However, we see problems also with this
approach. First, conditions in contemporary working life are
individualised and the same job title may include quite varied tasks and
conditions. Second, systematic under- or over reporting may be due to
adaptation of expectations over time.
However, we believe that both our, and Kolstad and Bonde’s,
approaches to improve exposure assessment in occupational studies of
determinants of mental disorder are of interest and may prove fruitful.
More studies on psychiatric outcomes not based on pure self-report of
exposure are certainly needed.
G Ahlberg, I Lundberg and K Waldenström
References:
1. Waldenstrom K, Lundberg I, Waldenstrom M, Harenstam A. Does
psychological distress influence reporting of demands and control at work?
Occup Environ Med 2003;60:887-891.
2. Waldenstrom K, Ahlberg G, Bergman P, Forsell Y, Stoetzer U,
Waldenstrom M, Lundberg I. Externally assessed psychosocial work
characteristics and diagnoses of anxiety and depression. Occup Environ Med
2008;65:90-96.
Numerous studies have documented that perception of adverse
psychosocial factors at work is related to major depression, but we still
do not know if this reflects causal characteristics of the working
environment, personal characteristics of the individual worker, trivial
associations, common method variance or other types of reporting bias
because most studies have relied on self-reported exposure information
(1)....
Numerous studies have documented that perception of adverse
psychosocial factors at work is related to major depression, but we still
do not know if this reflects causal characteristics of the working
environment, personal characteristics of the individual worker, trivial
associations, common method variance or other types of reporting bias
because most studies have relied on self-reported exposure information
(1).
Waldenström et al recently published a paper indicating a strong
association between hindrances and time pressure at work and depression
(2). This finding is important because assessment of psychosocial work
factors relied on external work content analysis, and therefore is
expected to be more objective and with a higher potential to guide
preventive measures by change of the environment rather than the
individuals’ psychological processing. We are concerned, however, whether
the new findings can be interpreted this way because Waldenström et al
previously reported that measures of psychological work characteristics
obtained by external work content analysis did not differ systematically
from measures based on self-reports in either distressed or non-distressed
individuals (3). This seems to indicate that the exposure information in
the Waldenström et al study was not independent of the individual worker’s
perception and appraisal of his or her working conditions and that the
risk estimates of depression may have been biased toward too high values.
External assessment relying on worker interviews may perhaps not be the
way forward to obtain unbiased psychosocial exposure data, even if study
participants are asked to be concrete and provide examples as they did in
the present study, as long as the information essentially is self-reported
and analyzed on an individual level. Aggregated, average exposure measures
obtained among colleagues with common working conditions, as suggested by
Frese and Zapf, have recently been introduced in risk factor studies of
depression and may be an alternative way forward (4;5).
REFERENCES
1. Bonde JP. Psychosocial factors at work and risk of depression: a
systematic review of the epidemiological evidence. Occup Environ Med 2008.
2. Waldenstrom K, Ahlberg G, Bergman P, Forsell Y, Stoetzer U,
Waldenstrom M et al. Externally assessed psychosocial work characteristics
and diagnoses of anxiety and depression. Occup Environ Med 2008; 65(2):90-
96.
3. Waldenstrom K, Lundberg I, Waldenstrom M, Harenstam A. Does
psychological distress influence reporting of demands and control at work?
Occup Environ Med 2003; 60(11):887-891.
4. Frese M, Zapf D. Methodological issues in the study of work
stress: Objective vs. subjective measurement of work stress and the
question of longitudinal studies. In: Cooper CL, Payne R, editors. Causes,
coping and consequences of stress at work. John Wiley & Sons Ltd.;
1988. 375-411.
5. Kouvonen A, Oksanen T, Vahtera J, Stafford M, Wilkinson R,
Schneider J et al. Low workplace social capital as a predictor of
depression: the Finnish Public Sector Study. Am J Epidemiol 2008;
167(10):1143-1151.
The letter from Drs Huff and Infante1 provides an opportunity to correct some misperceptions that have developed about the IARC Monographs. First, Huff and Infante call on IARC to make “appropriate adjustments” and “properly amend” the summaries for formaldehyde and other Monographs. It is important to understand that IARC does not change summaries, which are developed by independent Working Groups of scientists who conducted th...
The letter from Drs Huff and Infante1 provides an opportunity to correct some misperceptions that have developed about the IARC Monographs. First, Huff and Infante call on IARC to make “appropriate adjustments” and “properly amend” the summaries for formaldehyde and other Monographs. It is important to understand that IARC does not change summaries, which are developed by independent Working Groups of scientists who conducted the original research. This principle is meant to ensure confidence that IARC evaluations are free from the pressures that interested parties often use to influence public agencies.
A second point concerns the temporal relationship between the formaldehyde Monograph and IARC’s amended guidelines (the Preamble). The formaldehyde Working Group met and developed its conclusions in June 2004. The Preamble amendment process2 began in March 2005 and IARC posted the draft Preamble on its website for public comment from August to October 2005. Huff and Infante find fault that I wrote, “During 2005 IARC is updating the Preamble . . .”3 This statement appears in the proceedings of a September 2005 conference where I encouraged participants to examine the draft Preamble while the comment period was still open.
Third, Huff and Infante demand that “ALL exposure-associated tumour sites should be identified for ALL human carcinogens.” This is, in fact, done in the critical review portion of each Monograph, which discusses all tumour sites that have been studied and identifies all sites where increased risks were observed. The full list of sites is not obvious, however, because only the major findings appear in the short summary and evaluation sections and only these shorter sections have been available online. To increase public access to this information, IARC has begun making the full text of all Monographs freely available on its website (http://monographs.iarc.fr/). In the most recent formaldehyde Monograph,4 for example, the critical review identifies statistically significant associations for cancers of the lung, nasal cavity, nasopharynx, and hypopharynx; for lymphohaematopoietic cancer including myeloid leukaemia; for uveal melanoma and cancers of the brain and central nervous system, pancreas, salivary gland, rectum, and female breast; and for all cancers combined. After considering the epidemiological evidence overall, the Working Group highlighted in the short summary the strongest of these associations: nasopharyngeal cancer, leukaemia, and sinonasal cancer. Indeed, IARC is the first public agency to highlight the strong evidence associating formaldehyde with leukaemia.
A related question is whether to take a different approach and not to identify tumour sites at all in the final evaluation. The crux of the matter is whether to regard a list of tumour sites restrictively, as a finite number of sites where carcinogenesis is possible, or expansively, as examples where strong evidence exists at the time. IARC takes the expansive view and recognizes the likelihood that an agent may also cause cancer at other sites and by other mechanisms. For example, tobacco, first identified as a cause of lung cancer in smokers, has since been established to cause cancer at more than a dozen other sites and also in nonsmokers exposed to tobacco smoke.
Finally, Huff and Infante suggest that IARC should be re-evaluating probable and possible carcinogens during 2009 rather than continue its plan5 to review known human carcinogens (IARC Group 1) in Monograph Volume 100. A key objective of IARC’s plan for this volume, developed in collaboration with an international Advisory Group,6 is to elucidate mechanisms known to cause cancer in humans. IARC expects that future Monographs will use this information to identify additional carcinogens that act through similar mechanisms. In addition, epidemiologists can use mechanistic information to identify pre-cancerous biomarkers that can be measured long before tumours can be observed. We are convinced that taking this year to bring together information about mechanisms known to cause cancer will promote earlier identification of carcinogens in the future, including new chemicals and complex exposures that have not or cannot be studied by epidemiology. This is better than waiting decades for studies to document avoidable cancers in humans and would be a great achievement for workers and public health.
VJ Cogliano
Head, IARC Monographs Programme
International Agency for Research on Cancer, Lyon, France
Competing interests: None declared
REFERENCES
1. Huff J, Infante P. Identifying cancer sites for human carcinogens in the IARC monographs. Occup Environ Med 2009;66:140.
2. Preamble amendment process. http://monographs.iarc.fr/ENG/Preamble/amendments.php (accessed January 2009).
3. Cogliano VJ. Use of carcinogenicity bioassays in the IARC Monographs. Ann N Y Acad Sci 2006:1076:592–600.
4. Formaldehyde. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 88, Formaldehyde, 2-Butoxyethanol and 1-tert-Butoxypropan-2-ol. Lyon France: International Agency for Research on Cancer, 2006;39–325. http://monographs.iarc.fr/ENG/Monographs/PDFs/index.php (accessed January 2009).
5. Future Meetings. http://monographs.iarc.fr/ENG/Meetings/index.php (accessed January 2009).
6. Report of the Advisory Group to Plan Volume 100: A Review of Human Carcinogens. Lyon France: International Agency for Research on Cancer, 2007, IARC Int Rpt 07/001. http://monographs.iarc.fr/ENG/Publications/internrep/07-001.pdf (accessed January 2009).
Editor’s Note: When we receive letters commenting on material published in OEM, it is our policy to allow the original authors an opportunity to see those letters in advance of publication and, if they wish, to respond to them in a letter published simultaneously. We failed to do this with the letter submitted by Drs. Huff and Infante. We apologize for this error. Dr. Cogliano’s response appears on this page.
We are writing to respond to Dr.Kalman in regard to our recent
article entitled Maternal Occupational Exposure and Risk of Spontaneous
Abortion in Veterinary Practice.
Dr. Kalman believes that he has picked up an anomaly in the
presentation of data on radiation. We would like to reassure readers of
the journal that there is no anomaly in the presentation of data and all
presented results including radiation...
We are writing to respond to Dr.Kalman in regard to our recent
article entitled Maternal Occupational Exposure and Risk of Spontaneous
Abortion in Veterinary Practice.
Dr. Kalman believes that he has picked up an anomaly in the
presentation of data on radiation. We would like to reassure readers of
the journal that there is no anomaly in the presentation of data and all
presented results including radiation are correct. The presented results
for radiation in Table 2 are the crude risks. The presented results in
abstract are derived from Table 3 which indicates adjusted relative risks.
In Table 1 the radiation exposure has been categorized into three levels
of exposures (No exposure, 1-5 films/w, >5 films/w). The crude
relative risk for radiation exposure from Table 1 indicated that taking 1
to 5 films did not have any adverse outcome which has been mentioned in
the results section, paragraph 4, column 2, page 2. Therefore, in Table 3
to estimate adjusted relative risks using logistic regression, we combined
the first two exposure categories (No exposure and 1-5 films/w) as the
reference group (less than 5 films/w) and (more than 5 films/w) as the
exposure variable. A similar grouping has been used in another study in
female veterinarians with similar results (Reference No.5). So we have
not eliminated the unexposed group from logistic regression analysis as
postulated by Dr. Kalman. Furthermore, in Table 1, if we combine the
first two exposure categories in one group (as the reference group), we
will also see an increased risk of spontaneous abortion in those who
exposed to radiation for more than 5 films per week compared with those
who performed 5 or less films including unexposed group (crudeRR:1.38,
95%CI:0.94, 2.04 ).
Dr. Kalman also raises the issue that there are no measurements
presented for the dose of radiation. Our study was a questionnaire-based
study, and unfortunately we were not funded to obtain actual measurements.
In the absence of measurements, we used the self-report of the number of X
-rays taken as a proxy for dose. In some ways, this may have been a
better measurement of the number of X-rays undertaken at the time of
pregnancy as it would be virtually impossible to obtain measurements for
what may have been a different job many years previously.
Ionising radiation at high doses is historically known to be
embryotoxic and teratogenic. Therefore, we suggest that it is always wise
to continue to inform female (and male) veterinarians of the potential
risks in this profession.
On the basis of a retrospective mortality study Mastrangelo and his
co-workers (Occup Environ Med 2008; 65: 697-700) concluded that “a high
and prolonged exposure to cotton dust and other endotoxin-containing
organic dusts was related to a lower risk of lung cancer”. The paper
looked at the cancer risk, especially on lung cancer, among cotton mill
workers by using the Standard Mortality Ratio (SMR). We believe that
meth...
On the basis of a retrospective mortality study Mastrangelo and his
co-workers (Occup Environ Med 2008; 65: 697-700) concluded that “a high
and prolonged exposure to cotton dust and other endotoxin-containing
organic dusts was related to a lower risk of lung cancer”. The paper
looked at the cancer risk, especially on lung cancer, among cotton mill
workers by using the Standard Mortality Ratio (SMR). We believe that
methodological limitation inherent in this study makes that conclusion
unpersuasive.
The proportion mortality study is utilized well to analyze the effect
of drug on the prognosis of some disease, for example, the preventive
effect of aspirin on CVD death by comparison between aspirin users and non
-users among patients. However, the mortality study is not suitable for
causal analyses of diseases because the proportion of dead cases due to
some disease, such as lung cancer in Mastrangelo’s study, has been thought
to be a deceiving measure of occurrence for the disease, when it is not an
acute fatal illness. Giving a cancer due to a causal exposure, the
proportion of survivals among all cancer cases in index cohort will depend
on cancer stage at diagnosis, the general health of patients, etc. and
could be bigger or smaller than that of dead cases, and so may be among
reference cohorts. This situation will be the key variant that determines
the deviation of results. However, it is difficult to speculate in which
direction the study results might have been biased because the magnitude
of proportion of survivors is virtually unknown.
Based on the results of Mastrangelo’s study, We think, the conclusion
should be “a high and prolonged exposure to cotton dust and other
endotoxin-containing organic dusts was associated with a lower risk of
lung cancer mortality, and due to uncontrolled confounding other risk
factors for lung cancer death could not be ruled out as a contributor to
the association.”
Dear Editor,
This informative article on the occupational wood dust exposure in Italy requests a monitoring method for received personal doses. Such a method exists exploiting samples obtained by nasal lavage (1). It is based on the the chemical analysis for wood polyphenols. Although they are species specific they are good quantitative indicators of hardwood dust particles coarse enough to be retained in the na...
Dear Editor,
As described in this investigation only a minority workers with an occupational asthma due to a diisocyanate exposure have specific IgE antibodies towards the monomers (1).
Therefore, it is likely the host factors play an important role (2). However, their significance may not be so firm so as to be used as predictors of a disease. The concept is, however, important in the workers´ compen...
Comments on Koppelaar et al, 'Determinants of implementation of primary preventive interventions on patient handling in healthcare: a systematic review'. OEM 2009;66:353-360
Koppelaar et al put forward an interesting view on implementation in their article. They state that the results of interventions will depend not only on the effectiveness of the intervention itself but also on appropriate implementation in...
June 8th 2009
We are writing to respond to Dr.Kalman in regard to our article entitled “Maternal Occupational Exposure and Risk of Spontaneous Abortion in Veterinary Practice”.
Regarding the risk relating to radiation, we presented data separately for those with 1-4 x-rays a week in Table 2. Readers are able to use these analyses rather than those in Table 3 if they prefer. The results for exposure...
Dear Sir
I am grateful for the speedy response from Dr Shirangi and her colleagues to my original letter. I regret the delay in my further response.
Importantly, the authors justify the combination of the ‘no exposure’ and ‘one to 5 films per week’ categories (ie the elimination of an exposure category) on the identification that the crude relative risk data did not indicate any adverse outcome for t...
Reply to Kolstad and Bondes regarding “objective” exposure measurements of psychosocial working conditions
We agree with Kolstad and Bonde that it is important to identify measures of “psychosocial” working conditions that are less dependent of the individual appraisal than pure self-report. This was the intention of our two studies published in OEM (1-2). The studies were based on an exposure protocol to asses...
Numerous studies have documented that perception of adverse psychosocial factors at work is related to major depression, but we still do not know if this reflects causal characteristics of the working environment, personal characteristics of the individual worker, trivial associations, common method variance or other types of reporting bias because most studies have relied on self-reported exposure information (1)....
We are writing to respond to Dr.Kalman in regard to our recent article entitled Maternal Occupational Exposure and Risk of Spontaneous Abortion in Veterinary Practice.
Dr. Kalman believes that he has picked up an anomaly in the presentation of data on radiation. We would like to reassure readers of the journal that there is no anomaly in the presentation of data and all presented results including radiation...
On the basis of a retrospective mortality study Mastrangelo and his co-workers (Occup Environ Med 2008; 65: 697-700) concluded that “a high and prolonged exposure to cotton dust and other endotoxin-containing organic dusts was related to a lower risk of lung cancer”. The paper looked at the cancer risk, especially on lung cancer, among cotton mill workers by using the Standard Mortality Ratio (SMR). We believe that meth...
Pages