Document kYM97EB14kj4KkGVdoaeoaQ0

Journal of Occupational Medicine Vo 1-51(3) mOfficial Publication ol the AMERICAN COLLEGE OF OCCUPATIONAL MEDICINE Editor LLOYD B. TEPPER, MD Air Products and Chemicals. Inc. Allentown. PA Associate Editor CHARLES F. REINHARDT. MD E.l. du Pont de Nemours & Co. Newark, DE Editorial Board GEORGE W. ANSTADT. MD Eastman Kodak Company Rochester, NY CHARLES E. BECKER. MD Northern California Occupational Health Center San Francisco. CA H. DEAN BELK, MD Aluminum Company of America Pittsburgh. PA C. RALPH BUNCHER ScD University of Cincinnati College of Medicine Cincinnati, OH DAVID H. GARABRANT, MD University of Michigan School of Public Health Ann Arbor, Ml ELIZABETH E. GRESCH. MD The Dow Chemical Company Midland. Ml NORTIN M. HADLER, MD University of North Carolina Coliege of Medicine Chapel H i. NC PAUL KOTIN. MD Denver, CO DAVID B. ROBBINS, MD Chappaqua, NY ORIGINAL ARTICLES Occupational Contact Dermatitis Due to Epoxy Resin in a Fiberglass Binder .................................................... 87 D. Linn Holness. MD. and James R. Nethercott. MD Changing Employees'Dietary and Exercise Practices: An Ex perimental Study in a Small Company .............................. 90 Sharon K. Ostwald. RN. PhD Cigarette Smoking and Federal Black Lung Benefits in Bit uminous Coal Miners.......................................................... Thomas M. Roy. MD; Lynell C. Collins. MD. Harvy L. Snider. MD; and William H. Anderson. MD 98 Lung Cancer Due to Chloromethyi Ethers: Bias in Cohort Def inition .................................................................................... 102 William Weiss. MD Mortality from Leukemia and Other Diseases among Workers at a Petroleum Refinery..................................... 106 Chansuda Wongsrichanalai. MD. DrPH. Elizabeth Deizell. ScD; and Philip Cole. MD Effect of Chronic Chromolyn Sodium Therapy in a Beauti cian with Occupational Asthma 112 Howard J. Schwartz. MD Reproductive Outcomes of Pregnant Workers Employed at 36 Reinforced Plastics Companies Et. Lowered Birth Weight 115 Grace K. Lemasters, PhD; Steven J. Samuels. PhD. John A. Morrison. PhD; and Stuart M. Brooks. MD Update of Mortality among Chemical Workers with Potential Exposure to the Higher Chlorinated Dioxins 121 Gregory G. Bond. PhD. MPH; Elsie A. McLaren, RN; Thomas E. Lipps. MD; and Ralph R. Cook. MD. MPH Strategies for Risk Evaluation of Sudden Cardiac Incapacita tion in Men in Occupations Affecting Public Safety 124 Robert A. Bruce. MD; and Lloyd D. Fisher. PhD Costs of Workers' Compensation Claims for Hearing Loss 134 Brian C. Alieyne. MSc; Ronald M. Duiresne. MD; Nasim Kanji, BA. and Michael R. Reesal. MD Lung Injury in Dimethyl Sulfate Poisoning 141 Mary Ip. MBBS. Kee-Lam Wong. MBBS; Kit-Fai Wong. MBBS. and Shun-Yang So. MBBS MICHAEL A. SILVERSTEIN, MD International Union United Auto W orkers D etroit. Ml SUE H. WESTER. MD General M ills. Inc. Minneapolis. MN DEPARTMENTS Selected Reviews from the Literature Editorial Prevention ol Occupational Deafness; A Coming Crisis? Association Affairs 1989 American Occupational Health Conference ............. 69 139 144 Managing Editor ELIZABETH L. POPPER. MA P .0 Box 370 Bryn Mawr. PA 19010 Letters to the Editor Spontaneous Abortions among Semiconductor Manufacturers Occupational Medicine Forum Cancer Screening ......................................................................... Risks of Xylene Substitute Use 200 202 202 V *0 * General People and Events Calendar ol Meetings Classified Advertising Advertisers' Index 203 205 208 207 JOURNAL OF OCCUPATIONAL MEDICINE (ISSN 0096-1736) is the O fficial Journal of the American College of Occupational Medicine and is published monmiy by Williams & W.lk.ns, 428 East Preston Street. Baltimore. MD 21202-3993. Second-class postage paid at Baltim ore. MD. and additional mailing omces. Subscription rates, $60.00 ($80.00 foreign, $101.00 Japan); institutions. $85 00 ($105.00 foreign. $126.00 Japan); in-training, $45 00 ($65 00 fore'gn, $86 00 Japan); single copy, $8.00 ($10.00 foreign). Subscriptions pnces subject to change. To order, call 1-800-638-6423 from anywhere in the -vT n TM fylan<3' 0311 1-600-636-4007. Japanese Yen price is available from our sole agent USACO Corporation. 13-12, Shimbashi 1-Chome. Mmato-Ku. okyo 1C5, Japan, telephone 03-502-6471. POSTMASTER: Send address changes to the Journal of Occupational Medicine. 428 East Preston Street. Baltimore, MD 21202-3993. Copyright 1989 by the American College of Occupational Medtone Letters to the Editor Readers are invited to subm it letters lor public cation in this department. Subm it them to: The Editor. Journal o f O ccupational M edicine. PO Box 370, Bryn Mavnr. PA 19010. Letters should b e typewritten and double spaced and should b e designated *For Publication. ' Spontaneous Abortions among Semiconductor Manufacturers To the Editor: In the recent paper by Dr. Harris Pastidea et al., "Spontaneous Abortion and General Illness Symptoms among Semiconductor Manufacturers" (J. Occup. Med. 1988;30:543-651) I see a possible bias in the analysis, because it compares the reproductive experience of exposed women while employed with the reproductive experience of unexposed women both before and during employ ment. The authors explain that this was done because of the small sample size of the post-hire numbers for the unexposed group, but I suspect they may have en larged their sample by including the wrong population. The authors begin by calculating a spontaneous abortion- (SA) ratio in a group of currently employed women, in cluding only those pregnancies th at oc curred while they were exposed. Because mothers of babies tend to remove them selves selectively from the work force the resulting ratio is biased, in the sense th at it is higher than what would be found in a sample of similar pregnancies in the general population. Recognizing this, the authors chose as a comparison group unexposed women from the same plant, on the reasonable assumption that their SA ratio would be subject to the same biases. However, when they included the prehire experience of the unexposed women, in effect they assumed that the selection factors acting after hire were also acting before hire. The only way that this could happen, as far as I can see, is if the unexposed women did not report all of their live births th at occurred before they were hired. I think this is unlikely. The only remaining possibilities are (a) that the selection factors, ie, the selective removal of live births from the sample, are negligible in this study, in which case there is no problem, or (b) that the selection factors are indeed present, in which case the combination of pre- and post-hire data for the unex posed will give a lower value than the data for the exposed, even in the absence of an exposure effect. Regardless of sample size, it seems to me that the question could be resolved if we knew the post-hire SA ratio for the unexposed women. If it is low compared with the exposed group, then adding in the pre-hire experience would Increase the power of the analysis without greatly changing the SA ratio for the unexposed, and we could conclude th at (a) was truo. On the other hand, If the post-hire SA 'ratio for the unexposed women is, say, about as high as for the exposed women, then (b) is true, and adding in the pre hire experience not only Increases the sample size, but changes the mean. Therefore the results may In fact be due to the use of the pre-employment expe rience of the unexposed women. William R. Gaffey, PhD Epidemiology Director Monsanto Company-A3NK 800 N. Lindbergh Blvd St Louis, MO 63167 Pre-eminent in recruitment of occupational and environmental health professionals Walter K. Wilkins (snui) SAMPSON, NEILL & WILKINS INC First in Executive Search For The Health indu stries ________ ______J543 Valley Rd.. Upper Montclair. N.J. 07043 (201) 783-9600 200 MEDICALV-/?';, * '.j* DIRECTOR Manage and direct allaspectsofthe Occupational Health Program for the Nottnrop B-2 Division in Pico Rivera,CA in a modem medial facility. Staffincludes two physicians, three RNs, one lab tech and X-ray tech nician, physicians assistant, physical therapist, exercise physiologist, and EAP counselor. Scope of workperformed includespreplacement, periodicand executive physicals; therapeutic servicesfor occupational and, to an extent, personalaccidents and illnesses; sigmoidoscopyand treadmill evaluation; preven tive medicine including immunizations;case manage ment for employees on medicalkave; and coordination of two satellite medical fadliries. Candidate shouldbe an M.D. with internist or Fam ily Practice training with occupational medicine expe rience preferred. Salary is highly competitive. For immediate consideration, pleasesend vita to: RT. Huntley, HJOO/IA, Munqger, EarntreStfl/fing, NORTHROP B-2 DIVISION, P.Q R a IBS, Pico Rwra, CA 90660-9977. US. CITIZENSHIP REQUIRED. Northrop isan Equal Opportunity Employer M/F/H/V. NORTHROP B-2 Division Letters to the Editor1 ' W A t's V' 1' ^KfThe Authors Reply Dr Gaffoy suggests th at a more ap propriate estimate of the spontaneous abortion ratio in the nonexposed women in our study would have been achieved L by fnffimUng only their post-hire repro ductive history. Unfortunately, this would not provide a stable estimate for this measure, because the number of post-hire pregnancies in this group was quite (n = 46). This, In turn, was a result of two realities: the production facility was only about 6 years old a t the time of the study, and women who held nonmanufacturing jobs a t the facility were an older group, on average, than women who worked in manufacturing. Including the pre-hire reproductive his tory of nonexposed women not only in creased the number of nonexposed preg- nancies but also resulted in a comparison group whose mean age a t pregnancy was quite close to th at of the controls (25.5 years for photolithography, 26.0 for "dif fusion," and 25.5 for nonexposed). The potential of a bias as a result of ^,,t ; mothers of babies removing themselves ^ if c o m the work force, as Dr. Gaffey sug- ^ .'gested, was not operating in this study L-because we Identified only eight workers r- who voluntarily left the facility during ) Its short history; we successfully inter- _viewed half of these ex-workers for our - study. A few former workers terminated by the company "for cause" were not surveyed because of the g reater poten tial for biased reporting among this group. We conclude, therefore, th at Dr. Gaffey's first postulated explanation is more likely true; selection factors oper ating in this study did not pose a prob lem. In any event, all adjustments made in order to examine the potential for a reporting bias on the part of the nonex posed group, including limiting the analysis to post-hire pregnancies, re sulted in estimated spontaneous abortion ratios that were lower than those for the photolithographic and diffusion workers. The relative risks estimated in these analyses were always in the direction of an increased risk for manufacturing workers. Harria Pastides, PhD Edward J. Calabrese, PhD David W. Hosmer, Jr, PhD Donald R. Harria, Jr, MS University of Massachusetts Amhorst, MA 01003 Please Stay Tuned for this Im portant M essage! Thousands o f television viewers throughout the country will soon be seeing thefollowing message. And you can help drive the message home--by making your patients aware of the needfor eye safety, and by recommending the protective eyewear thatfits their lifestyles. Everyday activities like these . . . . . . cause over h a lf a million eye injuries every year. Protective eyewear could prevent almost all o f ife m . A sk your eye care professional about protective eyewear as your second pair o f glasses. I t only makes sense. : M E R'G E H! C Especially w hen y ou consider the alternatives. Pleasejoin us in helping to prevent eye injury at home. Recommend protective eyewear as every patient's second pair ofglasses. National Society toPreventBlindness 500 E ast Rem ington R oad Schaum burg, Illinois 60173 Journal of Occupational Medicine/Volume 31 No. 2/February 1989 MAINEJNPEPENDENT MEDICAL EVALUATION SYMPOSIUM September 10-13,1989 Sebasco, Maine COURSE OBTECTIVES To instruct and improve evaluation of disability patients. FACULTY HIGHLIGHTS Edwin Wyman, M.D. Medical Director, WC Injuries Massachusetts General Hospital Mark Battista, M.D. Medical Director, UNLJM Ralph Tucker, Chairman Maine Industrial Accident Commission Roland Hazard, M.D., Director New England Back Center PROGRAM HIGHLIGHTS Industrial Accident Commission Cost of Industrial Accidents Evaluation of Permanent Impairment and Disability Panel: Case Presentation Defendan t / Plaintiff/Physician Panel: Depositions and Court Appearances Independent Medical Evaluation Viewpoint of: Attorney Physiatrist Chiropractor Psychologist Orthopedist Osteopathic Physician DEMONSTRATION WORKSHOPS Chiropractic Examination Orthopedic Examination Osteopathic Examination For Information Write/Cail: Lawrence Crane, M.D. Maine Independent Medical Evaluation 229 Presumpscot Street Portland, ME 04103 207-775-3800 Registation Fcc: S250.00 201