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Biomedical subjects

A D LaMontagne

Publications and source records attributed to A D LaMontagne.

17 recordsLinked to original sources
PubMed2006

Primary prevention of latex related sensitisation and occupational asthma: a systematic review.

METHODS: Eight primary prevention intervention studies on natural rubber latex (NRL) published since 1990 were identified and reviewed. This is the largest evidence base of primary prevention studies for any occupational asthmagen. RESULTS: Review of this small and largely observational evidence base supports the following evidence statement: Substitution of powdered latex gloves with low protein powder-free NRL gloves or latex-free gloves greatly reduces NRL aeroallergens, NRL sensitisation, and NRL-asthma in healthcare workers. Evidence in support of this statement is ranked SIGN level 2+, referring to well conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal. CONCLUSION: Substitution of powdered latex gloves with low protein powder-free NRL gloves or latex-free gloves promises benefits to both workers' health and cost and human resource savings for employers. This message should be broadly disseminated beyond the hospital sector to include other healthcare settings (such as aged care facilities) as well as food service and other industries where latex gloves might be used.

Air Pollutants, Occupational↗
PubMed2004

Assessing and intervening on OSH programmes: effectiveness evaluation of the Wellworks-2 intervention in 15 manufacturing worksites.

AIMS: (1) To develop a transparent and broadly applicable method for assessing occupational safety and health (OSH) programmes or management systems; (2) to assess OSH programmes in a sample of manufacturing worksites; and (3) to determine whether a management focused occupational health intervention results in greater improvement in OSH programmes compared to minimal intervention controls. METHODS: OSH programmes were assessed using an adaptation of the US Occupational Safety & Health Administration's 1995 Program Evaluation Profile. Scores were generated from 91 binary indicator variables grouped under four "Essential Elements". Essential Element scores were weighted to contribute to an overall programme score on a 100 point scale. Seventeen large manufacturing worksites were assessed at baseline; 15 sites completed the 16 month intervention and follow up assessments. RESULTS: There was considerable variation in Essential Element scores across sites at baseline as judged by our instrument, particularly in "management commitment and employee participation" and "workplace analysis". Most sites scored highly on "hazard prevention and control" and "training and education". For overall OSH programme scores, most sites scored in the 60-80% range at baseline, with four sites scoring below 60%, suggesting weak programmes. Intervention sites showed greater improvements than controls in the four programme elements and in overall programme scores, with significantly greater improvements in "management commitment and employee participation". CONCLUSIONS: The OSH programme assessment method used is broadly applicable to manufacturing work settings, and baseline profiles suggest needs for improvement in OSH programmes in most such worksites. Despite a small sample size, results showed that sustained management focused intervention can result in improvement in these OSH programme measures.

Community Participation↗
PubMed2001

Cleanup worker exposures to hazardous chemicals at a former nuclear weapons plant: piloting of an exposure surveillance system.

Cleanup of former U.S. Department of Energy (DOE) nuclear weapons production facilities involves potential exposures to various hazardous chemicals. We have collaboratively developed and piloted an exposure database and surveillance system for cleanup worker hazardous chemical exposure data with a cleanup contractor at the Rocky Flats Environmental Technology Site (RFETS). A unique system feature is the incorporation of a 34-category work task-coding scheme. This report presents an overview of the data captured by this system during development and piloting from March 1995 through August 1998. All air samples collected were entered into the system. Of the 859 breathing zone samples collected, 103 unique employees and 39 unique compounds were represented. Breathing zone exposure levels were usually low (86% of breathing zone samples were below analytical limits of detection). The use of respirators and other exposure controls was high (87 and 88%, respectively). Occasional high-level excursions did occur. Detailed quantitative summaries are provided for the six most monitored compounds: asbestos, beryllium, carbon tetrachloride, chromium, lead, and methylene chloride. Task and job title data were successfully collected for most samples, and showed specific cleanup activities by pipe fitters to be the most commonly represented in the database. Importantly, these results demonstrate the feasibility of the implementation of integrated exposure database and surveillance systems by practicing industrial hygienists employed in industry as well as the preventive potential and research uses of such systems. This exposure database and surveillance system--the central features of which are applicable in any industrial work setting--has enabled one of the first systematic quantitative characterizations of DOE cleanup worker exposures to hazardous chemicals.

Colorado↗
PubMed2001

Development of an exposure database and surveillance system for use by practicing OSH professionals.

This report summarizes the development of an occupational exposure database and surveillance system for use by health and safety professionals at Rocky Flats Environmental Technology Site (RFETS), a former nuclear weapons production facility. The site itself is currently in the cleanup stage with work expected to continue into 2006. The system was developed with the intent of helping health and safety personnel not only to manage and analyze exposure monitoring data, but also to identify exposure determinants during the highly variable cleanup work. Utilizing a series of focused meetings with health and safety personnel from two of the major contractors at RFETS, core data elements were established. These data elements were selected based on their utility for analysis and identification of exposure determinants. A task-based coding scheme was employed to better define the highly variable work. The coding scheme consisted of a two-tiered hierarchical list with a total of 34 possible combinations of work type and task. The data elements were incorporated into a Microsoft Access database with built-in data entry features to both promote consistency and limit entry choices to enable stratified analyses. In designing the system, emphasis was placed on the ability of end users to perform complex analyses and multiparameter queries to identify trends in their exposure data. A very flexible and user-friendly report generator was built into the system. This report generator allowed users to perform multiparameter queries using an intuitive system with very little training. In addition, a number of automated graphical analyses were built into the system, including exposure levels by any combination of building, date, employee, job classification, type of contaminant, work type or task, exposure levels over time, exposure levels relative to the permissible exposure limit (PELS), and distributions of exposure levels. Both of these interfaces, allow the user to "drill down" or gradually narrow query criteria to identify specific exposure determinants. A number of other industrial hygiene processes were automated by the use of this database. Exposure calculations were coded into the system to allow automatic calculation of time-weighted averages and sample volumes. In addition, a table containing all the PELs and other relevant occupational exposure limits was built into the system to allow automatic comparisons with the current standards. Finally, the process of generating reports for employee notification was automated. The implementation of this system demonstrates that an integrated database system can save time for a practicing hygienist as well as provide useful and more importantly, timely information to guide primary prevention efforts.

Colorado↗
PubMed2001

Integrating workplace exposure databases for occupational medicine services and epidemiologic studies at a former nuclear weapons facility.

We outline methods for integrating epidemiologic and industrial hygiene data systems for the purpose of exposure estimation, exposure surveillance, worker notification, and occupational medicine practice. We present examples of these methods from our work at the Rocky Flats Plant--a former nuclear weapons facility that fabricated plutonium triggers for nuclear weapons and is now being decontaminated and decommissioned. The weapons production processes exposed workers to plutonium, gamma photons, neutrons, beryllium, asbestos, and several hazardous chemical agents, including chlorinated hydrocarbons and heavy metals. We developed a job exposure matrix (JEM) for estimating exposures to 10 chemical agents in 20 buildings for 120 different job categories over a production history spanning 34 years. With the JEM, we estimated lifetime chemical exposures for about 12,000 of the 16,000 former production workers. We show how the JEM database is used to estimate cumulative exposures over different time periods for epidemiological studies and to provide notification and determine eligibility for a medical screening program developed for former workers. We designed an industrial hygiene data system for maintaining exposure data for current cleanup workers. We describe how this system can be used for exposure surveillance and linked with the JEM and databases on radiation doses to develop lifetime exposure histories and to determine appropriate medical monitoring tests for current cleanup workers. We also present time-line-based graphical methods for reviewing and correcting exposure estimates and reporting them to individual workers.

Colorado↗
PubMed2001

The intervention research process in occupational safety and health: an overview from the National Occupational Research Agenda Intervention Effectiveness Research team.

The goal of occupational safety and health intervention effectiveness research is to determine whether specific interventions work to prevent work-related injury and illness. But that is not the whole story. It is also important that the development and implementation of the intervention be evaluated. All three phases (development, implementation, and effectiveness) are central to a model of intervention research proposed by the National Occupational Research Agenda Intervention Effectiveness Research team. Areas for future research are also presented.

Data Collection↗
PubMed2001

Evaluating OSHA's ethylene oxide standard: exposure determinants in Massachusetts hospitals.

OBJECTIVES: This study sought to identify determinants of workplace exposures to ethylene oxide to assess the effect of the Occupational Safety and Health Administration's (OSHA's) 1984 ethylene oxide standard. METHODS: An in-depth survey of all hospitals in Massachusetts that used ethylene oxide from 1990 through 1992 (96% participation, N = 90) was conducted. Three types of exposure events were modeled with logistic regression: exceeding the 8-hour action level, exceeding the 15-minute excursion limit, and worker exposures during unmeasured accidental releases. Covariates were drawn from data representing an ecologic framework including direct and indirect potential exposure determinants. RESULTS: After adjustment for frequencies of ethylene oxide use and exposure monitoring, a significant inverse relation was observed between exceeding the action level and the use of combined sterilizer-aerators, an engineering control technology developed after the passage of the OSHA standard. Conversely, the use of positive-pressure sterilizers that employ ethylene oxide gas mixtures was strongly related to both exceeding the excursion limit and the occurrence of accidental releases. CONCLUSIONS: These findings provide evidence of a positive effect of OSHA's ethylene oxide standard and specific targets for future prevention and control efforts.

Data Collection↗
PubMed1998

OSHA's renewed mandate for regulatory flexibility review: in support of the 1984 ethylene oxide standard.

BACKGROUND: The Regulatory Flexibility Act of 1980 requires that all federal agencies consider the impact of regulations on small entities. One of the provisions of the Act requires review of regulations ever 10 years to determine whether such regulations should be continued without changes, rescinded, or amended to make them more effective or less burdensome on businesses. The Small Business Regulatory Enforcement Fairness Act (SBREFA) of 1996 amended and expanded the Regulatory Flexibility Act. Most significantly, SBREFA entitles aggrieved small entities or their representative (e.g., trade associations) to sue OSHA for failure to fulfill Regulatory Flexibility Act requirements. In response to this new political reality, OSHA held the first public meeting of their kind in June of 1997 to gather information on the ethylene oxide and lock-out/tag-out standards for the purposes of Regulatory Flexibility review. METHOD: This paper presents the development of the Regulatory Flexibility review process and details our analysis of the ethylene oxide standard using OSHA's eight Regulatory Flexibility review criteria. RESULTS: Great progress in ethylene oxide health and safety has been made since the promulgation of the standard in 1984, including a considerable decrease in average workshift exposures. Yet, important concerns remain, such as the lack of safer substitutes for EtO's most common uses, the widespread occurrence of accidental exposures to EtO that are not captured by personal monitoring, and the recent increase in the occurrence of catastrophic EtO explosions. CONCLUSIONS: Because of the considerable study that has been devoted to EtO and to the EtO standard, there is a very strong cases for either making the EtO standard more worker protective, or continuing the standard without change while improving outreach and enforcement efforts to address shortcomings. Other valuable standards for which fewer data exist may be inappropriately threatened by the Regulatory Flexibility review process. Importantly, Regulatory Flexibility review could be constructive if accompanied by appropriations to fund sound evaluation studies. Instead, it will likely divert OSHA's limited resources from the numerous urgent health hazard that await initial rule-making. As signified by the designation of "intervention effectiveness research" as one of the 21 priorities on the National Occupational Research Agenda, evaluation studies of OSHA standards and other interventions are urgently needed. The occupational health community's response to this need will play a crucial role in preserving hard-won protections, as well as in developing other urgently needed protections in the future.

Environmental Monitoring↗
PubMed1997

Evaluating OSHA's ethylene oxide standard: employer exposure-monitoring activities in Massachusetts hospitals from 1985 through 1993.

OBJECTIVES: This study characterized exposure-monitoring activities and findings under the Occupational Safety and Health Administration's (OSHA's) 1984 ethylene oxide (EtO) standard. METHODS: In-depth mail and telephone surveys were followed by on-site interviews at all EtO-using hospitals in Massachusetts (n = 92, 96% participation rate). RESULTS: By 1993, most hospitals had performed personal exposure monitoring for OSHA's 8-hour action level (95%) and the excursion limit (87%), although most did not meet the 1985 implementation deadline. In 1993, 66% of hospitals reported the installation of EtO alarms to fulfill the standard's "alert" requirement. Alarm installation also lagged behind the 1985 deadline and peaked following a series of EtO citations by OSHA. From 1990 through 1992, 23% of hospitals reported having exceeded the action level once or more; 24% reported having exceeded the excursion limit; and 33% reported that workers were accidentally exposed to EtO in the absence of personal monitoring. CONCLUSIONS: Almost a decade after passage of the EtO standard, exposure-monitoring requirements were widely, but not completely, implemented. Work-shift exposures had markedly decreased since the mid-1980s, but overexposures continued to occur widely. OSHA enforcement appears to have stimulated implementation.

Central Supply, Hospital↗
PubMed1996

Overcoming practical challenges in intervention research in occupational health and safety.

In addition to more familiar research issues, intervention research projects in naturalistic settings present the investigator with a number of practical challenges including gaining access to potentially resistant populations, maximizing participation rates in the face of weak incentives for cooperation, getting valid answers to sensitive questions, and meeting ethical obligations when health or legal problems are discovered in the course of study. Generalizable approaches to these challenges are addressed in the context of a retrospective evaluation of the implementation of OSHA's 1984 ethylene oxide standard in Massachusetts hospitals. In the evaluation study, enthusiastic cooperation was secured, a 96% participation rate was realized, sensitive questions were posed successfully, and worker health risks discovered in the course of study received attention without having to wait for the write-up of the study results. Key elements in the study population's receptivity appear to have been (I) the investigator's familiarity with the hazard, its setting, respondent concerns and needs, and (2) reciprocity in the form of providing follow-up consulting services as an integral part of the research process, delivered to each hospital at the conclusion of data collection. Specific techniques used in the study are presented in the hopes of aiding other investigators facing similar practical challenges in occupational health and safety intervention research.

Air Pollutants, Occupational↗
PubMed1996

Medical surveillance for ethylene oxide exposure: practices and clinical findings in Massachusetts hospitals.

The medical surveillance requirements of the Occupational Safety and Health Administration's (OSHA) ethylene oxide (EtO) standard became effective in 1985. However, little is known about the nature of the response of EtO users to this regulatory requirement. In an effort to begin to understand this, we conducted a survey of EtO health and safety in Massachusetts hospitals (n = 92). We determined the cumulative incidence of provision of EtO medical surveillance, the characteristics of the surveillance interventions provided, and the clinical findings of EtO medical surveillance efforts in Massachusetts hospitals. From 1985 to 1993, medical surveillance for EtO exposure was provided one or more times in 62% of EtO-using hospitals. Sixty-five percent of EtO medical surveillance providers reported performance of all five medical surveillance procedures required by OSHA's EtO standard. Medical surveillance provider certification in occupational medicine or nursing, and a greater extent of coverage of written medical surveillance policies, were related to higher likelihoods of fulfillment of OSHA-required procedures. Twenty-seven percent of medical surveillance providers reported detection of EtO-related symptoms or conditions, ranging from mucous membrane irritation to peripheral neuropathy. These findings reveal wide-spread implementation of OSHA-mandated EtO medical surveillance, with concomitant incomplete fulfillment of OSHA-specified procedures. From the provider-based survey, we estimate that one or more workers at 19% of EtO-using Massachusetts hospitals have experienced EtO-related health effects.

Adult↗
PubMed1996

Determinants of the provision of ethylene oxide medical surveillance in Massachusetts hospitals.

An in-depth survey of ethylene oxide (EtO) health and safety was conducted in Massachusetts hospitals (n = 92) to investigate the determinants of the provision of medical surveillance for EtO exposure. We have evaluated the relationships between provision of EtO medical surveillance and (1) activating OSHA-specified triggers for providing EtO medical surveillance, (2) worker training on EtO health and safety, and (3) various public policy, organizational, group, and individual characteristics. Among the Occupational Safety and Health Administration's (OSHA) five specified triggers for provision of EtO medical surveillance, only accidental worker exposures were related to provision of surveillance (RR = 2.56, P < 0.001). Exceeding the Action Level for 30 or more days, one of OSHA's EtO triggers that is also used in a number of other standards, was not related to provision of surveillance (RR = 0.84, P = 0.714). Reports of coverage of EtO medical surveillance issues in worker training were also correlated with the provision of EtO medical surveillance (RR = 3.68, P < 0.001), supporting OSHA's premise that worker training plays an important role in medical surveillance implementation. The presence of detailed written EtO medical surveillance policies was positively related to the provision of EtO medical surveillance (RR = 1.81, P < 0.001). The relationships between these potential determinants and provision of medical surveillance were also validated in multivariate analyses. Implications for improvement of OSHA medical surveillance implementation through revised trigger schemes, improved worker training efforts, and other measures are discussed. Findings are relevant to the future development of medical surveillance and exposure monitoring policies and practices in both substance-specific and generic contexts.

Adult↗
PubMed1993

Utility of the complete blood count in routine medical surveillance for ethylene oxide exposure.

The 1984 OSHA Standard for ethylene oxide (EtO) mandates medical surveillance under various circumstances. When performed, medical surveillance for EtO must include a complete blood count (CBC) with differential leukocyte count. This requirement is based on reports of EtO-associated absolute lymphocytosis and other hematologic effects. This paper describes our experiences in providing EtO medical surveillance for a 300 bed hospital over a 6 year period. We observed an apparent relative lymphocytosis which persisted over 3-4 years in sterilization workers with documented TWA personal EtO exposures averaging 0.07 ppm. In addition, three workers had a history of acutely toxic overexposure to EtO as a result of a sterilizer malfunction. These workers became symptomatic following the high accidental overexposure, but did not show absolute lymphocytosis or altered patterns in the relative lymphocytosis. Finally, a cross-sectional comparison of the CBC data from the EtO-exposed workers to data from non-EtO-exposed hospital workers showed no significant differences, ruling out an association of the relative lymphocytosis with EtO exposure. These observations led us to review the basis for the inclusion of the CBC in routine EtO medical surveillance. Our experience, review of the literature on EtO-associated lymphocytosis and anemia, and review of the literature on the use of the CBC with differential as a screening test suggest that the leukocyte differential may not be useful in routine medical surveillance for EtO exposure.

Blood Cell Count↗
PubMed1992

A participatory workplace health and safety training program for ethylene oxide.

The Occupational Safety and Health Administration (OSHA) has regulated ethylene oxide (EtO) on the basis of its acute toxicity and its potential carcinogenic and reproductive effects since 1971. OSHA's 1984 EtO standard and its 1988 revisions focused new attention on health and safety training and other preventive measures. An EtO health and safety training program for hospital sterilization workers was developed by the staff of an independent occupational and environmental health clinic. Participatory and empowerment training methods were central to the approach. Also included were hands-on, demonstration, interactive presentation, and other methods. An EtO Health and Safety Training Manual was developed based on the training experiences. This paper presents the challenges, benefits, and limitations of incorporating participatory and empowerment approaches in the design, implementation, and evaluation of EtO health and safety training.

Central Supply, Hospital↗
PubMed1989

Differentiation of cultured epithelial cells: response to toxic agents.

Cell culture systems are instrumental in elucidating regulation of normal function and mechanisms of its perturbation by toxic substances. To this end, three applications of epithelial cells cultured with 3T3 feeder layer support are described. First, treatment of the premalignant human epidermal keratinocyte line SCC-12F2 with the tumor promoter 12-O-tetradecanoylphorbol-13-acetate suppressed cell growth and differentiation. This agent produced a biphasic growth response greatly inhibiting cell growth at 1 to 10 nM, but much less above 100 nM. Expression of the differentiated functions involucrin and transglutaminase was found to be inhibited markedly at concentrations above 10 nM. Second, 3-methylcholanthrene toxicity was surveyed in a variety of rat epithelial cell types. The two most sensitive to growth inhibition were epidermal and mammary epithelial cells, while those from bladder, prostate, thyroid, and endometrium were insensitive to growth inhibition. Great differences were evident even among those cells derived from stratified squamous epithelia (epidermal, esophageal, vaginal, forestomach) despite their expression of aryl hydrocarbon hydroxylase activities to similar degrees. Finally, expression of estrogen receptors in rat endometrial cells was shown to be stimulated by the cAMP-elevating agent forskolin. Maximal stimulation of 3- to 6-fold occurred in 6 hr, compatible with a requirement for protein synthesis. Although expressing keratinocyte character (transglutaminase activity and envelope forming ability), the cells thus retain some hormonal character that may be modulated by cAMP-dependent kinase activity. Pursuit of such results will aid in understanding differences in response among cell types and species, in elucidating mechanisms of action of known toxic substances and, ultimately, in predicting toxicity of less well understood agents.

Animals↗