Arrangement of municipal occupational health services for small workplaces. Conclusions of a survey of 163 small workplaces.
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Biomedical subjects
Publications and source records attributed to M Tolonen.
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An 8-year follow-up of workers exposed for at least 5 years to carbon disulfide showed an excess of deaths due to coronary heart disease in reference to a comparison cohort. However, after effective preventive measures, e.g., leaving only 19% of the original group exposed and reducing the level of exposure to less than 10 ppm, had been undertaken after the 5th year of follow-up, coronary mortality decreased and no excess mortality during the last 3 years of follow-up occurred. These results, although only suggestive -- due to the small number of deaths and the short time of follow-up after the intervention -- seem promising from the point of view of improving the prognosis of workers who have already accumulated an excess risk for coronary death.
Oculosphygmography (OSG), combined with electrocardiography, was performed on 38 male workers exposed occupationally to carbon disulfide (CS2) and 40 unexposed male paper mill workers. A statistical analysis of the results showed that the ocular pulse wave of the exposed group showed a significantly lower pattern than that of the unexposed group. A comparison between workers currently exposed to CS2 and those no longer exposed indicated that the hemodynamic alterations caused by CS2 exposure lead to a permanent condition. It is concluded that CS2 exposure increases the rigidity of the vascular bed of the eye. The data indicate that primarily chronic, subclinical CS2 poisoning causes capillary damage. Oculosphygmography seems to be one objective examination useful in diagnosing the subtle syndrome of chronic CS2 poisoning.
In 1967 two cohorts of 343 men each were formed and matched with respect to age, district of birth, and similarity of work. One cohort comprised viscose rayon workers with at least five years' exposure to carbon disulphide during any period between 1942 and 1967, and the other cohort consisted of workers from a paper-mill with no such exposure. The concentrations of carbon disulphide and hydrogen sulphide in the workroom air had been measured regularly since 1950, and about 4000 measurements were available. In all probability the concentrations had been very high in the 1940s, between 20 and 40 ppm in the 1950s, and about 10 to 30 ppm from 1960 onwards. On examination in 1967 it was confirmed that all of the relevant coronary risk factors had been kept under control. The only exception to this was blood pressure which was slightly higher among the exposed workers, a finding that was interpreted as a result of exposure rather than an independent risk factor. A five-year follow-up showed that 14 men had died from coronary heart disease (CHD) in the exposed group, against three in the control group (P smaller than 0:007). Other causes of death were evenly distributed. In addition, 11 nonfatal first infarctions had occurred in the exposed group as compared with four in the control group. On re-examination in 1972, nearly 25% of the exposed men, against 13% of the controls, had a history of angina (typical, probable, and possible) as measured by the World Health Organization questionnaire (P smaller than 0:0002). The prevalence proportions of typical angina were 12% and 5% respectively (P smaller than 0:001). As opposed to this, only slight differences were apparent for coronary ECGs. The higher degrees of prevalance in the exposed group may well have been attributable to chance. As in 1967/68, the mean systolic and diastolic blood pressures were slightly higher in the exposed group (P smaller than 0:001 and P smaller than 0:01, respectively). The relative risk was 4-8 for fatal attacks, 3-7 for all infarctions, 2-8 for nonfatal infarctions, 2-2 for angina, and 1-4 for ECG findings indicative of CHD. This implies that with increasing severity and specificity of the manifestations the causal role of CS2 in developing CHD becomes more evident. Further, it is inferred that exposure to CS2 seems to worsen the prognosis of CHD in addition to increasing its incidence. Although the exposure data in this study may not be representative of the personal exposure of the workers, the conclusion is drawn that a great deal of justification exists for lowering the threshold limit value of 20 ppm recommended by the American Conference of Governmental Industrial Hygienists.
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An "anti-oxidant cocktail" consisting of betacarotene, vitamins B6, C, E, zinc, and selenium or corresponding placebos were given for one y as daily dietary supplements to 45 elderly residents of a nursing home. Initially, the serum TBA reactant levels were higher (2.7 +/- 0.7 mumol/L) than those of an ad hoc control group of healthy younger adults (2.3 +/- 0.6 mumol/L), p less than 0.01. After three mo supplementation, the levels among the verum elderly had decreased to 2.2 +/- 0.6 mumol/L, and they remained at this lower level until the end of the study period, whereas the placebo group showed no change. A significant inverse correlation (r = -0.428, p less than 0.01) existed between the concentrations of serum TBA reactants and whole blood selenium (B-Se), but only B-Se levels above 200 micrograms/L were associated with a decrease in serum lipid peroxides. Serum alpha-tocopherol concentration also correlated inversely with serum TBA reactants but this correlation (r = -0.273, p less than 0.76) was not as strong as that of B-Se. Deficient vitamin B6 status, in biochemical terms, was observed in 25% of the elderly; a daily supplement of 2 mg B6 fully cured all cases of deficiency. The verum group improved slightly in several psychological tests, whereas subjects on placebo remained unchanged or deteriorated during the follow-up period. Clinical amelioration among the verum subjects was reported by the nurses; no toxic side effects were reported. In conclusion, the elderly benefited biochemically and clinically of dietary antioxidant supplements.
The effect of long-term occupational exposure to CS2 on various endocrinologic parameters was studied in 15 exposed men and 16 age-matched controls. Duration of exposure varied between 10 and 36 yr. The CS2 concentrations in the viscose rayon plant have been below the Finnish threshold limit value of 30 mg/m3 (10 ppm) under normal operating conditions for the past 10 yr. Before this the exposure was considerably greater. Of the various endocrinologic parameters, serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) were significantly increased in the exposed group, seven workers having values above the reference limit. This was taken as a sign of primary gonadal insufficiency, which was considered only latent as serum testosterone values were unaffected. No changes were seen in serum prolactin values before or after stimulation with thyrotropin releasing hormone (TRH). No disturbance was seen in thyroid function as evaluated by serum thyroxine (T4), free thyroxine index (FT1), triiodothyronine (T3), and the thyrotropin response to TRH. Serum cortisol was also unchanged. These results may reflect high exposure during past decades rather than exposure to the present low CS2 concentrations.
Serum levels of gonadotropins and testosterone were determined for 69 men exposed to CS2 in viscose rayon production and for 22 nonexposed male controls. Mean ages of the two groups were 40 and 39 yr, respectively. The duration of exposure to CS2 ranged from 1 to 36 yr (mean, 12.5). Follicle stimulating hormone (FSH) levels were significantly higher among the exposed men than among the controls (13.6 versus 10.0 IU/l). The level of sex hormone binding globulin (SHBG) was significantly lower among the exposed men than among the controls (44 versus 53 nmol/l). Luteinizing hormone (LH) values were significantly higher among the 24-31 yr old exposed men than the controls of the same age. Levels of SHBG, of the free testosterone index, and of FSH and LH in men under 39 yr who had been exposed to CS2 for 1-9 yr differed significantly from those of their controls, whereas only FSH differed significantly among those exposed for 10 or more years in the same age group. In men aged 40 yr or more, after at least 10 yr of exposure, only FSH and LH were significantly higher than in the controls. Although the observed alterations do not seem to have any overt clinical implications for the study groups, they indicate that overall levels of CS2 that are well below the current Finnish threshold limit value (30 mg/m3) may affect the hormonal balance in the pituitary-gonadal axis, favoring the view that there may be an increased risk of latent primary gonadal insufficiency.