We have been examining the issue of healthcare workers' exposure to antineoplastic drugs for nearly a decade and have observed that there appears to be more publications on the subject matter originating from Europe than from North America. The concern is that findings from Europe may not be generalizable to North America because of differences in handling practices, regulatory requirements, and training. Our objective was to perform a literature review to confirm our observation and, in turn, identify gaps in knowledge that warrants addressing in North America. Using select keywords, we searched for publications in PubMed and Web of Science. All papers were initially classified according to the originating continent and then categorized into one or more subject categories (analytical methods, biological monitoring, occupational exposure, surface contamination, and probability of risk/exposure). Our review identified 16 papers originating from North America and 55 papers from Europe with surface contamination being the subject matter most often studied overall. Based on our results, we are of the opinion that North American researchers need to further conduct dermal and/or urinary drug contamination studies as well as assess the exposure risk faced by healthcare workers who handle antineoplastic drugs. Trends in exposure levels should also be explored.
Antineoplastic Agents* ; Delivery of Health Care* ; Drug Contamination ; Environmental Monitoring ; Europe* ; North America* ; Occupational Exposure

The objectives are to compare the airborne asbestos concentrations resulted from mitering of abestos cement roof sheets by a high-speed motor and a hand saw, and to monitor whether other workers near the test sites are vulnerable to the fibers exceeding the occupational exposure limit. Four test cases were carried out and altogether 7 personal and 4 area air samples were collected. The NIOSH method 7400 was employed for the air samplings and analysis. Using the phase contrast microscopy, fiber counting was conducted under Rule A. The study showed that the fiber concentration medians for personal air samples gathered from the two tools were 4.11 fibers/cc (ranged: 1.33-12.41 fibers/cc) and 0.13 fibers/cc (ranged: 0.01-5.00 fibers/cc) respectively. The median for the area samples was 0.59 fibers/cc (ranged: 0.14-3.32 fibers/cc). Comparing each study case, the concentration level caused by the high-speed motor saw was more than twice that of the hand saw. According to the area samples, the workers nearby the test site are at risk from high exposure to asbestos.
Asbestos ; Hand ; Humans ; Microscopy, Phase-Contrast ; National Institute for Occupational Safety and Health (U.S.) ; Occupational Exposure ; Organothiophosphorus Compounds

OBJECTIVES: This study was conducted in order to obtain information concerning the health hazards that may result from a 13 week inhalation exposure of n-pentane in Sprague-Dawley rats. METHODS: This study was conducted in accordance with the Organization for Economic Co-operation and Development (OECD) guidelines for the testing of chemicals No. 413 'Subchronic inhalation toxicity: 90-day study (as revised in 2009)'. The rats were divided into 4 groups (10 male and 10 female rats in each group), and were exposed to 0, 340, 1,530, and 6,885 ppm n-pentane in each exposure chamber for 6 hour/day, 5 days/week, for 13 weeks. All of the rats were sacrificed at the end of the treatment period. During the test period, clinical signs, mortality, body weights, food consumption, ophthalmoscopy, locomotion activity, urinalysis, hematology, serum biochemistry, gross findings, organ weights, and histopathology were assessed. RESULTS: During the period of testing, there were no treatment related effects on the clinical findings, body weight, food consumption, ophthalmoscopy, urinalysis, hematology, serum biochemistry, gross findings, relative organ weight, and histopathological findings. CONCLUSION: The no-observable-adverse-effect level (NOAEL) of n-pentane is evaluated as being more than 6,885 ppm (20.3 mg/L) in both male and female rats. n-pentane was not a classified specific target organ toxicity in the globally harmonized classification system (GHS).
Animals ; Biochemistry ; Body Weight ; Female ; Hazardous Substances ; Hematology ; Humans ; Inhalation ; Inhalation Exposure ; Locomotion ; Male ; Ophthalmoscopy ; Organ Size ; Pentanes ; Rats ; Rats, Sprague-Dawley ; Urinalysis

OBJECTIVES: The objectives of this study were to determine the lead levels in blood samples from nielloware workers, to determine airborne lead levels, to describe the workers' hygiene behaviors, and to ascertain and describe any correlations between lead levels in blood samples and lead levels in airborne samples. METHODS: Blood samples and airborne samples from 45 nielloware workers were collected from nielloware workplaces in Nakhon Sri Thammarat Province, Thailand. Lead levels were determined by flame atomic absorption spectrometry (FAAS), at a wavelength of 283.3 nm. FAAS was used especially adequate for metals at relatively high concentration levels. RESULTS: The geometric mean of the 45 airborne lead levels was 81.14 microg/m3 (range 9.0-677.2 microg/m3). The geometric mean blood lead level of the 45 workers was 16.25 microg/dL (range 4.59-39.33 microg/dL). No worker had a blood lead level > 60 microg/dL. A statistically significantly positive correlation was found between airborne lead level and blood lead levels (r = 0.747, p < 0.01). It was observed that personal hygiene was poor; workers smoked and did not wash their hands before drinking or eating. It was concluded that these behaviors had a significant correlation with blood lead levels (p < 0.001). CONCLUSION: Improvements in working conditions and occupational health education are required due to the correlation found between blood leads and airborne lead levels.
Absorption ; Asian Continental Ancestry Group ; Drinking ; Eating ; Hand ; Humans ; Hygiene ; Metals ; Occupational Health ; Smoke ; Spectrum Analysis ; Thailand

OBJECTIVES: Knowledge, attitudes, and practices of healthcare providers related to occupational exposure to bloodborne pathogens were assessed in a tertiary-care hospital in Middle East. METHODS: A cross-sectional study was undertaken using a self-administered questionnaire based on 3 paired (infectivity known vs. not known-suspected) case studies. Only 17 out of 230 respondents had an exposure in the 12 months prior to the survey and of these, only 2 had complied fully with the hospital's exposure reporting policy. RESULTS: In the paired case studies, the theoretical responses of participating health professionals showed a greater preference for initiating self-directed treatment with antivirals or immunisation rather than complying with the hospital protocol, when the patient was known to be infected. The differences in practice when exposed to a patient with suspected blood pathogens compared to patient known to be infected was statistically significant (p < 0.001) in all 3 paired cases. Failure to test an infected patient's blood meant that an adequate risk assessment and appropriate secondary prevention could not be performed, and reflected the unwillingness to report the occupational exposure. CONCLUSION: Therefore, the study demonstrated that healthcare providers opted to treat themselves when exposed to patient with infectious disease, rather than comply with the hospital reporting and assessment protocol.
Antiviral Agents ; Blood-Borne Pathogens ; Body Fluids ; Communicable Diseases ; Cross-Sectional Studies ; Delivery of Health Care ; Health Occupations ; Health Personnel ; Humans ; Occupational Exposure ; Surveys and Questionnaires ; Risk Assessment ; Secondary Prevention ; United Arab Emirates

OBJECTIVES: Although evidence-based medicine (EBM) is a useful method for integrating evidence into the decision-making process of occupational physicians, occupational physicians lack EBM knowledge and skills, and do not have the time to learn the EBM method. In order to enable them to educate themselves at the time and place they prefer, we designed an electronic EBM course. We studied the feasibility and utility of the course as well as its effectiveness in increasing EBM knowledge, skills, and behaviour. METHODS: Occupational physicians from various countries were included in a within-subjects study. Measurements were conducted on participants' EBM knowledge, skills, behaviour, and determinants of behaviour at baseline, directly after finishing the course and 2 months later (n = 36). The feasibility and utility of the course were evaluated directly after the course (n = 42). RESULTS: The course is applicable as an introductory course on EBM for occupational physicians in various countries. The course is effective in enhancing EBM knowledge and self-efficacy in practising EBM. No significant effect was found on EBM skills, behaviour, and determinants of behaviour. After the course, more occupational physicians use the international journals to solve a case. CONCLUSION: An electronic introductory EBM course is suitable for occupational physicians. Although it is an effective method for increasing EBM knowledge, it does not seem effective in improving skills and behaviour. We recommend integrating e-learning courses with blended learning, where it can be used side by side with other educational methods that are effective in changing behaviour.
Education, Distance ; Education, Medical ; Electronics ; Electrons ; Evidence-Based Medicine ; Hypogonadism ; Learning ; Mitochondrial Diseases ; Occupational Health ; Ophthalmoplegia

OBJECTIVES: Slip and fall accidents in the workplace are one of the top causes of work related fatalities and injuries. Previous studies have indicated that fall risk was related to postural and dynamic stability. However, the usage of this theoretical relationship was limited by laboratory based measuring instruments. The current study proposed a new method for stability assessment by use of inertial measurement units (IMUs). METHODS: Accelerations at different body parts were recorded by the IMUs. Postural and local dynamic stability was assessed from these measures and compared with that computed from the traditional method. RESULTS: The results demonstrated: 1) significant differences between fall prone and healthy groups in IMU assessed dynamic stability; and 2) better power of discrimination with multi stability index assessed by IMUs. CONCLUSION: The findings can be utilized in the design of a portable screening or monitoring tool for fall risk assessment in various industrial settings.
Acceleration ; Discrimination (Psychology) ; Human Body ; Mass Screening ; Risk Assessment

OBJECTIVES: Small enterprises have higher exposure to occupational hazards compared to larger enterprises and further, they have fewer resources to control the risks. In order to improve the working environment, development of efficient measures is therefore a major challenge for regulators and other stakeholders. The aim of this paper is to develop a systematic model for the design of tailored intervention programmes meeting the needs of small enterprises. METHODS: An important challenge for the design process is the transfer of knowledge from one context to another. The concept of realist analysis can provide insight into mechanisms by which intervention knowledge can be transferred from one context to another. We use this theoretical approach to develop a design model. RESULTS: The model consist of five steps: 1) Defining occupational health and safety challenges of the target group, 2) selecting methods to improve the working environment, 3) developing theories about mechanisms which motivate the target group, 4) analysing the specific context of the target group for small enterprise programmes including owner-management role, social relations, and the perception of the working environment, and 5) designing the intervention based on the preceding steps. We demonstrate how the design model can be applied in practice by the development of an intervention programme for small enterprises in the construction industry. CONCLUSION: The model provides a useful tool for a systematic design process. The model makes it transparent for both researchers and practitioners as to how existing knowledge can be used in the design of new intervention programmes.
Construction Industry ; Occupational Health

This review summarizes the epidemiology of cancer of the female reproductive system and associated lifestyle factors. It also assesses the available evidence for occupational factors associated with these cancers. Cervical, endometrial, and ovarian cancers are relatively common, and cause significant cancer morbidity and mortality worldwide, whereas vulvar, vaginal, fallopian tube cancers, and choriocarcinomas are very rare. As several lifestyle factors are known to play a major role in the etiology of these cancers, very few published studies have investigated possible relationships with occupational factors. Some occupational exposures have been associated with increased risks of these cancers, but apart from the available evidence on the relationships between asbestos fibers and ovarian cancer, and tetrachloroethylene and cervical cancer, the data is rather scarce. Given the multifactorial nature of cancers of the female reproductive system, it is of the utmost importance to conduct occupational studies that will gather detailed data on potential individual confounding factors, in particular reproductive history and other factors that influence the body's hormonal environment, together with information on socio-economic status and lifestyle factors, including physical activity from multiple sources. Studies on the mechanisms of carcinogenesis in the female reproductive organs are also needed in order to elucidate the possible role of chemical exposures in the development of these cancers.
Asbestos ; Choriocarcinoma ; Endometrial Neoplasms ; Fallopian Tube Neoplasms ; Female ; Humans ; Life Style ; Motor Activity ; Occupational Exposure ; Ovarian Neoplasms ; Pregnancy ; Reproductive History ; Tetrachloroethylene ; Uterine Cervical Neoplasms ; Vaginal Neoplasms

Reflecting the current international trends toward proactive risk assessment and control at work with practical procedures, participatory action-oriented approaches are gaining importance in various sectors. The roles of these approaches in promoting the safety and health at work are discussed based on their recent experiences in preventing work-related risks and improving the quality of work life, particularly in small-scale workplaces. The emphasis placed on the primary prevention at the initiative of workers and managers is commonly notable. Participatory steps, built on local good practices, can lead to many workplace improvements when the focus is on locally feasible low-cost options in multiple aspects. The design and use of locally adjusted action toolkits play a key role in facilitating these improvements in each local situation. The effectiveness of participatory approaches relying on these toolkits is demonstrated by their spread to many sectors and by various intervention studies. In the local context, networks of trainers are essential in sustaining the improvement activities. With the adequate support of networks of trainers trained in the use of these toolkits, participatory approaches will continue to be the key factor for proactive risk management in various work settings.
Clinical Trial ; Primary Prevention ; Risk Assessment ; Risk Management