Mercury air, urine monitoring and health effects on occupationally exposed dental healthcare workers in Delhi, India

BACKGROUND

Mercury (Hg) is a toxic heavy metal with multiple uses in various medical devices. Hg is used in dentistry as a restorative material. Such use creates significant exposure to dental practitioners. Hence, it is important to assess the risk created by Hg use in healthcare.

OBJECTIVE

To quantify airborne Hg vapour exposure and Hg levels in dental healthcare workers, and determine the association of various symptoms and diseases to Hg exposure.

METHODS

Air monitoring of Hg vapours were conducted in dental clinics and amalgam rooms. Urine samples were collected from occupationally exposed dental healthcare workers and urine Hg levels were measured. A cross-sectional health survey was conducted in 23 healthcare units of Delhi to determine an association between Hg exposure and various health effects.

RESULTS

Hg vapour concentration ranged from 0.96μg/m3 to 15μg/m3, the highest concentration was recorded in the amalgam room (15μg/m3). Urine Hg levels in healthcare workers (0.51±0.17μg/L) were higher than the control (0.29±0.05μg/L). A cross-sectional health survey revealed a significant prevalence of confusion, forgetfulness, muscle spasm, and tremors by the respondents.

CONCLUSION

Hg concentration in dental clinics may hover above the prescribed safe levels posing a definitive health risk to healthcare workers. Urinary Hg measurements did not reveal an excess of body burden except in one case. Since Hg bio accumulates, it is probable as these workers grow older, they may end up with a higher body burden of Hg that may lead to a variety of adverse health outcomes.

Four mesothelioma cases from a single automotive dealership: A case series

BACKGROUND

Four cases of mesothelioma were noted in a workplace of some 110 persons at a tractor dealership between 2006 and 2023. Each worker had a different job title.

METHODS

Medical-legal case material was reviewed and abstracted from four cases from the same dealership, all supplied via one law firm.

RESULTS

Four mesotheliomas are reported from this single facility that used chrysotile asbestos automotive products. Two of the four cases had no other known exposures to asbestos.

DISCUSSION

Automotive products containing chrysotile do appear capable of causing mesothelioma. Job category is not a good surrogate for exposure.

Epidemiology of Asbestosis between 2010-2014 and 2015-2019 Periods in Colombia: Descriptive Study

Background

Asbestosis is a prevalent worldwide problem, but scarce data sourced from developing countries are available. We describe the sociodemographic characteristics and patterns in the occurrence of care provided for asbestosis in Colombia during the periods 2010-2014 and 2015-2019 to establish the behavior, trends, and variables associated with concentrations among people attended by asbestosis.

Methods

A retrospective descriptive study was carried out with data from the Integrated Social Protection Information System (SISPRO) for two 5-year periods. People attended by asbestosis (ICD-10: J61) were identified; the frequency of patient visits, sociodemographic characteristics, case distribution patterns, and trends in both five-year periods were described, as was the crude frequency (cFr, 95% CI) of asbestosis (1,000,000 people/year) in both five-year periods (cFr ratio, 95% CI).

Results

During the period 2010-2019, 765 people attended by asbestosis were identified; there were 308 people attended by asbestosis between 2010-2014 (cFr: 2.20, 1.96-2.47), and ther were 457 people attended by asbestos between 2015-2019 (cFr: 3.14, 2.92-3.50). In both periods, the estimated cFr in men was nine times the estimated cFr in women. The cFr increased in the 2015-2019 period (cFr_ratio: 1.23, 1.06-1.43). Compared with the 2010-2014 period, the cFr of asbestosis increased in women (cFr_ratio: 1.44, 1.03-2.01), in the Andean (cFr_ratio: 1.61, 1.35-1.95) and Caribbean regions (cFr_ratio: 1. 66, 1.21-2.30), in the urban area (cFr_ratio: 1.24, 1.05-1.48), and in the age groups 45-59 years (cFr_ratio: 1.34, 1.001-1.79) and ≥60 years (cFr_ratio: 1.43, 1.13-1.83).

Discussion

During two five-year periods, the cFr of asbestosis was higher in men; between the first and second five-year periods, it increased significantly, especially in urbanized geographic areas and in populations aged ≥45 years. The estimates possibly reflect the effect of disease latency or the expected impact of public health policies to monitor asbestos exposure and complications.

Mongolia: Failure of Total Banning of Asbestos

The primary uses of asbestos in Mongolia are in thermal power plants, construction and at railway companies. There is, however, limited data on both asbestos consumption and asbestos related disease (ARD) in Mongolia. The purpose of this paper is to report on the failure to completely ban asbestos in Mongolia. To write this paper, available asbestos related literature, published nationally and internationally, and legal regulations, national standards and guidelines on asbestos control were reviewed. Mongolia consumed a total of 44,421.9 metric tons of asbestos containing materials (AMCs) between 1996 and 2014. As a key indicator of ARD, 54 cases of mesothelioma were diagnosed at the National Cancer Center by pathological testing of tissue samples between 1994 and 2013. In 2010, The government made the decision to stop all types of asbestos use under the Law on Toxic and Hazardous Substances. However, there was no nationwide action plan to gradually reduce asbestos use, promote substitutes and raise awareness of health hazards and economic burdens in the future from asbestos use. There was also no planning for safe removal of asbestos currently in place. After the banning of asbestos, thermal power plants told the government that they could not produce electricity without insulation of AMCs and substitution materials were economically not feasible. Due to pressure from the energy sector and inadequate awareness of asbestos hazards, the government changed the legal status on asbestos in 2011 as a restricted chemical. Asbestos is still allowed to be used, and workers and the general community are still unnecessarily exposed to this carcinogen.

Analysis of the Indian Government's position on the use of asbestos and its health effects

Based on WHO guidance, all forms of asbestos are a health risk. In India, the mining of asbestos has been stopped, but chrysotile (a type of asbestos) is still imported and processed in large quantities. Chrysotile is mainly used for asbestos-cement roofing, and the manufacturers claim its use to be safe. We sought to understand the Indian Government's position on the use of asbestos. To do so, we have analysed the replies of the executive wing of the Indian Government to questions on asbestos in the Indian Parliament. This revealed that, despite a mining ban, the government has defended the import, processing and continued use of asbestos.

Does the Presence of Asbestos-Containing Materials in Buildings Post-construction and Before Demolition Have an Impact on the Exposure to Occupants in Non-occupational Settings?

This narrative review aims to determine if asbestos-containing materials in buildings pose a hazard to building occupants in non-occupational settings. This paper is limited to the post-construction and pre-demolition stages of a building. The researchers selected 19 studies from the 126 studies screened, concerning exposure to asbestos fibers in non-occupational building settings, with a focus on post-construction and pre-demolition phases. The literature review found that certain conditions, such as the measurement techniques, standards, and previous data availability, prevent a conclusive answer to the research question. Some studies have pointed towards an effect of asbestos-containing materials on health of occupants in non-occupational settings. But, there are some that do not suggest a positive relationship between non-occupational exposure and the presence of asbestos-containing materials, and therefore these provide scope for further research, as these studies also do not rule out the relationship completely. The present study highlights the gaps in current knowledge and indicates areas for further research. Until conclusive evidence based on revised threshold standards and accurate measurement techniques is available, asbestos-containing materials may be considered unsafe for use in non-occupational settings, especially ones that young people and children occupy.

Exposure to cosmetic talc and mesothelioma

AIM

Mesothelioma is associated with asbestos exposure. In this case series, we present 166 cases of individuals who had substantial asbestos exposure to cosmetic talc products as well as some who had potential or documented additional exposures to other asbestos-containing products and who subsequently developed mesothelioma.

METHODS

Data were gathered for all subjects referred to an occupational and environmental medicine specialist as part of medicolegal review. Years of total cosmetic talcum powder usage was noted as well as the latency from the onset of talcum powder use to the mesothelioma diagnosis. Alternate asbestos exposure in addition to the exposure from cosmetic talc was categorized as none, possible, likely, and definite.

RESULTS

In 122 cases, the only known exposure to asbestos was from cosmetic talc. For 44 cases, potential or documented alternate exposures in addition to the cosmetic talc were described.

CONCLUSION

Cumulative exposure to asbestos leads to mesothelioma; for individuals with mixed exposures to asbestos, all exposures should be considered. Use of cosmetic talc is often overlooked as a source of asbestos exposure. All individuals with mesothelioma should have a comprehensive history of asbestos exposure, including cosmetic talc exposure.

Human Health Risk Assessment due to Heavy Metals in Ground and Surface Water and Association of Diseases With Drinking Water Sources: A Study From Maharashtra, India

BACKGROUND

Contamination of freshwater sources can be caused by both anthropogenic and natural processes. According to Central Pollution Control Board, Maharashtra along with 2 other states, contribute 80% of hazardous waste generated in India, including heavy metal pollution. Hence, it is important to quantify heavy metal concentrations in drinking water sources in such areas.

MATERIALS AND METHODS

Water samples were analyzed for toxic elements (F, As, Cd, Hg, Pb, Ni, Cu, Zn, Mn, and Cr) using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) Agilent 7500. Health risks due to ingestion and dermal contact was assessed. A total of 557 people were randomly selected, with consumers from all 4 types of water sources that is surface water, hand pump, wells, and municipal water. Spot urine samples were collected from 47 people after considering inclusion and exclusion criteria. Urine was collected for estimating mercury and arsenic levels in the study participants.

RESULTS

Arsenic contributes the most health risk from ingestion from water. Among surface water users, 14 people (32%) reported frequent loose stool (P-value < .05) (OR 2.5), and 11 people (23%) reported frequent abdominal pain (OR 1.9). Hand pump and well water users reported frequent abdominal pain (27%) (OR 1.4) and gastric discomfort (31%) (P-value < .05) (OR 3) respectively. The mean value of urinary Hg and As were 4.91 ± 0.280 and 42.04 ± 2.635 µg/L respectively.

CONCLUSION

Frequent loose stool, gastric discomfort, and frequent abdominal pain were associated with the various sources of drinking water. Urine Hg levels were found higher than the NHANES (USA) Survey. It is recommended that frequent monitoring of drinking water should be enforced around the industrial hub, so that appropriate actions can be taken if present in excess.

Case-fatality study of workers and residents with radiographic asbestos disease in Libby, Montana

Background

Vermiculite ore from Libby, Montana contains on average 24% of a mixture of toxic and carcinogenic amphibole asbestiform fibers. These comprise primarily winchite (84%), with smaller quantities of richterite (11%) and tremolite (6%), which are together referred to as Libby amphibole (LA).

Methods

 A total of 1883 individuals who were occupationally and/or environmentally exposed to LA and were diagnosed with asbestos‐related pleuropulmonary disease (ARPPD) following participation in communitywide screening programs supported by the Agency for Toxic Substances and Disease Registry (ATSDR) and followed up at the Center for Asbestos Related Disease (CARD) between 2000 and 2010. There were 203 deaths of patients with sufficient records and radiographs. Best clinical and radiologic evidence was used to determine the cause of death, which was compared with death certificates.

Results

Asbestos‐related mortality was 55% (n = 112) in this series of 203 patients. Of the 203 deaths, 34 (17%) were from asbestos‐related malignancy, 75 (37%) were from parenchymal asbestosis, often with pleural fibrosis, and 3 (1.5%) were from respiratory failure secondary to pleural thickening.

Conclusions

Asbestos is the leading cause of mortality following both occupational and nonoccupational exposure to LA in those with asbestos‐related disease.

Malignant mesothelioma: Ongoing controversies about its etiology in females

Malignant mesothelioma (MM) is one of the most aggressive cancers with the poorest of outcomes. There is no doubt that mesothelioma in males is related to asbestos exposure, but some authors suggest that most of the cases diagnosed in females are "idiopathic." In our assessment of the science, the "low risk" of mesothelioma in females is because of the nonsystematic recording of exposure histories among females. Indeed, asbestos exposure is mentioned in only some of the studies that include females. We estimate the risk of MM among females to be close to that in males. The absence of detailed exposure histories should be rectified in future studies involving ​women. As a matter of social justice, the ongoing failure to recognize asbestos as the cause of a majority of cases of MM in females does them, and their kin, a profound disservice.

Ongoing downplaying of the carcinogenicity of chrysotile asbestos by vested interests

Industries that mine, manufacture and sell asbestos or asbestos-containing products have a long tradition of promoting the use of asbestos, while placing the burden of economic and health costs on workers and society. This has been successfully done in recent years and decades in spite of the overwhelming evidence that all asbestos types are carcinogenic and cause asbestosis. In doing so, the asbestos industry has undermined the WHO campaign to reach a worldwide ban of asbestos and to eliminate asbestos-related diseases. Even worse, in recent years they succeeded in continuing asbestos mining and consuming in the range of about 1.3 million tons annually. Nowadays, production takes place predominantly in Russia, Kazakhstan and China. Chrysotile is the only asbestos type still sold and represents 95% of asbestos traded over the last century.The asbestos industry, especially its PR agency, the International Chrysotile Association, ICA, financed by asbestos mining companies in Russia, Kazakhstan and Zimbabwe and asbestos industrialists in India and Mexico, continues to be extremely active by using slogans such as chrysotile can be used safely.Another approach of the asbestos industry and of some of its insurance agencies is to broadly defeat liability claims of asbestos victims.In doing so they systematically use inappropriate science produced by their own and/or by industry-affiliated researchers. Some of the latter were also engaged in producing defense material for other industries including the tobacco industry. Frequent examples of distributing such disinformation include questioning or denying established scientific knowledge about adverse health effects of asbestos. False evidence continues to be published in scientific journals and books.The persisting strong influence of vested asbestos-related interests in workers and public health issues including regulations and compensation necessitate ongoing alertness, corrections and appropriate reactions in scientific as well as public media and policy advisory bodies.

Global use of asbestos - legitimate and illegitimate issues

BACKGROUND

Exposure to asbestos causes non-malignant and malignant diseases including asbestosis, lung cancer, and mesothelioma. The modern history of such diseases goes back more than a century.

MAIN TEXT

While much is known about the ability of asbestos to cause disease, the carcinogenic mechanism is not yet understood. Continuing legitimate scientific questions include such issues as potential differential toxicity and carcinogenicity of different fiber types. Illegitimate issues include the supposed "safe" use of asbestos, and the chrysotile hypothesis.

CONCLUSION

Asbestos disease issues are highly politicized and vested economic interests perpetuate false issues regarding the hazards of asbestos.

Asbestos-related cancers: the 'Hidden Killer' remains a global threat

Introduction: Asbestos, the most frequent cause of occupational cancer, continues to be consumed on a massive scale, with millions of people exposed on a daily basis. This review explains why we have failed in curtailing the silent epidemic of asbestos-related disease and why the numbers of asbestos victims are likely to remain high. Emerging and developed countries have to be reminded that asbestos exposure has yet to become a problem of the past. The worldwide spread of asbestos, followed by the surge of asbestos-related cancers, resembles the lung cancer epidemic caused by smoking and stimulated by manufacturers.Areas covered: Underreporting of malignant mesothelioma and asbestos-induced lung cancer, frequently-used arguments in the amphibole/chrysotile debate and the conclusion from bona-fide research organizations, that all forms of asbestos are carcinogenic, are reviewed. Special attention is paid to the consequences of ubiquitous environmental asbestos and the 'changing face' of malignant mesothelioma in countries with heavy asbestos use in the past.Expert opinion: Experts in oncology, respiratory medicine, occupational and public health, and basic researchers must take responsibility and acknowledge the ongoing silent epidemic of asbestos-related diseases. The call for a world-wide asbestos ban is more urgent than ever.

A Legacy of Disease

In Appalachia, like much of America, there are important health issues that have not always been appropriately predicted or dealt with when they occur. Lifestyle issues in Appalachia lead to obesity and heart disease, not surprisingly due to extensive use of sugary drinks. The current opioid crisis could have been better predicted given the trauma of mining and the past abuse of less-potent narcotics. A continuing major problem in the whole country is inadequate support for preventive health activities.

Asbestos in commercial indian talc

Background

Easily available commercial Indian talc products widely used in Southeast Asia were examined for the presence of asbestos. Asbestos in talc products carry all risks of asbestos‐related disease.

Methods

Using polarizing light microscopy, transmission electron microscopy (TEM), electron diffraction, and X‐ray analysis, multiple over‐the‐counter Indian talc products were examined for the presence of asbestos.

Results

Results In an initial group of five Indian talc products, one was found to contain tremolite asbestos. The second group of eight products was tested and six of eight contained tremolite asbestos as well. No other regulated amphibole was found.

Conclusion

Large quantities of body talc products containing asbestos are used throughout Southeast Asia and are likely to pose a public health risk for asbestos‐related diseases, especially for the cancers related to asbestos exposure. The country of origin in which the talc examined was sourced for production is unknown to the authors, and further investigation to measure associated public health risk is needed.

Occupational lung diseases: from old and novel exposures to effective preventive strategies

Occupational exposure is an important, global cause of respiratory disease. Unlike many other non-communicable lung diseases, the proximal causes of many occupational lung diseases are well understood and they should be amenable to control with use of established and effective approaches. Therefore, the risks arising from exposure to silica and asbestos are well known, as are the means of their prevention. Although the incidence of occupational lung disease has decreased in many countries, in parts of the world undergoing rapid economic transition and population growth-often with large informal and unregulated workforces-occupational exposures continue to impose a heavy burden of disease. The incidence of interstitial and malignant lung diseases remains unacceptably high because control measures are not implemented or exposures arise in novel ways. With the advent of innovative technologies, new threats are continually introduced to the workplace (eg, indium compounds and vicinal diketones). In developed countries, work-related asthma is the commonest occupational lung disease of short latency. Although generic control measures to reduce the risk of developing or exacerbating asthma are well recognised, there is still uncertainty, for example, with regards to the management of workers who develop asthma but remain in the same job. In this Review, we provide recommendations for research, surveillance, and other action for reducing the burden of occupational lung diseases.

Health effects of manganese exposures for welders in Qingdao City, China

OBJECTIVES

To document if manganese from welding causes health effects including neurological symptoms associated with manganese exposure.

MATERIAL AND METHODS

An anonymous questionnaire survey for a total of 505 welders at 3 welding facilities in Qingdao City, China was administered and analyzed.

RESULTS

Numerous symptoms were reported by the welders including difficulty with eyes for 43% of them, sore throat for 30% of them, and tremors were reported by over 18% of them. Tremors were associated with longer periods of work as a welder and correlated with the relative cleanliness at the 3 different facilities. Tremors did not correlate with smoking.

CONCLUSIONS

Manganese-exposed welders reported a variety of symptoms related to work and showed neurological disturbances that correlated with amount of exposure. Int J Occup Med Environ Health 2017;30(2):241-247.

Working environment and myeloproliferative neoplasm: A population-based case-control study following a cluster investigation

BACKGROUND

Occupational exposures, including those to polycyclic aromatic hydrocarbons (PAH), are suspected risk factors for myeloproliferative neoplasms (MPN).

METHODS

We investigated occupational exposures and MPN risk (54 cases and 472 controls) in a population-based case-control study in three rural Pennsylvania counties. Occupational histories, coded to SIC/SOC 1980, were linked to a previously created PAH job-exposure matrix. Odds ratios for industry (17 categories), occupation (26 categories), and PAH exposure were adjusted using logistic regression.

RESULTS

No industries or occupations were strongly or consistently associated with increased MPN risk. Analysis of employment duration found that being employed for 5 or more years in transportation, communications, and other public utilities was associated with MPN risk. There was no indication of an association with cumulative PAH exposure.

CONCLUSIONS

These few associations did not appear to have a common exposure. This exploratory study does not support the hypothesis that occupational exposure, including PAH, are strong risk factors for MPNs.

Exposure to airborne asbestos in thermal power plants in Mongolia

BACKGROUND

Coal-fired thermal power plants (TPPs) in Mongolia use various types of asbestos-containing materials (ACMs) in thermal insulation of piping systems, furnaces, and other products.

OBJECTIVE

To investigate the occupational exposure of insulation workers to airborne asbestos in Mongolian power plants.

METHODS

Forty-seven air samples were collected from four power plants in Mongolia during the progress of insulation work. The samples were analyzed by phase contrast microscopy (PCM) and transmission electron microscopy (TEM).

RESULTS

The average phase contrast microscopy equivalent (PCME) asbestos fiber concentration was 0·93 f/cm(3). Sixteen of the 41 personal and one of the area samples exceeded the United States Occupational Safety and Health Administration (US OSHA) short-term exposure limit of 1·0 f/cm(3). If it is assumed that the short-term samples collected are representative of full-shift exposure, then the exposures are approximately 10 times higher than the US OSHA 8-hour permissible exposure limit of 0·1 f/cm(3).

CONCLUSION

Power plant insulation workers are exposed to airborne asbestos at concentrations that exceed the US OSHA Permissible Exposure Limit. Action to mitigate the risks should be taken in Mongolia.

The role of genotypes that modify the toxicity of chemical mutagens in the risk for myeloproliferative neoplasms

BACKGROUND

The etiology of myeloproliferative neoplasms (MPN) (polycythemia vera; essential thrombocythemia; primary myelofibrosis) is unknown, however they are associated with a somatic mutation--JAK2 V617F--suggesting a potential role for environmental mutagens.

METHODS

We conducted a population-based case-control study in three rural Pennsylvania counties of persons born 1921-1968 and residing in the area between 2000-2008. Twenty seven MPN cases and 292 controls were recruited through random digit dialing. Subjects were genotyped and odds ratios estimated for a select set of polymorphisms in environmentally sensitive genes that might implicate specific environmental mutagens if found to be associated with a disease.

RESULTS

The presence of NAT2 slow acetylator genotype, and CYP1A2, GSTA1, and GSTM3 variants were associated with an average 3-5 fold increased risk.

CONCLUSIONS

Exposures, such as to aromatic compounds, whose toxicity is modified by genotypes associated with outcome in our analysis may play a role in the environmental etiology of MPNs.

Mesothelioma in Mongolia: case report

BACKGROUND

More than 80% of cases of mesothelioma worldwide have a history of asbestos exposure. In Mongolia, workers in coal burning thermal power plants (TPP) have widely utilized asbestos as an insulation material.

METHODS

We describe the case of a 47-year-old woman diagnosed with a malignant pleural mesothelioma. She worked in a TPP in Ulaanbaatar, Mongolia for 28 years.

RESULTS

A computer tomography (CT) scan showed a circumferential ring around her left lung, and tissues' samples had a biphasic variant of mesothelioma with epithelioid and sarcomatoid components.

DISCUSSION

This is the first reported case of mesothelioma in Mongolia. We expect additional cases of mesothelioma, as well as other asbestos related diseases, will be identified in the future. In order to properly track asbestos related diseases in the country, we recommend the creation of an asbestos related disease registry.

Epidemiology and treatment of community-associated methicillin-resistantStaphylococcus aureusin children

Similar to the epidemiology of methicillin-sensitive Staphylococcus aureus, community-associated methicillin-resistant S. aureus infections occur in children in different regions of the USA and throughout the world. Although minor skin and soft-tissue infections predominate, life-threatening invasive disease and death can result. The novel genetic elements, staphylococcal cassette chromosome mec IV and V, explain the narrow antibiotic resistance pattern, and suggest the mechanism of spread among staphylococci. Panton-Valentine leukocidin apparently plays a role in its pathogenesis. Clindamycin therapy is often effective for treatment, but inducible resistance can develop if the isolate exhibits macrolide resistance due to the erm mechanism. Other drugs displaying in vitro activity against community-associated methicillin-resistant S. aureus include trimethoprim-sulfamethoxazole, tetracyclines, quinolones, linezolid and vancomycin. While experience in pediatric patients is limited, daptomycin, ketolides, glycylcyclines, newer glycopeptides and beta-lactamase-stable cephalosporins may be useful in the future. Further research could include well-designed studies of mechanisms of virulence, continued surveillance of changes in pathogenicity and susceptibility, as well as treatment effectiveness.

Health care access and health care workforce for immigrant workers in the agriculture, forestry, and fisheries sector in the southeastern US

BACKGROUND

The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in the US is comprised primarily of Latino immigrants. Health care access for these workers is limited and increases health disparities.

METHODS

This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers.

CONTENTS

Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers. C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US.

Hypothyroidism among former workers of a nuclear weapons facility

BACKGROUND

Ionizing radiation alters thyroid function, and workers at a nuclear weapons facility may be exposed to above environmental levels of radiation.

METHODS

Hypothyroid status was determined for 622 former workers of a nuclear weapons facility located in Texas, using a combination of measured thyroid stimulating hormone (TSH) levels and thyroid medication history, as part of an on-going health surveillance program. We classified 916 unique job titles into 35 job categories.

RESULTS

According to the most stringent TSH definition used in this study (0.3-3.0 IU/ml), 174 (28.0%) former workers were considered to be hypothyroid; of these 66 (41.8%) were females and 108 (23.3%) were males. In logistic regression analysis adjusted for age, gender, and smoking status, only having worked as a material handler (n = 18) exhibited an elevated risk of developing hypothyroidism compared to other jobs (OR 3.88, 95% CI 1.43-11.07). This is one of the jobs with suspected exposure to radiation. No excess risk of hypothyroidism was observed for any of the other job categories.

CONCLUSIONS

There is suggestive evidence that only material handlers at this nuclear weapons facility may have elevated risk of hypothyroidism; further evaluation of thyroid health in this population is warranted.