Srmena Krstev

In a previous analysis of a cohort of shipyard workers, we found excess mortality from all causes, lung cancer, and mesothelioma for longer work durations and in specific occupations. Here, we expand the previous analyses by evaluating mortality associated with five chemical exposures: asbestos, solvents, lead, oils/greases, and wood dust. Data were gathered retrospectively for 4,702 workers employed at the Coast Guard Shipyard, Baltimore, MD (1950-1964). The cohort was traced through 2001 for vital status. Associations between mortality and these five exposures were calculated via standardized mortality ratios (SMRs). We found all five substances to be independently associated with mortality from mesothelioma, cancer of the respiratory system, and lung cancer. Findings from efforts to evaluate solvents, lead, oils/greases, and wood dust in isolation of asbestos suggested that the excesses from these other exposures may be due to residual confounding from asbestos exposure.

Widespread use of antineoplastic drugs has led to higher health risks of personnel who prepare and administer these drugs. The short-term, non-specific health effects in nurses handling antineoplastic drugs (AND) have been documented. To establish work practices and preventive measures for nurses handling antineoplastic drugs and to determine the risk of developing symptoms. In eight Belgrade hospitals, 263 nurses were selected (response rate 90.1%) for the study. Among these, 186 were involved in preparation and administration of AND, and 77 were not exposed. Data on exposure, work practice, safety precautions, and symptoms were obtained via a questionnaire. The mean age of exposed nurses was lower than in a control group (35 vs. 39 yrs). Only 38% of all nurses used vertical laminar safety cabinets while mixing AND, 82% used gloves, and 57% masks. Special medical rooms for mixing AND, written instructions and special containers for waste material were available only sporadically. No exposure monitoring had ever been performed in any hospital or department. Periodic medical check-ups were rare (24.7% of all nurses). In exposed nurses ORs adjusted for age, smoking habit and shift work were significantly elevated for almost all symptoms, mostly for the following: hair loss (OR = 7.14), skin rash (OR = 4.70), and light-headedness (OR = 4.33), as well as the disappearance of symptoms during the weekend (OR = 4.78). The mean number of symptoms revealed an exposure-effect relationship, with the highest number of symptoms in daily exposed nurses and lowest in non-exposed nurses (6.3 vs. 3.1) (p < 0.001). Our results indicate without doubt that exposed nurses reported more symptoms than non-exposed nurses, an effect that was not dependent on age, smoking, or night shift. The use of safety precautions was inadequate and reflected the lack of awareness of potential hazards due to occupational exposure to AND.

The investigation included 134 workers from a viscose rayon factory who were exposed to average concentrations of carbon disulphide exceeding MAC values (x = 119.3 mg/m3) for more than 75% of their working hours. Workers' chronic morbidity from carbon disulphide exposure was analysed over a three-year period, and results were compared with those for a control group of the same age but with a shorter exposure duration. The percentage of ill workers and the prevalence rate were both similar to those of the control group. However, as concerns the specific morbidity caused by carbon disulphide exposure, toxic polyneuropathy was present only among the exposed workers. In that group hypertension too reached a higher prevalence rate, statistically significant, although both groups consisted of younger workers of similar age. The prevalence of other diseases was comparable, possibly because of the selection bias, and the healthy worker effect. Owing to that effect workers with the most distinct symptoms had been removed from their jobs and, consequently, excluded from examinations. That could have been a reason for underestimating exposure effects.

Carbon disulfide (CS2) exposure was assessed in several ways in a viscose fiber plant. Environmental exposure was measured by static area sampling and by personal monitoring using diffusive passive ORSA-5 Draeger badges. At the same time, as biological indicators of exposure the iodine-azide test (IAT) and 2-thiothiazolidine-4-carboxylic acid (TTCA) in urine samples obtained at the end of work shift were performed. The aim was to estimate the relationship between parameters of environmental exposure and biological indicators of internal exposure as well as to determine the influence of the exposure duration on urinary TTCA values. Environmental exposure determined by personal samplers as time-weighted average (TWA) concentrations was twice as high than when measured by static area sampling: 62.2 vs. 31.1 mg/m3 in the spinning rooms, and 18.3 vs 12.2 mg/m3 in the viscose manufacturing departments. The iodine-azide test showed high linear correlation with CS2, but only for very high CS2 values. In highly exposed spinners, higher urinary TTCA levels were found related to longer exposure to CS2, but without statistical significance. For TTCA levels in urine a high correlation coefficient existed, but in this case even for low CS2 levels. Using a linear regression equation, a biological limit value for TTCA which corresponds to the Yugoslav MAC of 30 mg/m3 for CS2 was calculated (9.89 mg/g creatinine) for the study population, which is higher than in other investigations.(ABSTRACT TRUNCATED AT 250 WORDS)

Background Women in Serbia have one of the highest smoking prevalence in Europe – 29.9% (2006), and smoking is still socially accepted. Objectives The goals of this National survey are to estimate smoking prevalence, cessation and maternal exposure to ETS during each trimester of pregnancy, and at 3 and 6 months post-partum. Infant outcomes are also examined, as well as percentage of women who were advised to stop smoking by a health professional. Methods A representative sample of approximately 2,700 women was drawn from all women giving birth in Serbia from April 1 to June 30, 2008 in 66 health care centers derived from 158 by probability proportionate to size cluster sampling. Trained patronage nurses visited women at home at 3-4 months, and then at 6-7 months post-partum to complete a specially constructed interviews and copy selected data from the Newborn Record. This study has received support from CPHA and CIDA. Results First preliminary results on the mothers visited in July...

Background/Aim. Bearing in mind a high smoking prevalence in Serbia (34% in adult population; men 38%, women 30%) and leading role of health professionals in intervention and prevention, a cross-sectional study was performed smong the representative sample of health professionals in Serbia. The aim of the study was to identify predictors of smoking and smoking cessation prior to the total smoking ban in November 2010. Methods. In this nationwide study, 3,084 physicians and nurses from 4 types of institutions and four geographical regions were selected and 2,282 included (response rate 74.0%). Data were collected using a self-administered structured questionnaire. Standard statistical methods were used to calculate prevalence rates, and multivariate logistic regressions to evaluate independent predictors of smoking pattern. Risks were expressed as odds ratios (OR) which represent approximation of relative risks of exposed persons with 95% confidence intervals (95% CI). Results. We fo...

Occupational health in Yugoslavia was once well organized in accordance with WHO declarations and ILO conventions and recommendations. Since the 1990s, the system has been disrupted by destruction of the former Yugoslavia, wars, refugees, changes in the economy, and NATO bombardment. Economic trends, main industries, and employment and unemployment conditions in Yugoslavia are presented. The organization of occupational health services, their tasks, and prevailing problems are discussed. Occupational diseases and relevant research and educational opportunities are described. The authors conclude by suggesting approaches to improving worker's health in the future.

The most common hazards in the forestry that may induce disorders of the musculoskeletal system are vibrations, unfavorable microclimatic conditions, noise, over-time working hours, work load and long-term repeated movements. The objective of this study was to analyze the prevalence of musculoskeletal diseases and its difference among workers engaged in various jobs in the forestry. Two groups of workers were selected: woodcutters operating with chain-saw (N=33) and other loggers (N=32). Selected workers were of the similar age and had similar total length of employment as well as the length of service in the forestry. Both groups of workers employed in the forestry had the high prevalence of musculoskeletal diseases (woodcutters 69.7% and other loggers 62.5%, respectively). Degenerative diseases of spinal column were very frequent, in dependently of the type of activity in the forestry. Non-significantly higher risk of carpal tunnel syndrome was found in woodcutters with chain-saw ...

No definite conclusion can be made from many epidemiological and clinical studies of lipid metabolism in workers exposed to carbon disulphide (CS2). The aim of our investigation was to study the serum lipid levels in workers exposed to different CS2 levels to establish possible exposure-response relationships. The first group, spinners, were exposed to high CS2 levels; the second group, workers in viscose production, to low CS2 levels; and the third group included non-exposed workers. As a part of a large examination, total and free serum cholesterol, total lipid and triglyceride levels were determined. Mean total lipid levels were similar in high and low CS2 exposed workers, but significantly lower in non-exposed workers. The total serum cholesterol mean levels were also similar in both groups, but significantly higher in the non-exposed group. Only serum triglyceride values were related to the CS2 levels: the most elevated were in the high exposed workers, somewhat lower in the low exposed, and the lowest in the non-exposed group. The finding is especially important as triglycerides are the most specific for developing atherosclerosis, which is often reported in workers with long-term exposure to carbon disulphide.

Current knowledge of the etiology of prostate cancer is limited. Numerous studies have suggested that certain occupations and industries may be associated with the occurrence of prostate cancer. Information on occupation and industry on death certificates from 24 states gathered from 1984 to 1993 was used in case control study on prostate cancer. A total of 60,878 men with prostate cancer as underlying cause of death was selected and matched with controls who died of all other causes except cancer. Similar to the findings of our parallel large case control study of prostate cancer, we observed excess risks in some white-collar occupations, such as administrators, managers, teachers, engineers, and sales occupations. However, some blue-collar occupations, such as power plant operators and stationary engineers, brickmasons, machinery maintenance workers, airplane pilots, longshoreman, railroad industry workers, and other occupations with potential exposure to PAH also showed risk of excess prostate cancer. Risk was significantly decreased for blue-collar occupations, including farm workers, commercial fishermen, mechanics and repairers, structural metal workers, mining, printing, winding, dry cleaning, textile machine operators, cooks, bakers, and bartenders. Although we observed excess risks of prostate cancer among some low socioeconomic status (SES) occupations, the overall results suggest that the effects of higher SES cannot be ruled out in associations between occupational factors and the risk of prostate cancer.

Although prostate cancer is a major disease, causal factors are only partially understood. We examined occupational risk factors for this disease in a large case control study among U.S. blacks and whites. The study included 981 new pathologically confirmed prostate cancer cases (479 blacks and 502 whites) diagnosed between 1986 and 1989, and 1,315 population controls (594 blacks and 721 whites) who resided in Atlanta, Detroit, and 10 countries in New Jersey, covered by population-based cancer registries. Information on occupation, including a lifetime work history, was collected by in-person interview. No clear patterns of risk were found for U.S. whites versus blacks, nor for white-collar versus blue-collar jobs. Farming was related to prostate cancer (OR = 2.17; 95% CI = 1.18-3.98). Risk was restricted, however, to short-term workers and workers in crop production. Risk was not limited to those farming after 1950, when widespread use of pesticides started. Risks increased with increasing years of employment in firefighting (chi 2trend, p = 0.02) and power plant operations (chi 2trend, p = 0.03), and were elevated among long-term railroad line-haulers (OR = 5.85; 95% CI = 1.25-27.4); jobs with potential polycyclic aromatic hydrocarbon (PAH) exposures. Risk was elevated among athletes (OR = 5.38; 95% CI = 1.48-19.6). However, most of the cases were athletes before 1960, so the potential use of anabolic steroids was excluded. Although some clues about potential occupational associations were found, the overall results show that occupation is not a major determinant of prostate cancer risk.