American Occupational Health Conference, April 26-29, 2009

American Occupational Health Conference

The annual American Occupational Health Conference, the largest conference of its kind in the country, took place April 26 to 29 in San Diego and attracted physicians, researchers, and other occupational and environmental medicine professionals. The conference was sponsored by the American College of Occupational and Environmental Medicine. This year's meeting featured concurrent sessions organized into the following five tracks: occupational and environmental medicine clinical practice; management and administration in occupational and environmental medicine; environmental health and risk management; regulatory, legal, military, and governmental occupational and environmental practice; and occupational and environmental education and scientific research.

Research presented at the meeting included an investigation that linked poor medication adherence and high blood pressure with impaired work productivity. Feride Frech-Tamas, of Novartis Pharmaceuticals Corporation in East Hanover, N.J., utilized data from the 2007 National Health and Wellness Survey, in which 3,041 respondents (mean age 51 years) who reported a physician diagnosis of hypertension, the use of anti-hypertensive prescription medication, and full-time employment were selected for study participation. Low medication adherence, assessed using the Morisky Medication Adherence Scale, was significantly associated with an increase in work impairment. Impaired work was predominantly related to presenteeism, or when an employee goes to work in spite of illness. Frech-Tamas also observed a significant association between the number of comorbidities, such as diabetes and dyslipidemia, and impaired work productivity among the respondents.

"Programs to improve compliance may present opportunities for employers to improve work productivity," Frech-Tamas said in a statement. "In an effort to improve health and productivity, and to lower costs, some health plans and/or employers offer wellness programs. The programs are implemented through joint efforts to impact outcomes by educating employees about disease conditions and treatment/management options."

Frech-Tamas and other study authors are employees of Novartis Pharmaceuticals Corporation, which manufactures several drugs used to treat hypertension.

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Sandeep Guntur, M.D., of the University of California in San Francisco, presented findings demonstrating a possible link between childhood arsenic exposure and decreased lung function later in life. Study participants were from two similar neighboring cities in northern Chile. Between the years 1958 and 1970, the water supply in one city contained very high arsenic levels (approximately 850 μg/L), while the water supply in the neighboring city had nominal arsenic levels (less than 10 μg/L). A total of 97 individuals (aged 37 to 65 years) from both cities were included in the analysis. Compared with unexposed participants, those with higher childhood arsenic exposure displayed a 6 to 9 percent decrease in lung function, measured by forced expiratory volume in one second, forced vital capacity, percent predicted forced expiratory volume, and percent predicted forced vital capacity. Guntur observed that this disparity remained even when adjusted for potentially confounding factors, such as a history of smoking. Other detrimental effects on pulmonary function and health, evidenced by an increased risk of respiratory symptoms, were also apparent in the group with higher arsenic exposure.

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Abdul Khalade, of the University of Birmingham in the United Kingdom, reported findings of a meta-analysis of the published literature regarding the risk of leukemia among workers with occupational exposure to benzene. A systematic literature review identified 19 studies that all reported an effect estimate greater than one, indicating an increased likelihood of leukemia with occupational benzene exposure. A fixed-effects model produced an overall odds ratio of 2.55, however, strong heterogeneity was evident in this model. Therefore, a random-effects model, which allowed for this heterogeneity, still resulted in an overall odds ratio of 2.30.

Khalade said in a statement, "this study pooled together results from others which now provide an overall benchmark to work upon when devising updated occupational exposure limits for benzene and leukemia risk."

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Ahmad B. Naim, M.D., of Centocor Ortho Biotech Inc. in Horsham, Pa., assessed work productivity, absenteeism, and presenteeism in patients with psoriasis who were currently employed (full-time, part-time, or self-employed). The author found that work productivity decreased and absenteeism and presenteeism rates rose significantly among patients with severe psoriasis, compared to those with mild or moderate disease. In a separate study, Boxiong Tang, M.D., also of Centocor Ortho Biotech Inc., performed a similar analysis of work productivity among patients with rheumatoid arthritis. Tang noted that rheumatoid arthritis patients who discontinued subcutaneous biologic therapy were more likely to experience decreased work productivity and activity.

Naim, Tang, and other study authors are employees of Centocor Ortho Biotech Inc., which produces Remicade®, a biologic therapy approved to treat plaque psoriasis and rheumatoid arthritis, along with other inflammatory immune disorders.

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Ken Dychtwald, Ph.D., the founding president and CEO of Age Wave in San Francisco, delivered the C.O. Sappington Memorial Lecture during the opening session of the conference. His lecture, "How the Age Wave will Transform Health and Health Care," addressed the impact of changing age demographics on the medical profession, which has been identified by the American College of Occupational and Environmental Medicine as an especially important topic for its physician members.

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Physician's Briefing