Exposure-response relationships for endotoxin as measured in dust and longitudinal decline in lung function were studied. A cohort of 171 pig farmers was followed over a 3-yr period. Long-term average exposure to dust and endotoxin was determined by personal monitoring in summer and winter, using data on farm characteristics and activities. Mean decline in FEV1 was 73 ml/yr and in FVC 55 ml/ yr. Long-term average exposure to dust was 2.63 mg/m3 (geometric SD [GSD] 1.30), and to endotoxin, 105 ng/m3 (GSD 1.5). Annual decline in FEV1 was significantly associated with endotoxin exposure. An increase in exposure with a factor 2 was associated with an extra decline of FEV1 of 19 ml/yr.

ABSTRACT:A cas e-referent study of 345 prostate cancer cases and 1,346 referents was carried out in the Netherlands to investigate the relationship between work environment and prostate cancer risk. Cases were selected from the Cancer Registry of the Comprehen sive Cancer Centre IKO. Referents (men diagnosed with benign prostate hyperplasia) were recruited with assistance of the pathology laboratories in the IKO region. Questionnaires were mailed to all subjects to obtain information on their work history and occupational exposure. Moreover, workers in farming (n = 323), and in metal work and maintenance (n = 340), were requested to complete short supplements to the questionnaire inquiring in more detail into specific types of exposure. Significantly elevated risks were found for work in food m anufacturing and for bookkeepers. Significantly elevated odds ratios (OR) were also observed for jobs held between 1960 and 1970 in administration, in storage, or as farm laborer. In addition, a statistically significant excess risk was found for subjects who re ported frequent occupational exposure to cadmium. Cases who worked in farming applied pesticides during significant more days per year than the referents did. A nonsignificantly elevated OR was found for maintenance of tractors and agricultural machinery. Among metal workers, mechanics, and repairmen, nonsignificantly increased ORs were observed with regard to the use of acids, solvents, iron, and steel, and for welding and maintenance of machinery.

ealth care workers, especially nurses, have been the subject of many studies to examine how physical stress and other work-related factors may affect their health.1' 11 These studies focused in the first instance on low back pain.7 Most research has been carried out in general hospitals so far, even though large numbers of nurses work in other but comparable settings, such as psy chiatric hospitals or nursing homes. Recent investigation tends to confirm that the physical work load of those working in nursing homes is relatively high.12 Data collected in the health care in the Netherlands support this conclusion. For example, the percent age of sick leave found in nursing homes (10.8%) was higher in 1990 than that in health care as such (9.3%).13 To get a better idea of com plaints and health problems affecting nursing staff in nursing homes, a study was carried out in three Dutch nursing homes to search for underly ing factors for these problems in the daily work situation.14 In this paper a particular part of this study is dis cussed, the one dealing with the asstrenuous aspects o f nursing work. Household and preliminary tasks, ergosessment of physical work load during a nurse's workday. Because Harber et al15,16 showed that it was not only patient-transfer activities that contrib uted to low back pain, we decided to observe all nursing activities and to investigate each task-specific contri bution to physical work load. To get a clearer understanding of task-specific work loads, 36 subjects working in these nursing homes were selected to participate in an observa tional study. In this study we tried to establish which activities took up most of their time, in which of them most of the poor work postures oc curred, which activities were per-

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It can be concluded that the course was successful, although it should be carefully investigated as to whether nurses remain capable of working safely in daily practice. The work pressure that nurses experience during their normal duties could prevent them from working safely during everyday work.