<strong><em><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldItalicMT;"><strong><em><font face="TimesNewRomanPS-BoldItalicMT" size="2"><font face="TimesNewRomanPS-BoldItalicMT" size="2"><p align="left">Objectives</p></font></font></em></strong></span><strong><em><font face="TimesNewRomanPS-BoldItalicMT" size="2"><p align="left"> </p></font></em></strong></span><p align="left"> </p></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">: Prevalence odds ratio (POR) is commonly used as a surrogate for relative risk (RR) in crosssectional studies. When prevalences are high, POR may be a poor approximation for RR. Prevalence ratios (PRs) are more easily interpretable when evaluating exposure effects. Our objectives were to compare estimates of PRs and corresponding 95% confidence intervals (CIs) using three different statistical methods on a real data set, furthermore, to report possible practical problems in applying the methods. </span></span><strong><em><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldItalicMT;">Methods</span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">: Two statistical methods were compared: log-binomial regression and Cox regression. We examined selected high prevalence symptoms: headache, tingling of limbs, and breathing difficulty, and their association with solvent-exposed work tasks in 164 Hebron shoe factory workers. </span></span><strong><em><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldItalicMT;">Results</span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">: The two methods estimated identical crude point PR estimates and quite similar adjusted estimates. CIs were wider in Cox regression than in log-binominal regression, as exemplified by adjusted estimates for the association between participation in cleaning tasks and tingling of limbs in log-binomial regression (PR=1.78; CI=1.25–2.54), Cox regression (PR=1.76; CI=1.01–3.06). When we used Cox regression with robust variance we obtained narrower CIs (PR=1.76; CI=1.19–2.60). In the log-binomial regression analysis we had to exclude a few subjects with a predicted risk exceeding one. </span></span><strong><em><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldItalicMT;">Conclusions</span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">: Log-binomial regression is appropriate from a theoretical viewpoint. However, some individuals had a predicted risk larger than one, which caused the computation to abort. Cox regression could produce heavy ties when adjusted for confounders and yielded rather wide CIs, however, by using robust variance we will obtain narrow CIs. In conclusion, the two suggested methods have certain limitations and difficulties. However, Cox regression encountered less serious problems than in the other methods, and is also widely available.</span></span></strong></strong></strong></strong>
The high prevalence of self-reported health complaints and the exposure-outcome association could be due to volatile organic solvents (dichloromethane, n-hexane)and plastic compounds (isocyanates and polyvinyl chloride). Absence of a satisfactory work environment is likely to contribute to high exposure levels.
Exposure to organic solvents has been reported to increase the risks for acute and chronic health effects among shoe industry workers. In developing countries, protection against chemical exposures is often not provided. The study was conducted to identify working conditions and estimate the concentrations of organic solvents used in shoe factories and workshops in Hebron City. Personal interviews containing questions related to personal protective equipment (PPE) were used to identify working conditions, and samples collected from factories and workshops were analyzed using gas chromatography. Geometric means (GMs) were calculated for the solvents. Six major organic solvents were detected in the factories. Acetone (GM = 51.5 mg/m3, GSD = 3.82) was common in gluing tasks. Dichloromethane (GM = 47 mg/m3, GSD = 2.62) was common in cleaning tasks. Heptane, methylethyl ketone, n-hexane, and toluene were common in gluing tasks. Four major organic solvents were detected in the workshops: acetone (GM = 32.3 mg/m:3, GSD = 6.33), toluene (GM = 70.3 mg/m3, GSD = 3.06), n-hexane (GM = 19.4 mg/m3:, GSD = 2.65), and methylethyl ketone (GM = 130 mg/mM3, GSD = 1.5). 81% of the factory workers had never used respiratory protective equipment, and 92% had never used work clothes. 97% of the workers in the workshops had never used respiratory protective equipment, 94% had never worn gloves, and 90% had never used work clothes. Exposures to solvents in the absence of personal Protective equipment, tasks barriers, and mechanical ventilation can adversely affect health.
Exposure to organic solvents has been reported to increase the risks for acute and chronic health effects among shoe industry workers. In developing countries, protection against chemical exposures is often not provided. The study was conducted to identify working conditions and estimate the concentrations of organic solvents used in shoe factories and workshops in Hebron City. Personal interviews containing questions related to personal protective equipment (PPE) were used to identify working conditions, and samples collected from factories and workshops were analyzed using gas chromatography. Geometric means (GMs) were calculated for the solvents. Six major organic solvents were detected in the factories. Acetone (GM = 51.5 mg/m 3 , GSD = 3.82) was common in gluing tasks. Dichloromethane (GM = 47 mg/m 3 , GSD = 2.62) was common in cleaning tasks. Heptane, methylethyl ketone, n-hexane, and toluene were common in gluing tasks. Four major organic solvents were detected in the workshops: acetone (GM = 32.3 mg/m 3 , GSD = 6.33), toluene (GM = 70.3 mg/m 3 , GSD = 3.06), nhexane (GM = 19.4 mg/m 3 , GSD = 2.65), and methylethyl ketone (GM = 130 mg/m 3 , GSD = 1.5). 81% of the factory workers had never used respiratory protective equipment, and 92% had never used work clothes. 97% of the workers in the workshops had never used respiratory protective equipment, 94% had never worn gloves, and 90% had never used work clothes. Exposures to solvents in the absence of personal Protective equipment, tasks barriers, and mechanical ventilation can adversely affect health.
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