More than 100 million American workers, 7 million workplaces, and 945,000 hazardous chemical products are covered under the Hazard Communication Standard (HCS), regulated by the Occupational Safety and Health Administration. There were a total of 1,183,500 recordable non-fatal illnesses and injuries in private industry workplaces in 2006 resulting in days away from work. Of these, 19,480 were due to chemicals and chemical products. In addition, there were a total of 5,703 work-related fatalities in 2006. In 191 of these, chemicals and chemical products were listed as the primary source of injury and as the secondary source of injury in 104 cases. The economic impact of both fatal and non-fatal occupational injuries amounted to $164.7 billion in 2006. OSHA established the HCS in order to ensure that workers are informed of the hazardous chemicals with which they work, yet OSHA admits that many adults may have difficulty reading material that communicates hazards. Violations of OSHA's HCS were the third most cited violation in 2007. Since only 12 percent of the adults surveyed in the United States demonstrated Proficient health literacy, the state of affairs poses a serious problem for hazard communication, which nurses and nurse practitioners are often responsible for conveying. Health tasks that require Proficient health literacy include "drawing abstract inferences, comparing or contrasting multiple pieces of information within complex texts or documents, or applying abstract or complicated information from texts or documents". Donabedian's Structure-Process-Outcome framework served as the conceptual basis for this study. Twelve research studies (nine journal articles and three doctoral dissertations) published between 1993 and 2003 were reviewed. None of these studies measured the participants' literacy level. The purpose of this single administration, cross-sectional study was to examine literacy levels as a hypothesized predictor of test scores of employees presenting to the Lakeside Occupational Medical Center, Downtown Clinic, for a physical examination, immunization, drug screening, or follow-up appointment. MSDS test scores served as the dependent variable and were measured by an investigator-made test consisting of seven passages, taken from seven separate MSDSs for sodium hypochlorite, each from a different manufacturer. Sodium hypochlorite is commonly utilized in numerous industries including the janitorial, pulp, paper, textile, dairy, and water-cooling industries and is known to cause work-related health effects such as asthma and irritation of the eyes and throat. Each passage was followed by five multiple choice questions. Literacy levels were measured utilizing the Short Test of Functional Health Literacy in Adults (STOFHLA). The readability level of the written material was measured utilizing the Simplified Measure of Gobbledygook (SMOG) and the Flesch-Kincaid Grade Level (FKGL). The characteristics of age, highest grade level completed, native language, and job category were measured by a demographic sheet. The results indicate that there was a significant positive correlation between the total STOFHLA scores and the total scores on the MSDS test. Therefore, hypothesis number 1 was supported. Findings on the readability level of the examples of the MSDSs to the participant's overall MSDS score were inconclusive. However, the format of the MSDS, specifically the number of lines/sentence and the number of words that are 3 syllables or more, may influence comprehension. Therefore, written hazard communication material should be written in short sentences and use words less than 3 syllables. This way the likelihood of the material being understood by the worker will be increased. Further research aimed at understanding exactly how reading grade level and sentence structure impacts comprehension of hazardous materials information is needed.

Amalgam has been used as a dental restorative material for centuries, but its potential health effects and biopersistance has lead to a decreased use especially in the Nordic countries. New materials have been introduced, partly to replace the mercury containing amalgam and partly because of esthetical reasons. The possible health effects of amalgam have been studied extensively and the material has been replaced with other less well-examined materials during the last few decades. The prevalence of side effects of dental materials is considered to be low in relation to the vast number of dental treatments undertaken. With the introduction of new and more complex materials, side effects related to dental treatment may increase. Epidemiological data suggest that the side effects of dental resins that have almost completely replaced amalgam fillings in Scandinavia, possess a risk for adverse reactions; however, the causal relation has not been fully established. Therefore, the type and extent of side effects caused by resin-based materials are of great interest. The aims of the study were: - to describe the change in health over time for patients with problems related to their dental materials. The hypothesis was that the patients could be divided into subgroups based on their symptoms and that the ability to recover differs between these groups [Paper I]. Furthermore, to determine whether factors such as the replacement of dental restorative materials and follow-up time had any impact on the perceived health. - to assess the long-term development of symptoms and their social consequences among patients referred for diagnosis and treatment of symptoms related to dental materials [Paper II] - to investigate the possible risks with dental restorative materials other than amalgam [Paper III]. - to describe side effects assessed to be caused by resin-based materials that occurred in a group of patients as well as treatment and long-term consequences of the reactions [Paper IV]. A questionnaire was sent to 614 patients [Paper I and II] that had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental materials. The questionnaire contained questions on, among others; civil status, present health, medical and dental treatment and other measures and precautions taken because of psychosocial problems related to current employment situation, feelings, self-image and coping behavior. Moreover, information was collected [Paper III] from the Swedish Dental Materials Register 2003 (DentMr), a compilation of MSDS for 487 materials, and information from the user guide of the materials. The Material Safety Data Sheets (MSDS) included in the DentMR were examined regarding the given composition of the products, the occurrence of CAS-numbers and the risk- and safety phrases of the substances. Information was collected [Paper IV] on 36 patients with reactions to resin-based restorative materials from the Swedish National Register of Side-Effects of Dental Materials. Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with local symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. However, the reason for this improvement was unclear. Replacement of dental restorative materials had no significant impact on the ability to recover completely. Our results also indicate a relationship between patients’ self-related health and social consequences in daily life. Those with remaining complex symptoms had more often stopped working or had decreased their work hours because of their symptoms The information about hazards with dental materials seems insufficiently described in MSDS and there might be materials with side effects unknown to both patients and dental professionals. A literature search indicated that some of the listed substances had possible hazards, e.g. substances with embryotoxic and neurotoxic potential. The patients were very heterogeneous; a few with only local symptom free reactions while other had more complex symptoms. The latter group would gain from a multidisciplinary approach, i.e. dental, medical, as well as social and psychological factors have to be considered when developing care management programs for this group of patients. Furthermore, there is a need for stronger regulations of dental materials, such as those applied to pharmaceutical drugs. Finally, it was found that the majority of symptoms suspected to be caused by resin-based materials were local or a combination of local and extra-oral symptoms that appeared within the first 24 hours after treatment. The most frequent adverse effect reported was skin problems/dermatitis. It appears as though immediate reactions to resin based materials are not uncommon and more prevalent than allergic reactions. Still, we have had, difficulties in verifying associations between the dental restorative materials and adverse reactions and also to identify the offending component.