The economic position of disabled people is often summarised by comparing their overall employment rate with that of non-disabled people. But the average figure masks a very wide range of variation in the prospects faced by individual disabled people – immensely wider than the range for the population as a whole. The severity of their impairments is a crucial influence, but the Labour Force Survey makes no attempt to measure it. Disabled people are also sensitive to other disadvantaging factors such as age and poor qualifications. More detailed consideration needs to be given to what distinguishes between those disabled people who are, and are not, in work.
In the preceding article general principles in setting biological occupational exposure limits (BOEL) and effect limits (BOEEL) were discussed. Here monitoring in every day occupational health practice is discussed. The specific objectives of biological monitoring (BM) and biological effect monitoring (BEM) determine to a large extent the choice of the parameters to be measured. According to the objective, the assessment may be either simple or sophisticated. The choice of an appropriate reference is essential for a valid evaluation of internal exposure, health risk and state of health. The measurement strategy depends on the working mechanism and the kinetics of the chemical. Protocols for BM and BEM-programmes should be regularly updated. Different compounds of the same metal may carry widely different health risks. In general it is necessary to correct the excretion of chemicals for dilution of the urine.
A survey of foundry workers was undertaken to assess the effect of respiratory disease on both absence in the year prior to the survey and labour turnover since a cross-sectional study of respiratory morbidity five years previously. The presence of a wheeze, but not an objective disturbance of airway function, was predictive of absence. Those with respiratory illness, detected in the survey five years previously, were no more likely to have left the foundry than those without such illness. Limited job opportunities may discourage moulders with respiratory disease from leaving the foundry. Absence was not related to cigarette smoking, the presence of bronchial hyperreactivity, or a positive skin test to common allergens. In view of the small number of subjects in this study, studies of larger work populations should be undertaken to further assess the effect of subjective and objective indices of respiratory morbidity on absence and labour turnover.
When looking for facts, fallacies and uncertainties of the use of biological exposure limits one has at first to discuss the general principles of biological monitoring (BM) and biological effect monitoring (BEM) because they determine the validity of the data that underpin the biological exposure limits. A difference between countries in preferred BM-methods can be observed. The terminology is still confusing: in addition to BM and BEM, biomonitoring and biological markers also are used. There are a number of problems in respect of the inter- and intra-individual variability in internal exposure and effect at similar exposure levels due to differences in for example, physical workload, body composition and genetics. Toxicokinetic models based on data from individual workers should be developed in order to get information on the variability and the cause of this. Both kinetics and dynamics may be sex-dependent. To date, BM methods have been tentatively suggested for only about 10 per cent of the regulated industrial chemicals. BM and BEM programmes yield important extra information on exposure and health risk, not to be gained by environmental monitoring alone.
Seventy-one male employees whose working environment was a temperature and dust controlled low-humidity 'Clean Room' and 144 male employees working in a natural factory environment were compared by means of period percentage prevalences of occurrence, severity and frequency of subjective symptoms of facial dermatitis. Using a cross-sectional interviewer-administered questionnaire it was possible to assess the percentage prevalence of each of 3 facial dermatitis symptoms among both low humidity exposed and non-exposed workers. The two prevalences were compared by calculating a ratio (the percentage prevalence ratio or PPR) of the prevalence of symptoms in the exposed, to that in the non-exposed workforce. A confidence interval (CI) for the PPR was also calculated. For the symptom of itching, the PPR was 1.65 (CI 1.32-2.07) in favour of the study group, whilst for the symptoms of redness and urticaria the PPRs were 1.96 (CI 1.54-2.48) and 2.53 (CI 1.40-4.59) respectively. The occurrence of a greater prevalence of all symptoms in the low-humidity exposed workforce confirms the clinical and laboratory reports of previous workers. A comparison was also made between the two groups of workers of both the severity, and the frequency of occurrence of symptoms. Whilst there was no statistically significant difference between the exposed and non-exposed groups for prevalence of one symptom, among those who had experienced two symptoms there was a PPR of 2.43 (CI 1.37-4.30) between the two groups. Furthermore, among those workers who had experienced all 3 symptoms of facial dermatitis there was a PPR of 3.38 (CI 1.18-8.93) in favour of the low-humidity exposed workforce.(ABSTRACT TRUNCATED AT 250 WORDS)
A prospective survey of patients attending the central Accident and Emergency Department and Eye Casualty Department in Aberdeen was made to determine the contribution of accidents at work to the workload of the departments and to estimate risks of injury in different industrial sectors. Work-related injuries accounted for 16.5 per cent of new patients attending the general accident department and 21.7 per cent of those attending eye casualty. Analysis by industrial sector led to estimates that almost one in 10 workers employed in manufacturing industries and in agriculture/forestry/fishing will attend casualty in the course of a year for a work-related injury. The relatively low-risk service sector, because of the large numbers of people employed, contributed the greatest number of individuals with work-related injuries. Two industries had very high rates of specific and preventable injuries--food and fish processing with an estimated 17 knife lacerations per 1000 per annum and mechanical engineering with 60 eye injuries per 1000 per annum. We give reasons for believing that our estimates of risk in the different industrial sectors are conservative.
Corrosive lung injuries caused by exposure to sodium hydroxide have seldom been described. A formerly healthy 25-year-old developed irreversible obstructive lung injury after working for one day with a caustic soda treatment of wood in a poorly ventilated room.
This paper discusses the surgical and medical problems affecting off-shore oil drilling workers in the south-eastern Atlantic coastline of the Nigerian territorial waters; about 50-60 kilometers from land. There were a total of 1300 attendances at the off-shore clinic within 12 months, ie 3.6 daily for a workforce of 110, were successfully managed by 2 well-trained industrial staff nurses who were supervised by an experienced base doctor on-shore. Although, most of the patients were treated for minor medical and surgical conditions such as headaches, malaria, cuts and bruises, a few acute emergencies arose which had to be taken on-shore by helicopters, for subsequent management. Four accidental deaths occurred during the period, one of them was clearly preventable but there were no major disasters. This demonstrated the effectiveness and significant role which well-trained nurses can play in industrial health.
The Occupational Health Management of Police Officers involved in the Piper Alpha Incident is described with reference to the factors likely to cause either physical or psychological distress and the measures taken to overcome these. Once the enormity of the Piper Alpha Disaster became apparent with the realization that the recovery of the bodies would extend over a period of months, the problems of maintaining the physical and mental health of the Police Officers involved assumed prime importance.
Journal Article Harmonization of Training for Occupational Medicine in the Member States of the European Community Get access J. L. KEARNS J. L. KEARNS Consultant Occupational PhysicianLondon, UK Requests for reprints should be addressed to: Dr J. L. Kearns, 9 Ascott Avenue, Ealing, London W5 3XL, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar Occupational Medicine, Volume 41, Issue 1, SPRING 1991, Pages 5–6, https://doi.org/10.1093/occmed/41.1.5 Published: 01 March 1991
Haematological parameters, iso-transferrin ratio in plasma and serotonin uptake in platelets were studied in 10 men (age range 21-54 years) with occupational long-term, low level exposure to vapours from epoxy paints. The control group consisted of 10 healthy men (age range 20-48 years) not occupationally exposed to chemicals or organic solvents. The mean cellular volume of erythrocytes was significantly higher for the house painters than the controls (p < 0.05). The plasma concentration of iso-transferrin with isoelectric point 5.7 (Tf5.7) and the ratio between Tf5.7 and total transferrin (Tf(tot)) were significantly higher in the exposed group (p < 0.05). The uptake of serotonin in platelets (V(max)) from the exposed workers was significantly lower than the values for the controls (p < 0.01). The results indicate an association between the observed biological effects and the chemical exposure, and we speculate that this is caused by changes in structure and function of the cell membranes.
This survey was carried out in response to anxiety among chiropodists as earlier reports had raised the possibility of respiratory damage as a result of sensitization to trichophytons. Questionnaires were sent to 327 chiropodists and 168 replies were received. The aim was to investigate respiratory symptoms and their relationship to work and drill usage. All of those completing questionnaires were invited to attend the occupational health department for prick tests and lung function tests. Just over one half of those who were invited attended. Although upper respiratory symptoms were common, only eye symptoms and wheeze were significantly more prevalent in those who used non-vacuum drills. Nasal symptoms were commoner in those who had spent less than ten years in the profession. Throat symptoms and multiple symptoms occurred more commonly in the 17 per cent of attenders who had positive prick tests to trichophytons. There were no cases of occupational asthma and no definite relationship between any symptom and work. It was confirmed that sensitization to trichophytons was common (16.5 per cent) but did not produce chest problems. Nail dust might produce symptoms by simple irritation of the upper respiratory tract.
A cross-sectional survey was carried out on 772 workers in 27 mills in the North of England involved in the processing of cotton waste. The overall prevalence of byssinosis as defined by Schilling's criteria was 9.8 per cent with 5.4 per cent having grades 2 and 3. The prevalence in workers who had only ever had cotton waste exposure (5 per cent) was significantly less than for those who had mixed waste and raw cotton exposure. There was no clear relationship between prevalence of byssinosis and years of exposure or dust levels.
The mortality experience of 716 male hydrometallurgical nickel refinery employees who worked at Sherritt Gordon Limited in Fort Saskatchewan, Alberta for at least 12 continuous months during the years 1954 to 1978 was examined. Mortality ascertainment was obtained utilizing the Canadian Mortality Data Base maintained by Statistics Canada and covered the years 1954 through 1984. Cause-specific mortality analyses were accomplished using male, age and calendar-year adjusted death rates for Canada and the province of Alberta. Total mortality was significantly below expectation (27 observed vs. 47 expected). Statistically significant fewer observed deaths were found for circulatory disease while multiple myeloma demonstrated a statistically significant increase of observed deaths. No deaths due to nasal cavity or paranasal sinus cancer were detected. Only one lung cancer death was found with three deaths expected (SMR 33). No association was found in this study between exposure to nickel concentrate or metallic nickel and the subsequent development of respiratory cancer.
Harmonization of Training Get access J. L. KEARNS J. L. KEARNS Chairman, European Communities Committee, Head of UK Delegation, Standing Committee of Doctors in the European Community 9 Ascott Avenue Ealing London W5 3XL Search for other works by this author on: Oxford Academic PubMed Google Scholar Occupational Medicine, Volume 41, Issue 3, AUTUMN 1991, Page 144, https://doi.org/10.1093/occmed/41.3.144-a Published: 01 October 1991
Screening for coronary risk factors (blood cholesterol greater than 5.2 mmol/l; body mass index greater than 25; blood pressure greater than 140/90 and positive smoking history) using nurse administered voluntary health assessments was studied in occupational health practice. A high employee participation rate (80.9 per cent) was achieved with few employees declining to attend, confirming the advantages of workplace based screening. Hypercholesterolaemia, overweight and smoking were the most prevalent risk factors. Men had higher rates than women as judged by independent or concomitant risk factor rates; 56.5 per cent of men were over ideal body weight, 40 per cent of men smoked, 35.7 per cent of men had two risk factors and 2 per cent of men had four risk factors. Blood cholesterol and blood pressure were shown to increase with increasing body weight. It is suggested that body weight reduction and smoking cessation are the preferred intervention strategies in occupational health practice.
Accuracy of diagnosis of malignant mesothelioma (pleural and peritoneal) was studied in a cohort of asbestos insulation workers in the United States and Canada. Initial clinical diagnosis, clinical diagnosis at death and death certificate diagnosis were compared with the diagnosis of malignant mesothelioma ascertained by full data review at the Division of Environmental and Occupational Medicine, Mount Sinai Medical Center, New York ('best evidence'). In both groups the death certificate diagnosis was somewhat less frequently accurate than clinical diagnosis at death. Knowledge of the patients' occupational history by the attending physician and its relation to accuracy of diagnosis of malignant mesothelioma is considered.
