Journal of occupational medicine. : official publication of the Industrial Medical Association最新文献

Preplacement screening is put forth by some as an effective method for preventing low back disability at the workplace. Although there are still large gaps in knowledge regarding the natural history of and risk factors for back disability, it is clear that the majority of costs are derived from the small proportion of those that will suffer with back symptoms for 6 months or more. Thus, if preplacement screening is to have an impact on health care spending and compensation costs, the screening test will have to be predictive not so much of all back injuries, but rather of work absenteeism and especially chronic disability. This paper presents some criteria for evaluating a screening program and explores the effect of choosing different outcomes for evaluation. The literature on the effectiveness of a number of preplacement screening techniques is examined. Current legislation related to preplacement screening is also described. The natural history, etiologic factors, and prognostic markers for back injuries need to be elucidated further before effective screening strategies can be developed to reduce the incidence of back injuries and back disability in the population.

No one is spared a regional backache. Some episodes will compromise function to the extent of work incapacity. Throughout the industrialized world, workers' compensation insurance programs provide recourse for the segment of people whose incapacitating backache is held to have arisen out of and in the course of employment. Most programs have evolved from the Prussian paradigm introduced a century ago. That evolution represents country specific, de facto experiments in health policy. In the case of Japan, the Prussian paradigm was imposed on a very distinctive tradition at the end of World War II. Therein lies one of the more dramatic experiments of health policy. This essay attempts to document the process that resulted. To gain such insight, relevant physicians and bureaucrats in Japan were interviewed and government documents reviewed. This information was supplemented by nonsystematic culling of relevant reflections of scholars also pursuing the heuristic method but with different, usually nonclinical, tempering. It is clear that Japan has evolved an approach to the worker with an incapacitating backache that favors options other than recourse in workers' compensation for redress.

A retrospective case-control study into the risk factors for injury during basic military training was conducted at the Recruit Training Unit, Royal Australian Air Force Base Edinburgh, South Australia. Case subjects were recruits suffering a musculoskeletal injury during the course, severe enough to result in backcoursing (being delayed and joining a later course) and usually requiring the loss of 5 days of training. Control subjects were 629 recruits selected randomly from recruits who were not case subjects from the same period of Jan 1, 1985 to Dec 31, 1990. Two hundred thirty-eight cases were identified (2.7% of the recruit population), of which 123 were overuse-type injuries and 115 acute-type injuries. Most injuries occurred in the first 2 weeks of training. Bivariate and logistic regression analysis of possible risk factors for injury was conducted, both for all case subjects and for the subgroup of case subjects with overuse injuries. Statistically significant associations were identified for female gender, body mass index > 26.9, winter training, a history of lower limb injury, and the presence of a lower limb deformity. All these associations were stronger for overuse injury, and preenlistment physical activity was also significantly associated with overuse injury. No significant association was found for height, weight, age, smoking, or gender makeup of courses. Most striking was a large rise in overuse injury incidence in women over the period of study, from 0.2% in 1985 to 8.8% in 1990. Reasons for this increase may include "social pathogenesis."

This investigation examined the associations between exercise habits, measures of physical fitness, and 10-year cardiovascular disease risk (CVD10, expressed as %) among 470 law enforcement officers of differing ages (range = 21 to 63 y). Only 32% of this group exercised regularly (> or = 3 days/week, > or = 20 min/session, > or = preceding 4 weeks). Only exercising subjects > 48 years old exhibited a significantly (P < .01) lower 10-year risk of a CVD event than their inactive peers (12.2 +/- 5.6 vs 16.3 +/- 6.9%, mean +/- SD). At all ages, the peak oxygen consumption per unit time was higher (50.1 +/- 6.7 vs 44.8 +/- 6.1 mL.kg-1.min-1) in the exercising than in the nonexercising group. Exercising subjects < or = 36 years old were significantly (P < .05) leaner than nonexercisers (16.3 +/- 5.5 vs 19.6 +/- 5.5% body fat, respectively) and had greater muscular endurance (45 +/- 9 vs 40 +/- 9 60-s sit-ups, respectively). These data suggest that exercise reduces CVD risk by modifying major CVD risk factors only in law enforcement officers > 48 years old.

We examined the prevalence of urolithiasis in 5574 men and women employees in 21 industrial plants in Israel who were screened for cardiovascular risk factors between 1985 and 1987 (the CORDIS Study). Among the data gathered were previous physician diagnosis of urolithiasis and ergonomic and demographic data. Urolithiasis was much more frequent in men than in women (age-adjusted prevalence of 4.5% in men and 1.2% in women, P < .0001). Older subjects had higher prevalence than young subjects. There were ethnic differences, and the highest prevalence was in subjects of European origin. Of the occupational factors, only industrial sector was related to prevalence of urolithiasis. Urolithiasis was more frequent among employees in wood industries than in other sectors (P < .05). We concluded that there is an effect of industrial sector on the prevalence of urolithiasis. To determine the cause and magnitude of the association of wood industries with increased prevalence of urolithiasis, ergonomic and chemical factors should be investigated.

The etiology of adult-onset asthma is incompletely understood. High-intensity exposure to irritants is one accepted risk factor and such cases are termed Reactive Airways Dysfunction Syndrome. The contribution to asthma of less intense and less acute exposure to irritants remains to be clarified. We report on 10 cases of nonsensitization adult-onset asthma in settings of exposure to noticeable but distinctly "tolerable" levels of inhalation irritants. This series of 10 cases represent 31% of verified asthma cases seen in our environmental and occupational medicine referral clinic over a 5-year period. We believe further exploration of this phenomenon of low dose Reactive Airways Dysfunction Syndrome is warranted.

The health impact of workplace solvent exposure remains an issue of substantial interest and concern to occupational health professionals. As a result of research performed in the 1970s and 1980s, policies and programs were developed throughout the world to control excessive exposure to solvents. To an extent, these programs have been responsible for reduction of the occurrence of solvent-associated encephalopathy and other health effects. In this review of research performed since 1985, particular attention is given to issues of reversibility of neurotoxicity following exposure cessation. Furthermore, health effects involving other organ systems, particularly reproductive, renal, and hepatic disorders, are discussed. Future research directions are discussed. Finally, the practical implications of these recent research findings are described with a focus on the management of prevention programs at the work site.

Using 10 guidelines for medical screening programs, this review assesses a screening protocol that seeks to identify presymptomatic occupational renal disease among workers with nephrotoxin exposure. The protocol uses urinary markers of early renal dysfunction for the screening test. The review reveals that arguments for screening are the clinical significance of renal disease, worker acceptance of urine collection, the availability of exposure reduction as an intervention, and the availability of diagnostic and treatment facilities. Obstacles to screening are the lack of an effective intervention, the lack of strong evidence to indicate that an elevation in the urinary markers represents a preclinical stage of occupational renal disease, and the absence of firm numbers to demarcate normal from elevated concentrations of urinary markers. Given these obstacles, screening for occupational renal disease is not recommended.