The Journal of the Society of Occupational Medicine最新文献

This paper describes the system of statutory medical examinations introduced in Singapore since 1985 and the role of designated factory doctors, as well as the progress of the system, problems and issues involved. The basic objective of the system is to ensure that workers in special risk occupations are fit for such work. Factory workers exposed to any of 14 prescribed hazards must undergo specific medical examinations and tests by designated factory doctors who are trained and registered with the Labour Ministry. Abnormal work-related cases are notified to the Ministry for further investigation. Currently there are 330 designated factory doctors and each year, over 38,000 workers are examined, 88 per cent for noise exposure. The system provides opportunities for early detection of both occupational and non work-related abnormalities, individual counselling and timely preventive action. It also complements industrial hygiene monitoring activities in the evaluation of health hazards and promotes self-regulation. To enhance the effectiveness of the system, the doctors must be properly trained and some degree of supervision is needed, particularly with regard to accuracy and interpretation of laboratory results, emphasis on counselling and re-orientation and updating of knowledge.

An epidemiological study was carried out in three textile mills of Ahmedabad. A total of 214 cotton dust exposed and 184 control subjects were examined for pulmonary function tests. Pulmonary function tests included forced vital capacity and forced expiratory volume in one second. The pulmonary function tests were carried out before starting the shift and after 7 hours of exposure on a vitalograph spirometer. The study shows that among the cotton dust exposed workers byssinotics behave distinctly and show the maximum acute and chronic changes in pulmonary functions. It seems that the effect of cotton dust exposure on the byssinotic subjects is more predominant than the effect of smoking.

Sixty-one male spice grinders from 14 factories were studied to determine if they had any skin problems, respiratory symptoms or hearing loss associated with their work. All subjects were interviewed and examined. Audiometric examinations were arranged for those with significant noise exposure. Assessments of dust and noise levels were conducted. Symptoms of upper respiratory tract irritation, such as sneezing and runny nose, during work were experienced by 49.2 per cent of workers. These symptoms were maximal in the first few weeks of employment in spice grinding and did not recur in half of the affected workers. Over 26 per cent of the workers experienced a warm or burning sensation of the skin when grinding chili or pepper. None of the spice grinders had symptoms or evidence on physical examination of allergic skin disease or asthma. Noise-induced hearing loss was detected in 21 per cent of the workers examined but none had severe disabling deafness. Dust levels ranged from 0.03 to 0.82 mg/m3, with a mean value of 0.15 mg/m3. Noise exposure was significant, with levels of between 87 and 98 dBA. Control measures to reduce the noise and dust exposure are discussed.

The operational structure of public transport will not change within the next ten years. The need is demonstrated for research to help improve the working environment, eliminate hazards and enable more effective deployment of staff to meet increasing demand on the industry.

Four cases of overt hypothyroidism, three of whom were men in their early forties, had occurred over a period of 6 years at a textile factory where thiourea and resorcinol were used in the finishing departments. A follow-up survey of 189 men and 48 women (44 per cent of employees) revealed 12 new cases of varying grades of hypothyroidism, categorized after the system proposed by Evered. These included a case of mild hypothyroidism in a male worker, who subsequently received thyroid hormone replacement therapy as a hospital out-patient. A full occupational hygiene survey was carried out to determine possible sources of exposure to thiourea and resorcinol. Although we were unable to demonstrate a statistically significant occurrence of biochemically and immunologically detectable disturbances in thyroid function among this workforce, we did note that three of the original index cases and several of those workers with varying degrees of minor dysfunction in the follow-up study seemed to cluster in locations where exhausted fumes could accumulate.

Hospital workers (509) in a health authority were surveyed, and asked if they were in contact with HIV positive or AIDS patients; about their perception of risk; of their knowledge about and attitudes towards HIV and AIDS problems at work; and their desire for more information about AIDS and HIV. Overall scores for level of knowledge and attitudes were calculated; clinical workers scored better than non-clinical workers. Following the first survey, an information booklet was distributed to all health authority staff and after distribution, 232 staff were surveyed again. In this group (the follow-up group), there was a reduction in perceived risk, an improvement in the level of knowledge and in attitudes, and a reduction in the desire for further information. The group who initially had the least level of knowledge and most unfavourable attitudes (non-clinical workers) were the group who improved most.

The attitude of 126 occupational physicians to the employment problems of patients with intestinal stomas were assessed by a postal questionnaire. Heavy work and work in hot places were commonly (65 and 49 per cent of respondents respectively) considered 'unsuitable'. Work as a food handler, handling toxic chemicals and driving duties was thought to be 'unsuitable' by 35, 14 and 10 per cent of respondents respectively and actually forbidden by a few physicians. Risk of spread of infection was perceived to be greater than normal for someone with a stoma by 28 per cent of respondents. This attitude was significantly more common (p less than 0.05 Chi square) among the associate members compared to full members of the Faculty of Occupational Medicine. Attitudes to people with either an ileostomy or a colostomy were similar. Most respondents (87 per cent) expected more sickness absences than normal for people with inflammatory bowel disease without a stoma but half appreciated that the creation of a stoma would result in normal amounts of sickness absence. The Occupational Physicians' views of which jobs within their industry were unsuitable for stoma patients were inconsistent. In practice most tasks can be performed normally by someone with a stoma so that each case should be assessed on an individual basis. There is a need for greater understanding and awareness by doctors of the good employment potential of people with intestinal stomas. The reasons for present attitudes are reviewed and new guidelines suggested.

Oncogene protein detection may be a valuable molecular epidemiological marker of commitment to the carcinogenic pathway in worker populations exposed to carcinogens. This paper reports the use of serum immunoblotting with monoclonal antibodies to oncogene proteins to screen hazardous waste workers with potential carcinogen exposure who employ state-of-the-art work practices and personal protective equipment to minimize real exposures. Two individuals in this cohort were found to be trace positive for the ras oncogene protein in their serum, but this may have been due to their cigarette smoking. These results are contrasted to previous results in hazardous waste workers with real workplace carcinogen exposures.