The Journal of the Society of Occupational Medicine最新文献

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.

In this study a systematic method for workplace investigation was developed and then tested as part of the regular occupational health care procedures in the building trade. Workplace investigation is a concept which entails the analysis of hazards inherent in the work as well as assessment of their effects on workers' well-being. The aim of this paper is to evaluate the effectiveness of the workplace investigation method. The newly developed method, called Job Load and Hazard Analysis, has the following characteristics: a job analytic approach; the application of group problem-solving; and cooperation between occupational health professionals, occupational safety personnel, and line management. The method comprises the identification of health hazards, their assessment, and conclusions and proposals as to their prevention and follow-up. The method was tested as part of one constructor's actual occupational health care programme, over a 2.5-year period. The method worked well as a central component of preventive occupational health care. It yielded concrete data that could be applied to make the occupational health care programme better suited to preventing the hazards inherent in the building trade. The contents of the occupational health care programme were clearly enhanced, the number of preventive measures increased, and the organizational climate improved; the workers praised the increased emphasis on safety. More research is needed, eg in other production settings and to determine the most effective utilization of the data gathered by the method.

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.

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)

This paper reports on the findings of a cross-sectional study of 79 data entry clerks employed by an Ontario-based organization in five separate offices. The study was conducted to identify factors associated with physical complaints experienced by these office workers. A large percentage of the data entry clerks reported chronic physical complaints (eyestrain, musculo-skeletal pains, headache) as well as emotional or mental stress which they felt were associated with their occupation. Poorly designed overhead lighting systems in all offices contributed to both eyestrain and headache. Duration of employment as a data entry operator within the organization was not associated with stress or physical health complaints. The presence of an adjustable workstation did not in itself guarantee any protection from these conditions. Highly significant associations between occupational stress levels and some physical complaints were observed. The presence of these associations indicated that the management of both physical and stress complaints within these office environments should be tackled simultaneously.

Thirteen workers with persistent abnormalities in one or more liver function tests (LFT) at a vinyl chloride monomer (VCM) polymerization plant were investigated. Twelve workers were found to have VCM-induced liver dysfunction based on circumstantial evidence. They were employed between 1971 and 1982 when the VCM levels ranged from 1 to 21 p.p.m. After 1982 when the environmental VCM levels were controlled to below 1 p.p.m., no cases of VCM-induced liver dysfunction were detected. In most cases, glutamic pyruvic transaminase was the earliest parameter to be raised. The second most common parameter is serum gamma glutamyl transpeptidase. The latent period ranged from 1 to 13 years. An improvement in their LFT results was shown by 83.3 per cent of workers within 6 months to 2 years after removal from further VCM exposure. For workers who returned to VCM work, their LFT became abnormal again. Liver scans showed hepato and/or splenomegaly in most cases. Liver biopsies on 9 workers were reported as 'non-specific fatty changes' of varying degrees. These observations highlight the need for continual vigilance with environmental monitoring and medical surveillance of VCM-exposed workers.