The Journal of the Society of Occupational Medicine最新文献

Out of a cohort of 1200 apprentices in Switzerland, 781 boys and 417 girls completed a questionnaire on their perceived health and health problems in their selected apprenticeship. Each participant was interviewed afterwards by the school nurses in three state-owned professional schools where the apprentices attended their classes. Ninety-five per cent of the respondents enjoyed excellent health, 28 cases had nervous system or psychological problems, 17 cases had problems of a locomotor nature, 12 subjects had gastrointestinal or endocrinological symptoms, and there was one with a past history of a malignant disease. Twelve cases also had respiratory symptoms or diagnoses. One hundred and nineteen apprentices reported that they had been troubled by the workplace. Exposure to solvents, chemicals in general, dust, smoke and noise were often mentioned as causes. Thirty-eight of them had contacted their family physician in connection with these problems. The cohort had experienced, mostly during their first year, 191 cases of accident necessitating medical care. Cuts, shocks and falls were the most common occurrences. Meat cutters and butchers had the highest frequency of accidents. Near-accidents had been experienced so far by 46 per cent of the respondents. At the interviews, school nurses provided counsel and intervened in flagrant cases of occupational risks. It seems that an ordinary medical certificate does not predict accident-proneness or possible medical problems, while in-school health programmes could provide rapid intervention and support.

To assess the attitude of General Practitioners towards Occupational Health Services in the NHS and industry, a questionnaire was sent to 63 GPs with a response rate of 83 per cent. The majority of GPs felt that Occupational Health Departments acted in the best interests of their patients; but felt that occupational physicians sometimes meddle in primary care. The views of GPs on the acceptability of occupational health involvement in health screening, education and specific vaccinations was varied, with enthusiasm for health education and very limited screening, but little enthusiasm for vaccinations. The overall view of occupational health was positive, but specific areas of communication and overlap of function need to be explored in more depth. The new GP contract places specific requirements on GPs to undertake health screening and to reach targets for vaccination and cervical cytology. If the quality of the interface between occupational health services and primary care can be improved, both specialties would benefit.

Work-associated back problems are a major problem in the British National Health Service. Attempts to reduce the problem can only be judged when effective measuring and monitoring systems are available. This article highlights the problems associated with some currently available systems and describes a new system developed especially for the health service. Examples of the use of the new system are given to demonstrate its potential.

A 42-year-old, previously healthy man, developed dizziness and headaches. A CT scan revealed areas of demyelination in the left temporal lobe. He had been exposed to large amounts of organic solvents for most of his working life and as other possibilities could be excluded it was suspected that this was the cause.

The period from 1 January 1980 to 31 December 1989 produced a total of 244 training and operational diving accident reports involving Royal Navy and Royal Marines personnel. Because the incidence figures fluctuated widely year by year, a clear trend over the decade failed to emerge. However, the incidence of Type II decompression sickness, as a percentage of total decompression sickness, was greater in the second half of the decade than in the first, a trend similar to, although more moderate than, recent experience of dysbaric illness amongst sport divers. Student divers were disproportionately highly represented in the statistics, particularly with regard to pulmonary barotrauma and near-drowning.

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.

Workers in developing countries face as many, if not more, work-related health problems as their counterparts in industrialized nations. This paper concentrates on occupational health problems in the sugar industry, which exists in 40 countries, mostly in the Third World. Sugar cane workers have a high level of occupational accidents and are exposed to the high toxicity of pesticides. They may also have an increased risk of lung cancer, possibly mesothelioma. This may be related to the practice of burning foliage at the time of cane-cutting. Bagassosis is also a problem specific to the industry as it may follow exposure to bagasse (a by-product of sugar cane). The workers may also be affected by chronic infections which reduce their productivity. The legal framework for their protection is often inadequate. In conclusion, areas of future research are suggested.

Workers who process raw silk are exposed to a fine dust derived from the gum that binds the strands secreted by the silkworm. Fifty-three such workers, all women and non-smokers with an average of 5.8 years of service in the industry, were examined. Eighteen (33.9 per cent) workers had occupational asthma, the highest proportion (48.2 per cent) being in those twisting silk. A lower prevalence (20.0 per cent) was found in workers in the degumming sector, while the least (16.6 per cent) was in weavers. This declining prevalence in the three processing stages appears to be in line with their declining exposure to dust. The occupational asthma was of the intermediate and late types occurring 30 minutes to 6 hours after starting work and subsiding 1 to 8 hours after leaving the factory.

The creation of over fifty consultant posts in occupational medicine in the National Health Service in the last few years has paved the way for the development of occupational health research in the health services in the United Kingdom. General research topics that await further study include: health inequalities amongst health care workers, the Sick Doctor and Sick Nurse; job stress, back problems, pregnancy, and infection risks from blood. Topical specific hazards include glutaraldehyde, cytotoxic drugs, nuclear magnetic resonance imaging, and implications of new technology in surgery. The coordination of databases across different district health authorities would create large populations for epidemiological research, such as the surveillance of sentinel diseases, the delivery of occupational health services and vaccination strategies. Occupational health should be seen as an integral part of delivering health care and adequate funding for occupational health research should be made available.