The Journal of the Society of Occupational Medicine最新文献

A cohort of 501 workers in a steel mill in Ontario, Canada was followed up from 1974 to 1986 for 13 years. Results indicate that the 13-year cumulative incidence of urological diseases among workers who had a positive urinalysis result of microscopic haematuria at the beginning of the follow-up period (1974) was 1.3 times that of those who had a negative urinalysis result (95% confidence interval 0.6-2.8). This relative risk remained the same after adjusting for age and smoking. This indicates that there is a possibility that urinary screening for microscopic haematuria could be a useful predictor of urological disease occurrence. However, the benefits of early detection and management were difficult to demonstrate. Serious urological diseases, particularly urinary cancers, were not detected earlier as a result of the urinary screening test in this study. Several studies have been done to validate the test in the past. More work to validate the test and to determine the predictive accuracy is recommended.

Simulator sickness describes a symptom reported by aircrew during or after flight simulator training. Some features are common to motion sickness but others, which are unusual during real flight, are believed to result specifically from the simulator environment. This paper describes the results of a questionnaire study examining the incidence and factors influencing simulator sickness in any army training system. Case histories are described and conclusions drawn with respect to health and safety, training and the effect on flight operations. One hundred and fifteen aircrew were registered in the questionnaire study. Data were collected from a history questionnaire, a post-sortie report and a delayed report form. Sixty-nine per cent of aircrew gave a history of symptoms in the simulator and 59.9 per cent experienced at least one symptom during the study period although few symptoms were rated as being other than slight. Only 3.6 per cent of subjects reported symptoms of disequilibrium. Comparative analysis of the results was performed after scoring symptoms to produce a sickness rating. This showed: association between simulator-induced sickness and greater flying experience; adaptation to the simulator environment; a history of sea sickness may predict susceptibility to simulator sickness; and no association of crew role and simulator sickness. Although some authorities believe simulator sickness to be a potential flight safety hazard there was little evidence from this study. Guidelines for the prevention of the problem are presented now that many factors have been identified. A general policy to 'ground' aircrew for a period following simulator training is not necessary, but severe cases should be assessed individually.

There is an increasing awareness of the need for medical audit. A method for peer review medical audit that has been applied to two large industries is described. Occupational physicians act as auditors of randomly selected case notes from their colleagues' list of consultations using an agreed proforma as a guideline. Open discussion by the occupational physician of the auditor's comments identifies needs, such as for a change on policy or further education. Implementation of the agreed changes and subsequent review completes a cycle of audit.

In the spring of 1984, British Airways was involved in a major food poisoning outbreak which affected nearly 1000 passengers, aircrew and ground personnel. The operational impact was worldwide and could have resulted in the cessation of the airline's day-to-day operations. The investigation paralleled a major aircraft disaster in the number of national and international agencies involved and in the variety of disciplines engaged. Although the causative organism was rapidly identified (salmonella), and its introduction into the food chain proved to be a key factor, the scale of the outbreak was the result of an interaction of other factors. As with a major aircraft accident, none of the factors alone would have caused the near disaster that occurred.

A short anxiety and depression questionnaire developed by Goldberg et al. was applied to 796 employees of an oil company operating offshore in the North Sea. Anxiety and depression scores were compared in offshore staff and their onshore counterparts at different levels of seniority. These scores were taken to be indicators of stress levels. No statistically significant differences in anxiety or depression scores were identified between groups working onshore or offshore.

This paper deals with the occupational health and hygiene advice that was given in the immediate aftermath and clean-up period of a major fire in a large warehouse with an asbestos cement roof. Work on site was carefully monitored and we believe that no health hazards occurred subsequent to the fire, in particular only very low levels of asbestos were detected during the clean-up. In addition, the need to disseminate information as widely and as rapidly as possible to the workforce and others following such a disaster is emphasized.

Of 79 male Post Office employees in the UK undergoing first coronary artery bypass grafting in 1984 and 1985, 78 per cent resumed work, most within 2-6 months. By the end of the follow-up period (median 550 days) 65 per cent were working, 84 per cent of them normally. Prior to surgery 38 per cent had been able to work, 76 per cent of them normally. Return to work was more likely in younger employees and in those working until admission for surgery or who had only a short period off before surgery. A previous myocardial infarction made little difference to the likelihood of returning to work after surgery or continued working. The effect of type of work on work capability before and after surgery was also studied. All differences could not be related to physical demands of the job. Motivational and socioeconomic factors may have accounted for some differences.

A new technique for detecting oncogene activation based on immunoblotting for oncogene proteins in serum has been applied to screen a cohort of foundry workers with well-defined workplace exposures to polycyclic aromatic hydrocarbon carcinogens. Three of the 18 individuals screened were found to have abnormal expression of the proteins of the ras and fes oncogenes. These three individuals were known to have had medium to high workplace exposures to benzo(a)pyrene and to have correspondingly high levels of benzo(a)pyrene-DNA adducts in their peripheral leukocytes. No individuals among the unexposed controls were found to have abnormal serum oncogene protein expression. These results suggest the feasibility of using serum oncogene proteins along with DNA-carcinogen adducts as potential molecular epidemiological markers in exposed worker populations; further, larger scale studies will be necessary to demonstrate the utility of these markers for identifying individuals at risk for the development of malignant disease due to their occupational exposures.

Work-associated back problems are a major health issue for which the traditional approaches of manual skills training and worker selection have demonstrated little effect. The common alternative, direct ergonomics intervention, risks work group resentment and non-compliance problems. This paper describes a new ergonomics training approach which changes the role and content of training to facilitate staff and management collaboration.