Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

乌鲁木齐空港口岸化学恐怖事件应急处置演练情况分析

目的积极应对我国西北边境口岸日益严重的恐怖威胁,加强乌鲁木齐机场口岸应对化学恐怖事件的处置能力。方法按照《有害气体泄漏事件应急处置演练脚本》,启动《核生化突发公共卫生事件应急处置预案》,通过合理安排,多部门协作,展开对涉恐化学泄漏事件的应急处置演练。结果演练过程基本按照《演练脚本》的预定规程进行,通过演练提高了口岸检验检疫部门相关人员的专业水平和应对能力。结论现有《核生化突发公共卫生事件应急处置预案》的实用性得到了检验,检验检疫人员以往的培训成果得以发挥,同时在演练现场也暴露出若干问题,如：部分仪器过于老旧,预案体系完整性不足等,需要进一步加强完善。     

Incidence and suspected cause of work-related musculoskeletal disorders, United Kingdom, 1996-2001

BACKGROUND: Musculoskeletal conditions are the most common self-reported work-related disease, with high costs incurred from long-term disability. In the United Kingdom, occupational physicians and rheumatologists have been reporting new cases of work-related musculoskeletal disorders to voluntary surveillance schemes since 1996. AIMS: To estimate population incidence rates for work-related musculoskeletal disorders reported by rheumatologists and occupational physicians by occupation and industry, in relation to tasks and movements suspected as causal. METHODS: Estimated average annual incidence rates were calculated for nine main job categories and eight industrial groups; Labour Force Survey figures were used as the denominator for rheumatologists, and a special survey for the occupational physicians. These were then related to tasks and movements reported as causal. RESULTS: Between October 1997 and the end of 2001, an estimated 2,599 new cases/year were reported by rheumatologists, and from January 1996, 5,278 cases/year by occupational physicians. Average annual rates overall were 94 per million for rheumatologists and 1,643 per million for occupational physicians (a 17-fold difference). Jobs at highest risk for the upper limb were primarily clerical, craft-related and machine work. Tasks associated with upper limb disorders and with neck and back problems were predominantly keyboard work and heavy lifting, and in craft-related occupations with gripping or holding tools. CONCLUSIONS: Jobs at risk and the associate tasks were identified which should assist prevention, but the extent to which these factors were causal or aggravating previous injury requires further study. The much higher rates reported by occupational physicians reflect, in part, the type of industries they served.     

Chronic fatigue syndrome and occupational health

Chronic fatigue syndrome (CFS) is a controversial conditionthat many occupational physicians find difficult to advise on.In this article we review the nature and definition of CFS,the principal aetiologic hypotheses and the evidence concerningprognosis. We also outline a practical approach to patient assessment,diagnosis and management. The conclusions of this review arethen applied to the disability discrimination field. The implicationsof the new UK occupational health legislation are also examined.Despite continuing controversy about the status, aetiology andoptimum management of CFS, we argue that much can be done toimprove the outcome for patients with this condition. The mosturgent needs are for improved education and rehabilitation,especially in regard to employment. Occupational physiciansare well placed to play an important and unique role in meetingthese needs.     

The history of woolsorters' disease: a Yorkshire beginning with an international future?

Woolsorters' disease was a feared industrial disease associated primarily with Yorkshire's textile industry of the nineteenth and early twentieth centuries. Early occupational health methods were attempted locally before concerted national efforts produced legislative measures. When its link with anthrax was established, attention in prevention focused upon chemical disinfection methods. Together, these factors were instrumental in decreasing the incidence of woolsorters' disease. However, by the beginning of the Second World War, the lack of treatment options for anthrax meant that the bacterium was experimented upon as a potential war-winning weapon. Today, woolsorters' disease and other industrial manifestations of anthrax are extremely rare, but the increasing threat of bioterrorism means that the international dread and historical lessons of this significant condition should never be forgotten. Consequently, this paper reveals the history of woolsorters' disease in order to remind those involved in occupational medicine today of the dread it caused both physicians and workers in previous generations.     

SWORD '95: Surveillance of Work-related and Occupational Respiratory Disease in the UK

An estimated 2,741 new cases of occupational respiratory diseaseswere reported by chest and occupational physicians in 1995.Total cases reported by ‘core’ chest physiciansand occupational physicians have risen but cases reported by‘sample’ physicians have fallen by 32%, reducingthe estimated total overall by approximately 16% from 1994.Steps are being taken to reverse this downward trend. Occupationalasthma remains the single most frequently reported disease ofwhich more than two thirds of cases were attributed to sensitization.Non-malignant pleural disease was the next most frequently reported,with pleural plaques predominating in 71% of cases. In a studyof a selected sample of 158 cases of non-malignant pleural disease,81 (51%) were seen for medico-legal reasons; of the remainder13% had signs or symptoms ascribed to the disease.     

Customer health: a new role for occupational physicians

BACKGROUND: Many employees are required to travel by air as part of their work, and occupational physicians may be asked to give travel health advice and to carry out risk assessments. AIMS: This review examines the stresses of air travel, including those due to travel to and transit through the airport, as well as those arising from the aircraft cabin environment. Guidance is given on the potential effects of these stressors, particularly on those with certain underlying medical conditions, and advice given on how to mitigate some of the effects. Finally, the review looks at in-flight medical incidents and recent developments in in-flight medical care. CONCLUSION: Despite the stresses of air travel, most people are able to fly safely. Some individuals are more vulnerable to these stresses and occupational physicians have an important role in ensuring that an appropriate risk assessment is carried out.     

Are tribunals given appropriate and sufficient evidence for disability claims?

BACKGROUND: Occupational physicians are sometimes surprised at the decisions made by employment tribunals. AIM: To assess employment tribunal judgements on disability discrimination in order to determine whether the evidence placed before the tribunal was appropriate and sufficient. METHOD: Qualitative review of recorded tribunal judgements for an 18-month period between 1 January 2005 and 31 June 2006. RESULTS: Of a total of 2497 cases, 2271 (91%) were withdrawn or settled before going to tribunal. Of the remaining 226 cases, 38 were default judgements. In total, 188 cases were actually heard and only 65 judgements were recorded. Of these, 50 (2% of all cases) were full hearings. In 18 full hearings, there was input from an occupational physician, and the tribunal view was that there was discrimination in six cases, four where the advice had been ignored. Only four cases had input from a consultant occupational physician; in three cases, the finding was that discrimination had not taken place and in the fourth, the advice from the consultant was ignored by the management.     

Improving mental well-being in the workplace

Occupational physicians, who are in a key position to influencecompany policy on mental health, have limited access to educationon mental health. This paper discusses the results of a postalsurvey of occupational physicians that was designed to identifythe mental health information needs of occupational physicians,determine the way in which this information should be disseminatedand measure the extent to which occupational physicians encountermental health problems in the workplace.     

Diagnosing and reporting of occupational diseases: a quality improvement study

AIM: To assess the need for quality improvement of diagnosing and reporting of noise-induced occupational hearing loss and occupational adjustment disorder. METHODS: Performance indicators and criteria for the quality of diagnosing and reporting were developed. Self-assessment questionnaires were sent to all occupational physicians recorded on the Netherlands Centre for Occupational Diseases database. The performance of responding occupational physicians was then assessed by separate scores per performance indicator and by a total quality score. RESULTS: Twenty-three questionnaires on noise-induced occupational hearing loss and 125 questionnaires on occupational adjustment disorder were available for analysis. The mean quality score for diagnosing and reporting was 6.0 (SD: 1.4) for noise-induced occupational hearing loss and 7.9 (SD: 1.5) for occupational adjustment disorder on a scale of 0-10. For noise-induced occupational hearing loss, there was a need for quality improvement of the aspects of medical history, audiometric measurement, clinical diagnosis of the disease and reporting. For occupational adjustment disorder, the assessment of other non-occupational causes needed improvement. CONCLUSIONS: The quality of diagnosing and reporting could be improved for noise-induced occupational hearing loss and occupational adjustment disorders. Information, education and practical tools are proposed for quality improvements.     

Sexual health and HIV in travellers and expatriates

Travellers engaging in sexual contact with a new partner abroad may be at high risk of acquiring a sexually transmitted infection. This review examines the impact of travel on sexual health and provides prevention, management and treatment recommendations to practising occupational health physicians.     

Joint effects of smoking, noise exposure and age on hearing loss

BACKGROUND: Smoking has been shown to have adverse effects on hearing, but it's unclear whether smoking interacts with known causes of hearing loss such as noise exposure and ageing. AIMS: To examine the hypothesis that smoking, noise and age jointly affect hearing acuity. METHODS: This cross-sectional study was carried out in 535 male adult workers of a metal processing factory. Pure-tone audiometric tests were utilized to assess hearing loss. Noise exposure assessment was based on a job exposure matrix constructed with industrial hygienist scoring and job titles. Each participant answered questionnaires about socio-demographic, life-style, occupational and health-related data. Analysis of the possible underlying biological model was undertaken assessing departures from additivity using measures of the size of the interaction present. RESULTS: Age and occupational noise exposures were, separately, positively associated with hearing loss. For all the factors combined the estimated effect on hearing loss was higher than the sum of the effects from each isolated variable, especially for smoking and noise among those 20-40 years of age, and for smoking and age among those non-exposed to occupational noise. CONCLUSIONS: The synergistic effect of smoking, noise exposure and age on hearing loss, found in this study, is consistent with the biological interaction. Furthermore, it is possible that distinct ototoxic substances in the chemical composition of mainstream smoke may synergistically affect hearing when in combination with noise exposure, which needs to be examined in future studies.     

Improved communication between doctors and with managers would benefit professional integrity and reduce the occupational medicine workload

BACKGROUND: Professional expectations for communication skills are explicit. These skills are needed for professional integrity and personal morale. Nevertheless, occupational physicians see doctors as patients for whom communication among between doctors and with their managers are the principal cause of their presenting health problems. AIM: To describe the frameworks of professionalism in medicine and the duty to care for good communication; present issues surrounding competency in communication skills; identify health problems among doctors associated with poor communication; and consider roles of economic appraisal and preventive strategies. METHOD: A literature review identified key publications of professional expectations and requirements of doctors for their communication skills. Health problems among doctors associated with poor communication and presenting at least twice in a National Health Service (NHS) occupational health (OH) department during January-December 2002, were sought by manual retrieval of all doctor-patient records. The categories of communication difficulty were agreed in the focus group discussion of the presenting problems with occupational physicians. RESULTS: Nine categories of communication difficulties among doctors resulting in their presentation in OH departments with health problems were identified. CONCLUSIONS: Personal health problems caused by poor communication involve considerable time and potential litigation costs. Doctors need to be reminded of their responsibilities. Opportunity cost studies would help to strengthen an evidence base for the need of doctors to adhere to the professional requirements of good communication skills.     

Work-related infectious disease reported to the Occupational Disease Intelligence Network and The Health and Occupation Reporting network in the UK (2000-2003)

BACKGROUND: Infectious diseases remain an important cause of self-reported work-related illness, with socio-economic consequences, including sickness absence. Reporting of infectious disease by occupational and specialist physicians is an important tool in the investigation of occupationally related infections and is relevant in their management. AIMS: To examine the reporting of cases of infectious disease by occupational and specialist physicians to schemes collecting data on occupational ill-health. METHODS: Cases of infectious disease reported by occupational and specialist physicians to the UK based schemes, Occupational Disease Intelligence Network (ODIN) and The Health and Occupation Reporting network (THOR), from 2000 to 2003 were analysed by reporting patterns, diagnosis, single case or outbreak reporting and industry. RESULTS: The total number of estimated cases of infectious disease reported to ODIN and THOR from 2000 to 2003 was 5606; 74.9% cases were diarrhoeal disease, and 11.1% scabies. The majority (81.4%) of cases were reported in SIDAW, where the participation rate for reporters was 55%. Reporting rates were much higher in OPRA, SWORD and EPIDERM (ranging from 86 to 96%). The most frequently reported industrial sectors were social care (39.5%) and health (29.4%); while the manufacture of chemical products contributed 4.3% overall, but 33.8% to estimated cases in OPRA. CONCLUSIONS: Despite limitations related to under reporting, the occupational and specialist physician schemes in ODIN and THOR provide data that may be used to look at patterns of case reporting for occupational ill-health, including infectious disease. The reporting schemes also provide an important means of alerting peers about potential novel causes, precipitating factors, or industrial sectors associated with occupational disease.     

Surveillance of Australian workplace Based Respiratory Events (SABRE): notifications for the first 3.5 years and validation of occupational asthma cases

AIMS: In Australia, the SABRE programme, a notification scheme, has been established to collect incidence data on occupational lung disease. This paper reports the first 3.5 years of this scheme and the results of an occupational asthma validation study. METHODS: A notification form is mailed regularly to thoracic physicians and occupational physicians in the Australian states of Victoria and Tasmania, who use this to report new cases of occupational lung disease. The validation study was performed by a blinded panel of two doctors, who reviewed information extracted from the medical files of a sample of reported cases of occupational asthma. RESULTS: A total of 520 diagnoses were reported. The mean (+/- SD) age of the 448 patients notified was 55.7 +/- 16.2 years. There were 394 (88%) males and 54 females. The most common single condition was asthma for which the most common causative agent was wood dust. However, the most commonly reported agent overall was asbestos. The validation study of occupational asthma found only fair agreement (kappa = 0.4) between the panel and notifying doctors. However, agreement was better (kappa = 0.5) when the analysis was restricted to those cases where the reporting doctor considered the likelihood of the diagnosis was high. CONCLUSIONS: Occupational asthma is the most common occupational respiratory condition reported, which suggests increasing importance for this disease over more traditional forms of occupational lung disease. The validation study suggests that such schemes should restrict notifications only to those cases where the likelihood of the diagnosis is considered high.     

International community efforts in prevention of nuclear terrorism

Terrorism is now a global threat, spreading its shadows over regions which were previously regarded as the exclusive domain of the military superpowers. One of the prime threats is nuclear terrorism, using nuclear or radiological agents. To assess the threat, it is important to include all factors that make it possible. A nuclear terrorist attack can be conducted in three basic ways, by detonation of a nuclear weapon, by sabotage or diversion of a nuclear facility or by dispersion of radioactive material into the environment (radiological weapon). Each possibility is specific and with different consequences. Nuclear terrorism can be prevented by establishing a global system which requires from all countries to strictly follow international rules of trading, storing and using nuclear and radioactive materials and to produce an efficient national legislation. The United Nations have provided a basis for such legislation in the form of the International Convention for the Suppression of Acts of Nuclear Terrorism.     

Addressing the psychosocial and communication challenges posed by radiological/nuclear terrorism: key developments since NCRP Report No. 138

One of the most innovative aspects of NCRP Report No. 138 (Management of Terrorist Incidents Involving Radioactive Material) was the high priority it accorded to psychosocial and communication issues. While previous discussions of radiological and nuclear terrorism had occasionally referred to these topics, NCRP Report No. 138 was the first report of its kind to recognize the profound challenges posed by these issues and to place them at the heart of preparedness and response efforts. In the years since the report's release, a host of important developments have taken place in relation to psychosocial and communication issues. This paper reviews key changes and advances in five broad areas: (1) training exercises, (2) policy and guidance development, (3) findings on hospital and clinician needs, (4) survey research on public perceptions of radiological terrorism, and (5) risk communication for radiological and nuclear terrorism situations. The article concludes with a discussion of continuing psychosocial and communication challenges, including critical areas needing further attention as the nation moves to meet the threat of terrorism involving radioactive materials.     

Disability management through positive intervention in stakeholders' information asymmetry. A pilot study

BACKGROUND: One increasingly attractive hypothesis to account for prolonged sickness absence from work is the presence of 'information asymmetry' among stakeholders. Information asymmetry refers to a situation in which critical information is not (appropriately) exchanged, in this case among those involved in disability management. AIM: The purpose of this study was to intervene positively in the information asymmetry that currently exists between social insurance physicians and occupational physicians in Belgium. METHODS: We developed a novel model aimed at improving information exchange, and a pilot study protocol based on the model. Our first objective was to investigate feasibility of implementing the study protocol. Our second and main objective was to obtain preliminary results on whether improving information exchange between physicians would facilitate work resumption of employees out on sickness absence. RESULTS: Of 126 patients recruited, 91 were eligible and assigned to one of two groups: a control group, whose physicians used the standard Belgian evaluation protocol, and an intervention group, whose physicians used our new protocol. Outcome parameters from the 15 patients assigned to the intervention group revealed that enhanced inter-physician information exchange produced favourable work resumption rates (73%), suggesting that both the model and study protocol show promise. CONCLUSIONS: The issue of sharing information among all stakeholders involved in disability management is an important one. Moreover, professional reintegration of employees after a sickness absence is universally important to occupational health practitioners. Our preliminary results suggest that reducing information asymmetry among physicians should be investigated further in larger intervention trials.     

Incidence by occupation and industry of work-related skin diseases in the United Kingdom, 1996-2001

BACKGROUND: Work-related skin disease is common but few cases are documented in statutory reports or disability systems. Voluntary reporting by specialist physicians provides more complete information. AIMS: To summarize incidence rates of work-related skin diseases reported by consultant dermatologists and occupational physicians, with emphasis on contact and allergic dermatitis by occupation and industry. METHODS: Cases reported in 1996-2001 to the EPIDERM and OPRA national surveillance schemes were analysed by causal agent, occupation and industry, with incidence rates calculated against appropriate denominators. RESULTS: Average annual incidence rates based on data from dermatologists were 97 per million overall, 74 for contact dermatitis and 14 for neoplasia. The corresponding rates for occupational physicians were 623 overall, 510 and 2, respectively. For infective disease, the rates for occupational physicians were 28 compared to 2 for dermatologists. Contact dermatitis was most frequently attributed to rubber chemicals, soaps and cleaners, wet work, nickel and acrylics; most cases of contact urticaria were attributed to rubber chemicals or foods and flour. The pattern of incidence rates by occupation and industry was complex, but correlated with the probable type of exposure. Rates of contact dermatitis were highest among skilled workers in the petrochemical and rubber and plastic manufacturing industries, with machine operators and technical workers in metal and automotive industries also at increased risk. High proportions of cases attributed to rubber chemicals were in nurses and technicians in the health and social services. CONCLUSIONS: These findings identify jobs and types of work where contact with causal agents is common and potentially preventable.