Portrait professional

Most medical photographers, unless working as dedicated ophthalmic photographers or retinal screeners, will shoot portraits or publicity pictures. Many will spend a proportion of their time producing brochure shots for patient information material or their Trust's Annual Report. High-quality images of staff at work are often required by the strategic planning departments of Trusts to support bids for business from service commissioners. This "non-clinical" work is in reality commercial work - the jobs that high street portrait and general practice photographers would undertake in different settings. Medical photographers use many of the same tools as their commercial cousins. They use the same DSLR cameras and lenses. They use Adobe Photoshop to manipulate images. However, one software tool extensively used by portrait and social photographers, but possibly unfamiliar to many medical photographers, is Portrait Professional. Currently in its 10th version, it is produced by Anthropics Technology ( http://www.anthropics.com ), a London-based company specialising in image manipulation software.     

BOOK REVIEWS

Most medical photographers, unless working as dedicated ophthalmic photographers or retinal screeners, will shoot portraits or publicity pictures. Many will spend a proportion of their time producing brochure shots for patient information material or their Trust's Annual Report. High-quality images of staff at work are often required by the strategic planning departments of Trusts to support bids for business from service commissioners.

This “non-clinical” work is in reality commercial work – the jobs that high street portrait and general practice photographers would undertake in different settings.

Medical photographers use many of the same tools as their commercial cousins. They use the same DSLR cameras and lenses. They use Adobe Photoshop to manipulate images. However, one software tool extensively used by portrait and social photographers, but possibly unfamiliar to many medical photographers, is Portrait Professional. Currently in its 10th version, it is produced by Anthropics Technology (http://www.anthropics.com), a London-based company specialising in image manipulation software.     

Interactions between physical and psychosocial risk factors at work increase the risk of back disorders: an epidemiological approach

OBJECTIVES: To investigate the possible interactions between physical and psychosocial risk factors at work that may be associated with self reported back disorders. METHODS: 891 of 1514 manual workers, delivery drivers, technicians, customer services computer operators, and general office staff reported risk factors at work and back disorders with a self administered questionnaire (59% return rate). Of the 869 respondents with a valid questionnaire, 638 workers were classified in to one of four exposure groups: high physical and high psychosocial; high physical and low psychosocial; low physical and high psychosocial; and low physical and low psychosocial. Low physical and low psychosocial was used as an internal reference group. The exposure criteria were derived from existing epidemiological publications and models for physical and psychosocial work factors. The frequency and amplitude of lifting and the duration spent sitting while experiencing vibration were used as physical exposure criteria. Ordinal values of mental demands, job control, and social support from managers and coworkers were used as psychosocial exposure criteria. RESULTS: The highest increase in risk was found in the high physical and high psychosocial exposure group for symptoms of back disorders. In the crude and multivariate analyses, a departure from an additive risk model was found for the 7 day prevalence of symptoms of a low back disorder and also for a recurrent back disorder not present before the current job but also experienced in the past 7 days. CONCLUSION: This study suggests that an interaction between physical and psychosocial risk factors at work may exist to increase the risk of self reported back disorders. Ergonomic prevention strategies that aim to minimise the risks of symptoms of work related back disorders should not only focus on physical but also on psychosocial risk factors at work. The greatest benefits are likely to be realised when both physical and psychosocial factors are put right.       

Conceptual problems in identifying risk factors for functional decline in the elderly: a commentary.

Assessment of risk factors for chronic disease and disability among the elderly is a complex issue. Findings may be affected by the age at which the putative risk factor was measured, interval between the time of measurement of risk and outcome, possibility of changing patterns of exposure throughout the life span, and selective survival. We illustrate the complexity of risk assessment with findings from the Iowa 65+ Rural Health Study on the relationship between body mass and changing physical function. In baseline cross-sectional analyses, both high and low body mass were associated with poorer function. In 6-year longitudinal analyses limited to persons who were functionally intact at baseline, high body mass was associated with poorer lower-extremity function but relatively preserved upper-extremity function. High body mass was also associated with elevated rates of transient impairments. Extremes of teenage body habitus were associated with impaired physical function in old age. Function was poorest among those with a lifetime history of high body mass, and changes in body mass were complexly associated with subsequent function. Thus conceptual and analytic models of chronic illness and disability need to consider multiple, changing exposures over the lifetime, as well as the impact of illness, disability, and their treatment on subsequent risk factor exposure.     

From dermal exposure to internal dose

Exposure scenarios form an essential basis for chemical risk assessment reports under the new EU chemicals regulation REACH (Registration, Evaluation, Authorisation and restriction of Chemicals). In case the dermal route of exposure is predominant, information on both exposure and dermal bioavailability is necessary for a proper risk assessment. Various methodologies exist to measure dermal exposure, providing quantitative or semiquantitative information. Although these studies may provide very specific and relevant information, it should be realized that case by case in-depth exposure assessment would be a very expensive process. Dermal bioavailability data are most often obtained from in vitro studies or animal experiments. For the design of studies, which generate data relevant for chemical risk assessment, detailed information on the exposure conditions is crucial (skin surface exposed, exposure duration, dose and physical state of the chemical). Results from non-testing methods for skin absorption, such as (Q)SARs, have been used only to a very limited extent for regulatory purposes. Suggestions are made in order to extend the use these methods to dermal risk assessment of chemical substances, thereby improving the practicability of REACH.     

Work-related violence, lifestyle, and health among special education teachers working in Finnish basic education

BACKGROUND: Studies have reported higher levels of absenteeism due to illness among special education teachers compared to other teachers, but it is not known which factors might contribute to this difference. We examined whether health, health behaviors, and exposure to violence at work differed between special education and general education teachers in Finnish basic education. METHODS: Survey data from 5760 general and special education teachers were analyzed with multilevel logistic models adjusted for individual‐ and school‐level confounding factors. RESULTS: No difference was found between the health behaviors of general and special education teachers. The differences in physical and mental health between the two groups were also relatively small. With regard to work‐related violence, however, male special education teachers were 3 times more likely to be exposed to mental abuse, and 5 times more likely to be exposed to physical violence when compared to their male colleagues in general education. Although female special educators were also at an increased risk of mental abuse and physical violence compared to their female general teacher colleagues, their odds ratios for such an encounter were smaller (2‐ and 3‐fold, respectively) than those of male special education teachers. The school‐level variance of physical violence toward teachers was large, which indicates that while most schools have little physical violence toward teachers, schools do exist in which teachers' exposure to violence is common. CONCLUSIONS: These findings suggest that special education teachers may benefit from training for handling violent situations and interventions to prevent violence at schools.     

Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb

Objectives: To investigate potential interactions between physical and psychosocial risk factors in the workplace that may be associated with symptoms of musculoskeletal disorder of the neck and upper limb. Methods: 891 of 1514 manual handlers, delivery drivers, technicians, customer services computer operators, and general office staff reported on physical and psychosocial working conditions and symptoms of neck and upper limb disorders using a self administered questionnaire (59% return rate). Of the 869 valid questionnaire respondents, 564 workers were classified in to one of four exposure groups: high physical and high psychosocial, high physical and low psychosocial, low physical and high psychosocial, and low physical and low psychosocial. Low physical and low psychosocial was used as an internal reference group. The exposure criteria were derived from the existing epidemiological literature and models for physical and psychosocial work factors. The frequency and amplitude of lifting and the duration spent sitting while experiencing vibration were used as physical exposure criteria. Ordinal values of mental demands, job control, and social support with managers and coworkers were used as psychosocial exposure criteria. Results: In the multivariate analyses, the highest and significant increase in risk was found in the high physical and high psychosocial exposure group for symptoms of hand or wrist and upper limb disorders after adjusting for years at the job, age, and sex. A potential interaction effect was found for the symptoms of the hand or wrist and upper limb disorders but not for the neck symptoms. Conclusion: This study showed that workers highly exposed to both physical and psychosocial workplace risk factors were more likely to report symptoms of musculoskeletal disorders than workers highly exposed to one or the other. The results suggest an interaction between physical and psychosocial risk factors in the workplace that increased the risk of reporting symptoms in the upper limbs. Psychosocial risk factors at work were more important when exposure to physical risk factors at work were high than when physical exposure was low. Ergonomic intervention strategies that aim to minimise the risks of work related musculoskeletal disorders of the upper limb should not only focus on physical work factors but also psychosocial work factors.     

Risk assessment and health surveillance of pesticide workers

Occupational health has two main objectives: the protection of workers from health hazards associated with the working environment, and the promotion of workers' health. Fundamental aspects of health protection are health risk management, information and training, first aid and medical treatment. Risk management comprises risk characterization, and exposure assessment. Integrating information on the identified hazards and exposure levels, and assessing the likelihood and severity of health effects performs risk characterization. Health surveillance includes medical surveillance and biological monitoring. The physician in charge of the occupational health programme, taking into account the results of the risk assessment process should determine frequency and contents of periodical medical examinations. Pre-employment medical examinations should be carried out in order to determine the physical ability to do the job the candidate is recruited for. Periodical medical examinations are aimed at detecting, in an early and reversible phase, any adverse effect attributable to exposure. A worker should undergo a broad medical examination when returning to work after a significant illness. Records of occupational health programmes should be filed and kept for at least 30 years.     

Work-related asthma and implications for the general public

Asthma has been increasing over the last two decades in the United States. The onset of asthma has also been increasingly reported as a result of occupational exposures to over 350 different agents. Work-related asthma (WRA) has become the most frequently diagnosed occupational respiratory illness. Epidemiologic studies from the United States reported WRA incidence rates of 29-710 cases per million workers per year and suggest that 10-25% of adult asthma is work related. Much can be learned about asthma in the general population from investigations of asthma in the workplace. Surveillance of WRA continues to highlight an important role for low molecular weight chemical sensitizers, as well as high molecular weight antigens. Additionally, recent reports implicate mixed exposures, including commercial cleaning solutions, solvents, and other respiratory irritants, as well as contamination in nonindustrial environments, including schools and offices. Investigations of WRA have demonstrated a clear dose-related increase in sensitization and symptoms for exposures to both chemical and protein sensitizers. High proportions of exposed working groups can be affected. Skin exposures may affect the likelihood of individuals developing respiratory symptoms. Atopy increases the risk of sensitization and illness from workplace exposure to antigens but not to chemical sensitizers. Irritant exposures can act as adjuvants among individuals exposed to sensitizing substances, increasing the proportion who become sensitized. Atopy might also be a result of irritant exposures in some persons. Occupational asthma often has important long-term adverse health and economic consequences but can resolve completely with timely control of exposures. Detailed study of such asthma "cures" may prove useful in understanding factors that influence asthmatic airway inflammation in the general population.     

Study of self-reported hypersensitivity to electromagnetic fields in California

Cases of alleged hypersensitivity to electromagnetic fields (EMFs) have been reported for more than 20 years, and some authors have suggested some connection with the "multiple chemical sensitivity" illness. We report the results of a telephone survey among a sample of 2,072 Californians. Being "allergic or very sensitive" to being near electrical devices was reported by 68 subjects, resulting in an adjusted prevalence of 3.2% (95% confidence interval = 2.8, 3.7). Twenty-seven subjects (1.3%) reported sensitivity to electrical devices but no sensitivity to chemicals. Characteristics of the people reporting hypersensitivity to EMFs were generally different from those of people reporting being allergic to everyday chemicals. Alleging environmental illness or multiple chemical sensitivity diagnosed by a doctor was the strongest predictor of reporting being hypersensitive to EMFs in this population. Other predictive factors apart from self-reporting chemical sensitivity were race/ethnicity other than White, Black, or Hispanic; having low income; and being unable to work. The perception of risk of exposure to EMFs through the use of hair dryers (vs. exposure to power and distribution lines) was the factor the most associated with self-reporting about hypersensitivity to EMFs. However, risk perception was not sufficient to explain the characteristics of people reporting this disorder.     

Illness beliefs in schizophrenia

Beliefs about health and illness shape emotional responses to illness, health-related behaviour and relationships with health-care providers in physical illness. Researchers are beginning to study the illness beliefs of people with psychosis, primarily using models developed in relation to physical illness. It is likely that modifications to these models will be necessary if they are to apply to mental disorders, and it is probable that some of the assumptions underlying the models will be inappropriate. In particular, different dimensions of understanding may be present in mental illness in comparison to those identified in physical illness. The present study examines the beliefs of 20 patients in the UK diagnosed with schizophrenia, including 10 currently psychotic inpatients and 10 outpatients in remission, about their experiences, using qualitative interviews and thematic analysis. Patients currently experiencing psychosis did not identify their experiences as separable 'illnesses' and did not have 'illness beliefs'. Patients currently in a period of remission appraised their experiences as distinct from their own normal behaviour, but used conceptual frameworks of understanding that deviated significantly from conventional 'health belief' models. Patients' ways of understanding mental illness did not parallel those described in physical illnesses. Methods for assessing beliefs about mental illness should therefore not be transferred directly from studies of beliefs about physical illness, but should be tailored to the nature of patients' beliefs about mental illness.     

2008-2018年我国出生缺陷影响因素的Meta分析

目的 探讨我国出生缺陷的主要影响因素,为制订出生缺陷预防决策和干预措施提供科学依据。方法 采用Meta分析方法对2008-2018年国内外已发表的我国出生缺陷影响因素的病例对照研究进行定量综合评价。结果 家族遗传史、母亲吸烟、父亲吸烟、孕期致畸因素接触史、居住地有环境污染源、不良孕产史、孕早期患病、孕期情绪不良、孕期服用药物等因素是出生缺陷的危险因素;婚检、孕检、叶酸增补、孕期经常摄入优质蛋白等因素是保护因素。结论 预防出生缺陷,应避免孕期接触各种物理和化学有害物质,重视常规婚检、孕检,建立健康的生活方式,保持良好的心态,及时增补叶酸,多补充优质的蛋白质以增强母亲体质。     

What do negative associations between potential risk factors and illness in analytical epidemiological studies of infectious disease really mean?

In epidemiological studies of infectious diseases it is not unusual to find that some potential risk factors are negatively associated with risk of illness. The mechanisms generating these associations are unclear in many cases, though one explanation is immunity due to prior exposure. We derive mathematical models for the proportion of a population who are infected with a disease and the proportion who are susceptible in any year of life when individuals are at risk of exposure through more than one route. It is shown that risk of illness declines with increasing age and that this risk declines most rapidly in those groups at increased exposure. In high exposure groups, the relative risk of illness, compared to a group with lower exposure, also declines with age, eventually becoming less than one. The threshold age at which the relative risk is less than 1, i.e., factor B becomes protective decreases with higher exposure rates. Epidemiological studies may substantially underestimate the importance of risk factors where exposure is consistent over many years.     

Occupational risk in basic and advanced emergency life support units

This study aimed to identify occupational risk factors the professionals of Basic and Advanced Emergency Life Support are exposed. Semi-structured interview was used. The study subjects were 40 workers who are part of two Emergency Healthcare System teams in a city of S?o Paulo State-Brazil. Most workers identified the following risk factors: physical (high temperature and environmental noise levels); chemical (manipulating chemical substances); biological (exposure to microorganisms and lack of material available). Typical risks of emergency activities were: risk of car accidents (90% of the workers), physical and moral aggression (90% of the workers) and accidents with piercing and cutting material (72.5% of the workers). 75% of the workers described violence as the most worrying risk factor at work. Most of the workers identified the occupational risks. However only a minority of them uses adequate safety measures, which reveals the need for interventions.     

Reported vague symptoms and at-risk status: the case of polyvinyl chloride workers in Louisville

This study concerns the frequency of visits to the dispensary by workers with vague symptoms of physical illness at a polyvinyl chloride plant in Louisville, KY, where an outbreak of hepatic angiosarcoma occurred. The illness behavior of three cohorts of workers at three levels of risk--workers removed from the chemical plant to a pallet plant (PP) because their screening results indicated liver abnormalities; workers who had some positive test results (TP); and workers whose test results were negative (TN)--was studied before (time 1) and after (time 2) the angiosarcoma crisis. It was predicted that, during time 2, the groups' visits to the dispensary would increase in relation to their levels of risk (PP greater than TP greater than TN). Although there was an overall increase in the percentage of visits because of vague symptoms during time 2, the only cohort with different behavior was the group of TP workers: they reduced their use of the dispensary. These results are similar to those in a previous study in which all symptoms of illness were included. It is speculated that social and individual factors, as well as the labeling phenomenon, explain the results. Health care providers are encouraged to follow up with workers at risk who seem to avoid monitoring their health.     

Combined chemical, physical hazards make exposures harder to calculate. Studies show multiple exposures must be evaluated wholly rather than 'adding up' individual risks

Clearly, current research adds to the mounting scientific evidence that combined exposures can produce greater toxicity than would be predicted using an additive model. Although there is not yet a quantitative method to determine the risks associated with multiple exposures, safety and health specialists must begin to consider the health effects from the entire work process, rather than individual chemical or physical agents. Moreover, organizations involved in risk assessment and standard-setting must evaluate the interactive effects of combined chemical and physical agent exposures. This will make personnel exposure standards comprehensive in addressing realistic occupational health risks.     

Use of microbial risk assessment to inform the national estimate of acute gastrointestinal illness attributable to microbes in drinking water

Microbial risk assessment (MRA) evaluates the likelihood of adverse human health effects that occur following exposure to pathogenic microorganisms. This paper focuses on the potential use of MRA to provide insight to the national estimate of acute gastrointestinal illness (AGI) in the United States among persons served by public water systems. This article defines MRA, describes how MRA is implemented, provides an overview of the field of MRA and discusses how MRA may be useful for characterizing the national estimate. Communities served by drinking water systems with relatively contaminated source waters, sub-standard treatment facilities, and/or contamination problems in their distribution systems are subject to higher risks than communities where such issues are less of a concern. Further, the risk of illness attributable to pathogens in drinking water in each community can be thought of as the sum of the risk from the treated drinking water and the risk from the distribution system. Pathogen-specific MRAS could be developed to characterize the risk associated with each of these components; however, these assessments are likely to under-estimate the total risk from all pathogens attributable to drinking water. Potential methods for developing such MRAs are discussed along with their associated limitations.     

Breaks and maintenance work in the water distribution systems and gastrointestinal illness: a cohort study

BACKGROUND: During maintenance work or breaks on the water distribution system, water pressure occasionally will be reduced. This may lead to intrusion of polluted water-either at the place of repair or through cracks or leaks elsewhere in the distribution system. The objective of this study was to assess whether breaks or maintenance work in the water distribution system with presumed loss of water pressure was associated with an increased risk of gastrointestinal illness among recipients. METHODS: We conducted a cohort study among recipients of water from seven waterworks in Norway during 2003-04. One week after an episode of mains breaks or maintenance work on the water distribution system, the exposed and unexposed households were interviewed about gastrointestinal illness in the week following the episode. RESULTS: During the 1-week period after the episode, 12.7% of the exposed households reported gastrointestinal illness in the household, compared with 8.0% in the unexposed households [risk ratio (RR) 1.58, 95% confidence interval (CI): 1.1, 2.3]. The risk was highest in households with higher average water consumption. The attributable fraction among the exposed households was 37% in the week following exposure. CONCLUSION: Our results show that breaks and maintenance work in the water distribution systems caused an increased risk of gastrointestinal illness among water recipients. Better data on the occurrence of low-pressure episodes and improved registration of mains breaks and maintenance work on the water distribution network are needed in order to assess the public health burden of contamination of drinking water within the distribution network.     

Adjusting exposure limits for long and short exposure periods using a physiological pharmacokinetic model

The rationale for adjusting occupational exposure limits for unusual work schedules is to assure, as much as possible, that persons on these schedules are placed at no greater risk of injury or discomfort than persons who work a standard 8 hr/day, 40 hr/week. For most systemic toxicants, the risk index upon which the adjustments are made will be either peak blood concentration or integrated tissue dose, depending on what chemical's presumed mechanism of toxicity. Over the past ten years, at least four different models have been proposed for adjusting exposure limits for unusually short and long work schedules. This paper advocates use of a physiologically-based pharmacokinetic (PB-PK) model for determining adjustment factors for unusual exposure schedules, an approach that should be more accurate than those proposed previously. The PB-PK model requires data on the blood:air and tissue:blood partition coefficients, the rate of metabolism of the chemical, organ volumes, organ blood flows and ventilation rates in humans. Laboratory data on two industrially important chemicals--styrene and methylene chloride--were used to illustrate the PB-PK approach. At inhaled concentrations near their respective 8-hr Threshold Limit Value-Time-weighted averages (TLV-TWAs), both of these chemicals are primarily eliminated from the body by metabolism. For these two chemicals, the appropriate risk indexing parameters are integrated tissue dose or total amount of parent chemical metabolized. Since methylene chloride is metabolized to carbon monoxide, the maximum blood carboxyhemoglobin concentrations also might be useful as an index of risk for this chemical.(ABSTRACT TRUNCATED AT 250 WORDS)     

Work environment and occupational risk assessment for small animal Portuguese veterinary activities

The professional work of small animal veterinary staff encompasses a wide diversity of demanding tasks. This has prompted a number of studies covering physical, chemical, biological, ergonomic, or psychological hazards, as well as their health effects upon veterinary workers. However, such results were obtained from self-reported surveys (via paper or online). This study reports the identification of potential hazards and provides a risk assessment of 15 veterinary clinics based on data from walk-through surveys, interviews with workers, and quantification of indoor air quality parameters including concentration of volatile organic compounds (total, isoflurane, and glutaraldehyde). The risk arising from X-ray exposure was unacceptable in seven clinics; X-ray examination should be discontinued in the absence of isolated radiation rooms, poor safety practices, and lack of personal protective equipment. Ergonomic-related hazards and work practices should be revised as soon as possible, considering that improper postures, as well as moving and lifting heavy animals are major causes of musculoskeletal disorders. The risk levels were, in general, small or medium (acceptable) with regard to exposure to physical hazards (such as bites, scratches, cuts, and burns) and biological hazards. It was observed that the indoor air quality parameters including temperature, respirable particulate matter and total volatile organic compounds do not indicate a comfortable workplace environment, requiring clinics' attention to keep the safe environment. The veterinarians and nurses were exposed to isoflurane (above 2 ppm) during surgery if an extractor system for waste gas was used instead of a scavenging system. Finally, veterinary workers did not possess any type of training on occupational safety and health issues, even though they recognized its importance.