Circadian rhythms of arterial pressure, heart rate and oral temperature in truck drivers

Circadian rhythms of arterial pressure (AP), heart rate (HR)and oral temperature (OT) were studied in healthy male truckdrivers and in a control group of air traffic controllers. Twenty-four-hourrecords of systolic and diastolic AP and HR and of OT were obtainedfrom 12 truck drivers both during the outward and homeward journeyin Europe and Asia, and from 12 air traffic controllers duringa morning shift. Data were analyzed by the cosinor method. Theresults obtained in the control group were as follows (mesor/amplitude/acrophase):systolic AP (mm Hg): 111.1/6.1/16.51 h; diastolic AP: 68.4/5.6/16.58h; HR (b.p.m.): 77.0/7.6/17.46 h; OT (dg C): 36.74/0.21/17.26h. Statistically significant acrophase advances were observedfor the circadian rhythms of systolic, diastolic and mean APand of HR in TD during the outward journey in comparison withthe control ATC group. These differences were still presentduring the homeward journey, in combination with an acrophasedelay of the circadian rhythm of OT. Our results supply groundsto suppose that extended working time combined with greaterload during a long-lasting trip may act to generate an internaldesynchronization of circadian rhythms in long-haul truck drivers.     

The performance of the ICEROSS prostheses amongst transtibial amputees with a special reference to the workplace--a preliminary study

A clinical trial was conducted to evaluate the efficiency ofICEROSS on randomly selected 46 male transtibial amputees. Afterrejection, only 27 (58.69%) amputees volunteered for variousstages of the ICEROSS trial. All 27 were categorized into GroupA—persons in employment (n=16) and Group B—personsout of employment or economically inactive (n=11). The studywas conducted on the basis of questionnaire information, clinicalexamination and objective tests. The pre- and post-ICEROSS statuswere compared between the groups. Group A was younger and didbetter. Trauma was the main cause of amputation. There werecertain changes of the stump before and after ICEROSS. The amputeeswith ICEROSS suspension performed better and had improved mobilityin Group A. At the workplace, dynamic activities were less thanthe static activities (p<0.001) and there were overall improvementsin comfort and performance of amputees with ICEROSS.     

Absence attributed to incapacity and occupational disease/accidents among female and male workers in the fish-processing industry

Sick-leave between 1984 and 1989 was higher among both female(n=515) and male (n=304) fish-processing workers [observed/expected(O/E) 2.24 and 1.69, respectively] than among non-exposed groups(0.62 and 0.89). Diagnoses in the musculoskeletal system dominated(i.e., neck/upper limbs; females, exposed vs. non-exposed workers:30 vs. 12%: males: 11 vs. 5.8%). In subjects who left employment,the O/E-ratio decreased (females: 3.02 vs. 1.55; males: 2.40vs. 1.55). Among those women hired before the start of the observationperiod, exposed subjects had higher frequencies of sick-leavethan non-exposed, for both total illness and musculoskeletaldiagnoses. In the men, there were corresponding differences,though not fully statistically significant. Reported occupationaldiseases [O/E: females: 4.5; (95% confidence interval) Cl=3.2–6.1;males: 2.3; Cl=1.3–3.9] and accidents (females: 4.3; Cl=3.0–5.9;males: 1.8; Cl=1.2=2.7) were also higher in female than in malefish-processing workers, and much higher than in non-exposedworkers. In conclusion, work in the fish-processing industrywas associated with increased frequencies of sick-leave, especiallybecause of diagnoses of the musculoskeletal system, and occupationaldisorders and accidents, in particular among female workers.     

Reasons for Rejection: Why People Fail to Qualify as Firefighters

In the decade beginning 1 January 1985, 916 individuals (includingfive females) were medically examined with a view to joiningthe full-time service of Strathclyde Fire Brigade (SFB). Onehundred and nine (11.9%), including two females, were rejected.The five main causes of failure were: ocular (n = 46, 42.2%);lack of stamina (n = 21, 19.2%); ‘others’ (n = 12,11.0%); cardiovascular (n = 9, 8.3%) and orthopaedic (n = 6,5.5%). Thirty-two had chest X-rays. One abnormality was found— an azygous lobe — but it played no part in thedecision to decline the applicant. There was little life- orhealth-threatening pathology found. The most serious cases weremurmurs consistent with mitral stenosis and regurgitation (oneeach), one case of ocular melanoma, four cases of hypertensionand two cases of haematuria/ proteinuria (++). This study showsthat potentially serious findings can occasionally be detectedin a population of 18–30 year olds who might be expectedto be of better than average fitness, and that routine chestX-rays are not helpful in the selection process.     

Doctors, their mental health and capacity for work

Background Information about doctors’ mental ill-healthis limited. This study looks at doctors’ careers followingmental illness and the strategies that helped them return towork. Aim To examine the effect of mental ill-health on doctors’careers. Methods Questionnaire survey of members of the Doctors SupportNetwork (DSN). The DSN is a peer support group for doctors whohave experienced, or are experiencing, mental ill-health. Results One hundred and sixteen doctors (35% response rate)returned completed questionnaires (n = 116, 63% female, 37%male). Prior to their ill-health, 80% worked full time, 15%part-time, 2% were not working and 3% were medical students.Following illness, 33% worked full time (P < 0.05), 36% part-time(P < 0.05) and 29% were not working (P < 0.01). Flexibleworking practices were the most helpful reported strategy forenabling a doctor to return to work. Conclusions Following mental ill-health, a doctor’s capacityto work full time is reduced. Most doctors return to full-timeor part-time work. With improved support, more doctors may beable to return to work.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Blood Pressure Variability at Annual Periodic Health Examination for Employees and Cardiovascular Risk Factors

The employees with hypertension at the annual periodic healthexamination (HE) for employees in Japan usually receive a re-examinationof blood pressure (BP) on another day and are often found tobe normotensive. In this study, we analyzed data from the HEat the workplace to determine whether or not such employeesshould receive medical care. Two groups of subjects were selected.One group (group 1) was composed of 50 subjects with normotensionat the HE (controls). Another group (group 2) was composed of33 subjects with hypertension at the annual HE but with normotensionin re-examinations. Cardiovascular risk factors were significantlyhigher in group 2 than in group 1: mean values of the body massindex (group 1, 22.2±2.7 vs. group 2, 24.3±3.1kg/m² p<0.01), total cholesterol (group 1, 197±36vs. group 2, 222±42 mg/dl, p<0.01), and low densitylipoprotein (group 1, 118±32 vs. group 2, 137±38mg/dl, p<0.05). The proportion of the employees with high-normalBP in group 2 (42.5%) was significantly higher than that ingroup 1 (28.0%) (p<0.01). These indicate that the employeeswith hypertension at the annual HE but with normotension inthe re-examination require further medical attention and shouldreceive medical supervision. The occupational physician shouldsupervise these employees.     

A study of South Korean casino employees and gambling problems

Background Casino employees are exposed to disproportionatelyhigh levels of gambling, drinking and smoking compared to otheroccupations. Because of their occupation, they have the opportunityto detect and prevent pathological gambling (PG). Aims To identify differences in the mental health status andsocial attitudes towards PG among casino workers in South Koreadepending upon whether they report any gambling problems. Methods Data were collected from 388 full-time casino employees.This data provided information about the prevalence of gamblingproblems, alcohol and tobacco use and depression. Employeeswere grouped according to their scores on the Korean versionof South Oaks Gambling Screen (SOGS), and those employees whogambled without experiencing any gambling problems (Group NP:SOGS = 0) and those who reported any gambling problems (GroupP: SOGS > 0) were compared. An exploratory factor analysesidentified the domains of casino employee social attitudes towardsgambling. Results Employees who reported gambling problems (Group P) reporteda higher prevalence of smoking, alcohol problems and depression(P < 0.01) compared to employees who did not report gamblingproblems (Group NP). The primary employee social attitude towardsgambling was identified by the factor of ‘Disease concept/socialawareness’. Group NP reported more positive attitudesin this domain than Group P (P < 0.01). Conclusions Employees who reported any gambling problems reporteda less positive attitude towards developing the public healthsystem to be responsive to gambling problems. These findingsindicate a need to develop health education programmes thatfocus more specifically on casino employees with gambling problems.     

A Study of the Impact of Occupational and Domestic Factors on Insomnia among Industrial Workers of a Manufacturing Company in Japan

Insomnia is one of the most common health problems and has recentlybeen re-termed ‘Disorders of Initiating and MaintainingSleep’, or DIMS. The main purpose of the present studywas to investigate the relationship between daily psychosocialstressors, to which workers are exposed in occupational and/orprivate life, and insomnia among male industrial workers ina medium-sized company located in Nagasaki City, Japan. Allof the workers in the company (n=368, male=319) were asked toanswer six sleep related questions and 24 questions about workingand private conditions. Two hundred and seventy-one (85.0%)of them completed the questionnaire (average age was 40.9 yearsold). Twenty seven point seven per cent of the subjects complainedof insomnia in the last month prior to the survey and the prevalencewas in general accord with previous surveys. On the other hand,the proportion of hypnotic use (1.1%), especially in insomniacgroup (2.7%) was lower than previous reports. The results ofmultiple logis regression analysis demonstrated that four psychosocialfactors were significantly associated with insomnia: i.e. VDTwork overload (odds ratio [OR] 5.058; 95% confidence intervals[95% Cl] 2.381–10.745), limited space of bedroom (OR 2.612;95% Cl 1.283–5.683), over-involvement in job (OR 2.78;95% Cl 1.188–6.540), frequent alcohol beverages consumption(OR 2.595; 95% Cl 1.177–5.719).     

Salivary acetylcholinesterase as a biomarker for organophosphate exposure

Background Workers exposed to organophosphate (OP) pesticidesare required to undergo periodic statutory medical surveillancein several countries. Aim To study the relationship between serum, erythrocyte andsaliva acetylcholinesterase (AChE) levels and to explore theuse of salivary AChE as potential biomarker for OP exposure. Methods A cross-sectional study was conducted on 19 healthyadult male lead-exposed workers who were undergoing six monthlystatutory medical examination. Passive drool saliva sampleswere collected from each worker. Each blood sample was testedfor serum and erythrocyte AChE, and each saliva sample was testedfor AChE. Results Among the 19 subjects, the mean (±standard deviation)of salivary, erythrocyte and serum AChE/cholinesterase were22.7 (±17.4), 17171 (±1467), 8861 (±1876)U/l, respectively. There was a moderate correlation betweensalivary and erythrocyte AChE (r = 0.42, P = 0.071), but notsalivary and serum AChE (r = –0.17, P = 0.48). The levelof AChE in saliva was 1820 times lower than AChE in erythrocytes. Conclusion It is probably not feasible to use saliva as a replacementfor blood for the measurement of AChE levels. This is becauseof the much lower levels of AChE in saliva relative to erythrocytes,the weak correlation between the two measurements and the previouslyreported high intra-individual variation of salivary AChE.     

Which agents cause reactive airways dysfunction syndrome (RADS)? A systematic review

Aim To identify those agents reported as being associated withreactive airways dysfunction syndrome (RADS). Methods A systematic review was undertaken. Abstracts were screenedand those selected reviewed against pre-determined diagnosticcriteria for RADS. Results Significant information gaps were identified for allmeasures of interest. In some articles, even the causative agentwas not reported. The most commonly reported agents were chlorine(nine subjects), toluene di-isocyanate (TDI) (n = 6) and oxidesof nitrogen (n = 5). Most exposures occurred in the workplace(n = 51) and affected men (60%). Dyspnoea (71%) and cough (65%)were the commonest symptoms. Median symptom duration was 13months (interquartile range = 6.5–43.5) for RADS. Conclusions Although the most commonly reported agent associatedwith RADS was chlorine, the main finding of a general lack ofadequate information on exposure, investigation and outcomesuggests that to better explore RADS a more structured approachto gathering information is required. A minimum data set forreporting RADS cases is proposed.     

The impact of Hymenoptera venom allergy on occupational activities

The objective of this study was to investigate the impact ofallergy to hymenoptera venom on the occupational activitiesof patients undergoing immunologic treatment for insect stinganaphylaxis. The design was a cross-sectional study conductedin a sample of 500 out of 1,500 patients undergoing venom inmunotherapyfor insect sting reaction in 13 allergy clinics in Israel. Aself-administered questionnaire was used to collect data aboutdemographic characteristics of patients, severity of the allergicreaction, and adverse effects on occupational activities. Ofthe 204 respondents who were part of the labour force, 48.5%reported adverse effects on routine occupational activities.The factors with a significant influence on the probabilityof adverse occupational effects were: (1) patient's type ofwork (blue collar vs. white collar: OR=;3.22, p<0.001; armyvs. white collar: OR=5.28, p=0.001); (2) severity of the allergicreaction (severe reaction vs. mild/moderate reaction: OR=2.34,p=0.007). Our findings suggest that severe insect sting allergyhas an adverse impact on patients' occupational activities.This factor requires special attention by the medical community.Social workers and occupational physicians should collaboratein the assessment and management of these patients.     

Erythrocyte cholinesterase activity levels in desert farm workers

In this study we have examined 532 migrant farm workers engagedmainly in the cultivation of vegetable crops, in both greenhousesand openfarms, and an equal number of controls. Erythrocyteacetylcholinesterase activity (AChE) was measured to determinethe degree of toxicity due to exposure to organophosphate andcarbamate pesticides in the farm workers employed either asforemen (41.5%) or farmers (58.5%). The mean ages of the farmworkers and controls were 35.2±7.4 (mean±SD) yearsand 34.6±7.1 years. AChE activity of the farm workersand controls was 3.89±0.64 Ul/ml (mean±SD) and4.15±0.29 Ul/ml. The haemoglobin adjusted erythrocytecholinesterase activity (HAChE) was 29.96±4.14(mean±SD)for farm workers and 32.10±2.26 for controls. AChE activitywas very highly significantly lower for the foremen (3.76±0.69)compared to farmers (3.98±0.59) (Student's t-test=4.13,p=0.0001). HAChE was also very highly significantly lower forforemen (29.24±4.37) compared to farmers (30.46±3.88)(Student's t-test=3.64, p=0.0001). The poorly controlled useof pesticides in the farms appeared to have caused sub-clinicalintoxication in the farm workers and indicated the need fortraining and implementation of hygiene practices.     

Piecework, musculoskeletal pain and the impact of workplace psychosocial factors

Aim To investigate the impact of piecework on musculoskeletalpain and general health, and the influence of perceived workplacepsychosocial factors on any such associations, in a generalUK population. Methods A questionnaire was mailed to an age-stratified randomsample of 10 000 adults aged 18–75 in North Staffordshire,UK. Respondents reporting a current main job were asked if thisjob was paid by a piecework system. Health measures were (i)number of pain areas according to a body manikin and (ii) generalhealth (SF-12v2). Other measures included questions on occupationalhistory and psychosocial aspects of the work environment. Results The adjusted response was 54%. A total of 1193 respondentsreported a current main job, of whom 201 (17%) reported piecework.Pieceworkers were more likely to be older (P < 0.05), male(P < 0.001) and in lower socioeconomic groups (P < 0.001)than non-pieceworkers. Piecework was associated with perceptionsof a poor psychosocial working environment, more pain areas(P < 0.05), more elbow (P < 0.01), forearm (P < 0.001)and hand pain (P < 0.05), and a lower physical health score(SF-12v2; P < 0.01), but no difference in mental health score(P = 0.60), compared with non-pieceworkers. After controllingfor psychosocial factors, and socioeconomic group, the associationsbetween piecework and pain areas, or physical health, were nolonger statistically significant. Conclusions These results show that piecework was associatedwith poorer self-reported general physical health and more areasof pain, which may be attributed to low socioeconomic group,and workplace perceptions of little job control, high physicaldemand and little supervisor support.     

A five-year study comparing early retirements on medical grounds in ambulance personnel with those in other groups of health service staff: Part I: Incidences of retirements

The objective of this study was to compare morbidity betweenambulance staff and other groups of health service workers,to facilitate planning of occupational health (OH) services.A retrospective study of employees of The Eastern Health andSocial Services Board, Northern Ireland was conducted. Subjectswere 181 men and 353 women assessed at OH between 1988–92and found eligible (on the basis of permanent incapacity) toapply for early retirement on medical grounds (EROMG). Ambulancepersonnel showed a high rate of EROMG (55.9/1,000 per annum)both compared with previous ambulance studies (5.7–22.5/1,000),and with other groups in the present study (manual 24.8/1,000,nursing 5.9/1,000 and non-manual 2.6/1,000). Indirect standardizationwas used to correct for age-sex differences between groups,by deriving standardized early retirement ratios (SERR). Ambulanceand manual staff showed high SERRs (636, Cl=558–714 and164, Cl=149–179), whereas nursing and non-manual staffshowed low SERRs (91, Cl=75–107 and 38, Cl=25–52),(all results except that for nursing staff being significantat <0.001). There is evidence that ambulance staff are agroup with high morbidity, and thus deserving of particularattention in terms of preventative and health promotional activities.Other issues requiring consideration in relation to ambulancestaff are redeployment and lowering of the retirement age.     

Overtime work and stress response in a group of Japanese workers

Background Working long overtime hours is considered a causeof mental health problems among workers but such a relationshiphas yet to be empirically confirmed. Aim To clarify the influence of overtime work on response tostress and to assess the role of other stress-related factorson this relationship. Methods The study was conducted among 24 685 employees of acompany in Japan. Stress response, job stressors and socialsupports were assessed by the Brief Job Stress Questionnaire.Participants were divided into five categories of overtime (0–19,20–39, 40–59, 60 h of overtime per month and exemptedemployees). Results The nonadjusted odds ratios for stress response for40–59 and 60 overtime hours per month in reference to0–19 overtime hours were 1.11 [95% confidence interval(CI) 1.03–1.19] and 1.62 (95% CI 1.50–1.76), respectively.After adjustment for self-assessed amount of work, mental workloadand sleeping time, the association between overtime work andstress response disappeared. Conclusions This large cross-sectional study shows that overtimework appears to influence stress response indirectly throughother stress factors such as self-assessed amount of work, mentalworkload and sleeping time.     

The impact of the COSHH regulations on workers with occupational asthma

In the UK, the COSHH Regulations give specific guidance thatemployers have duties to inform, instruct and train their employeesabout occupational risks and provide them with suitable healthsurveillance. The aim of the study was to evaluate the impactof the Regulations on employees with occupational asthma. Onehundred consecutive patients attending an occupational lungdisease clinic completed a questionnaire assessing the implementationof the COSHH Regulations in their workplace. Twenty-eight percent had a pre-employment inquiry about asthma, 31% had regularhealth surveillance by questionnaires and 19% had regular lungfunction assessment at work. Pre-employment spirometry was carriedout in 44% of the workers who were exposed to one of the originalseven prescribed agents, significantly more than those who wereexposed to other agents (19%) (p < 0.05). Moreover, figuresfor spirometry during employment were 31% and 8% respectively(p < 0.05). The patients who worked after ‘COSHH’but before ‘MS25’ had a tendency to be providedwith health surveillance more than those who worked after both‘COSHH’ and ‘MS25’. Ninety-one per centof the patients had never been informed about the risks of gettingasthma at work and 73% had never seen the safety data sheets.The workers who (1) worked after ‘COSHH’ introduction;(2) worked in larger firms and (3) were exposed to one of theoriginal seven prescribed agents, had a tendency to be informed,instructed and trained more than the rest. However, there wereonly significant statistical differences (p<0.05) in termsof the safety data sheet provision between the cases who workedbefore the time of the legislation and those employed afterwards.     

Estimating measures of interaction on an additive scale for preventive exposures

Measures of interaction on an additive scale (relative excess risk due to interaction [RERI], attributable proportion [AP], synergy index [S]), were developed for risk factors rather than preventive factors. It has been suggested that preventive factors should be recoded to risk factors before calculating these measures. We aimed to show that these measures are problematic with preventive factors prior to recoding, and to clarify the recoding method to be used to circumvent these problems. Recoding of preventive factors should be done such that the stratum with the lowest risk becomes the reference category when both factors are considered jointly (rather than one at a time). We used data from a case-control study on the interaction between ACE inhibitors and the ACE gene on incident diabetes. Use of ACE inhibitors was a preventive factor and DD ACE genotype was a risk factor. Before recoding, the RERI, AP and S showed inconsistent results (RERI = 0.26 [95%CI: −0.30; 0.82], AP = 0.30 [95%CI: −0.28; 0.88], S = 0.35 [95%CI: 0.02; 7.38]), with the first two measures suggesting positive interaction and the third negative interaction. After recoding the use of ACE inhibitors, they showed consistent results (RERI = −0.37 [95%CI: −1.23; 0.49], AP = −0.29 [95%CI: −0.98; 0.40], S = 0.43 [95%CI: 0.07; 2.60]), all indicating negative interaction. Preventive factors should not be used to calculate measures of interaction on an additive scale without recoding.     

A Strength-Endurance Index for Power Grip

Introduction The purpose of this study was to quantify muscle strength and endurance in power grip. Method Workers (74 M and 74 F, 18–72 years) squeezed a dynamometer for a 60 s, 18-cycle test. Initial strength (IS) and final strength (FS) were calculated as the mean peak force for cycles 1–3 and 16–18, respectively. Endurance was defined by the strength decrement index (SDI) where SDI = (IS − FS)/IS × 100. A grip strength-endurance analyzer was constructed from IS and SDI data which were depicted on two parallel, linearly scaled axes. Discrete IS and SDI scores were connected on each axis with a vector. The vector (Vmag) was measured directly from the analyzer and its direction identified from its slope. Integer scales transformed discrete IS and SDI scores into individual strength-endurance performance scores (SEPS). Results Better than 95% of the sample (n ≥ 141) scored within acceptable test ranges defined as the combined sample mean ± 2SD, for SDI, Vmag and SEPS. Vmag was the best predictor for SEPS. Linear regression for SEPS was SEPS (combined) = 0.09 (Vmag) − 0.29: (SEE = 0.829). The analyzer revealed individual scores outside acceptable ranges for injured and uninjured efforts. Conclusion The development of a power grip strength-endurance analyzer provided a simple method to graph individual power grip performances. Converting strength and endurance scores to integers and summing them (SEPS) provided a simple means to represent individual estimates of power grip strength-endurance performance.