Superficial Copper Staining of the Teeth in a Brass Foundry Worker

A 21 year-old man developed green surface staining of the cervicalmargins of his teeth 10 months after starting work in a brassfoundry. During this time he was exposed intermittently to brassfumes which contained approximately 75% copper and 2–5%lead. The staining of his teeth was attributed to the absenceof respiratory protection in the knock-out process and was accompaniedby a rising blood lead concentration. Staining of the teethby copper was described early this century but seems to havebeen neglected in the recent literature and texts on occupationalmedicine. We suggest that in brass foundry workers it is a warningof failure to control fume or dust exposure with the attendantrisk of lead toxicity. Received       19 July 1995 Accepted        1 November 1995     

Respiratory response in simultaneous exposure to flax and hemp dust

Žuškin, E., and Valíc, F. (1973).British Journal of Industrial Medicine,30, 375-380. Respiratory response in simultaneous exposure to flax and hemp dust. The effect of exposure to high concentrations of mixtures of hemp and flax dust was studied in 124 workers in two textile mills (mill A: 65-70% hemp and the rest flax, mean dust concentration 13·9 mg/m³; and mill B: about 35% hemp and the rest flax, mean dust concentration 15·8 mg/m³). A high prevalence of byssinosis was found in both mills (80% in mill B; 46·8% in mill A) after a mean exposure of no more than 13 years. In both mills, byssinotics had a higher prevalence of all chronic respiratory symptoms than non-byssinotics. This difference was more pronounced in mill A. Forty-eight percent of byssinotic women and 43% of byssinotic men had byssinosis of grade 2 or 3. Significant mean acute reductions in FEV_1·0 and ˙V_max 50% VC on Monday were recorded in subjects with and without byssinosis with a significantly larger mean reduction in byssinotics (FEV_1·0, P < 0·01; ˙V_max 50% VC, P < 0·05). ˙V_max 50% VC proved to be a more sensitive test for detecting acute effects of vegetable dust than FEV_1·0. The acute respiratory response of the subjects exposed to similar concentrations of flax and mixtures of two different proportions of flax and hemp dust was found to be equal.     

Pneumoconiosis in the Haematite Iron Ore Mines of West Cumbria. A Study of 45 Years of Control

Pneumoconiosis amongst haematite miners in West Cumbria hasbeen studied over a 45-year period. In 1934 the disease causedthe deaths of miners in early middle life from massive lungfibrosis, often complicated by tuberculosis and sometimes bycarcinoma. Many more suffered from advanced emphysema and hadto cease heavy face work 20 years before their time for retirement. The X-ray appearances and clinical symptoms are described. Studieshave been carried out on the lung physiology and comparisonsmade with similar groups of South Wales coal miners. All haematiteminers have been examined clinically and radiologically beforeadmission to the industry and regular two yearly examinationsby radiography have been made. Men with complicated pneumoconiosis(progressive massive fibrosis) have been withdrawn from dustyjobs and, where indicated, referred for treatment. Men withuncomplicated pneumoconiosis have been allowed to work in goodconditions and have been carefully supervised. The methods of mining control are described demonstrating thechanges from dense dustiness with many times the allowed limitof nitrous fumes to excellent conditions. Serial dust countsover many years have been personally undertaken, and subsequentlyregular estimations of mass of respirable dust per m³ of air.The results show that there has been almost complete eliminationof dust during the past 20 years. The disease has been eradicated and no miner who commenced workafter 1935 has shown X-ray evidence of proved pneumoconiosis.No case has been certified by the Pneumoconiosis Panel for 17years. Men are now fit to work at the face until retirementage, and young men are no longer aware that such a conditionever existed. Accepted        1 October 1981 ^*Based on the Fifth Meiklejohn Lecture read to the North StaffordshireMedical Institute, Arlidge Section of Occupational and PreventiveMedicine, at The Medical Institute, Stoke-on-Trent on the 15November 1979.     

Occupational Mortality in the Armed Services

This article intends to show that the Services mortality experiencehas been somewhat misrepresented in recent publications, andthe reasons for this. I have also pointed out some areas wherewe are well aware that our experience is below average, andhave highlighted accidental deaths mainly due to road trafficaccidents and deaths in soldiers from ischaemic heart disease,as areas of concern. Accepted        1 October 1981 Requests for reprints should be addressed to: Col. P. J. Blackburn, Ministry of Defence (AMO 5), First Avenue House, High Holborn, London. ^*Paper presented at the Joint Services and Faculty of OccupationalMedicine Conference held at the Institute of Naval Medicine,Alverstoke, 29-30 January 1981.     

Acute cooling of the feet and the onset of common cold symptoms

Background. There is a common folklore that chilling of thebody surface causes the development of common cold symptoms,but previous clinical research has failed to demonstrate anyeffect of cold exposure on susceptibility to infection withcommon cold viruses. Objective. This study will test the hypothesis that acute coolingof the feet causes the onset of common cold symptoms. Methods. 180 healthy subjects were randomized to receive eithera foot chill or control procedure. All subjects were asked toscore common cold symptoms, before and immediately after theprocedures, and twice a day for 4/5 days. Results. 13/90 subjects who were chilled reported they weresuffering from a cold in the 4/5 days after the procedure comparedto 5/90 control subjects (P = 0.047). There was no evidencethat chilling caused any acute change in symptom scores (P =0.62). Mean total symptom score for days 1–4 followingchilling was 5.16 (±5.63 s.d. n = 87) compared to a scoreof 2.89 (±3.39 s.d. n = 88) in the control group (P =0.013). The subjects who reported that they developed a cold(n = 18) reported that they suffered from significantly morecolds each year (P = 0.007) compared to those subjects who didnot develop a cold (n = 162). Conclusion. Acute chilling of the feet causes the onset of commoncold symptoms in around 10% of subjects who are chilled. Furtherstudies are needed to determine the relationship of symptomgeneration to any respiratory infection. Keywords. Cold exposure, common cold, infection, nose.     

A Survey of Hearing Loss in Army Aircrew

Military aircrew are exposed to excessive noise at work, withthe concurrent risks of acquiring Noise Induced Hearing Loss(NIHL). Past studies have related aircrew NIHL to a varietyof factors; however, no clear causal relationship has been shown.The difficulty of establishing NIHL due to flying remains whenmany other confounders are present, especially age and exposureto firearms noise in the military environment. A cross sectionalprevalence study of hearing loss in Army Air Corps aircrew hasbeen undertaken. One hundred and twenty one aircrew who hadmore than ten years flying experience were studied and the resultsshow that there appears to be a threshold shift in excess ofthat expected from the ISO levels for otologically normal malesof the same age. The hearing threshold shift was found to correlatewith the number of years flying and aircrew age, with the numberof flying hours being less significant. Received       28 June 1995 Accepted       12 September 1995     

Reversal of ethanol-induced hepatic steatosis and lipid peroxidation by taurine: a study in rats

We read with interest the study reported by Kerai et al. inthe July–August (1999) issue of Alcohol and Alcoholism.The authors concluded that hepatic steatosis and lipid peroxidationcaused by chronic alcohol consumption in rats can be reversedby administration of taurine. Furthermore, . . . [Full Text of this Article]FOOTNOTESREFERENCES     

The Use of Chelating Agents in Occupational Lead Poisoning

Chelating agents have long been used in the pharmacologicaltreatment of lead poisoning, whose management is still a problem,particularly in developing countries. This article reviews thepharmacological properties of dimercaprole, penicillamine, CaNa2EDTAand dimercaprosuccinic acid, examines their indications, contraindicationsand side effects and discusses the possible use of each drugoccupational Pb poisoning. Proposals are also presented forthe treatment and follow-up of subjects with signs and symptomsof poisoning and of subjects with low-moderate Pb absorption.CaNa2EDTA seems to be the most reliable and safer chelatingagent nowadays available and with a wider spectrum of action.DMSA seems to be promising in the treatment of occupationalPb poisoning. Even though there is no doubt that chelation therapyhas significantly contributed to reduce mortality and morbidityfrom occupational Pb poisoning, the efficacy of this treatmentin subjects with subtle neurological or renal damage has notyet been studied properly. Received       21 February 1995 Accepted       11 April 1995     

A Comparison of the Rates of Sickness Absence between the Male Population of Royal Air Force Waddington and the Lincolnshire Police Force During November 1980

A survey of male sickness absence notifications during the monthof November 1980 was performed at Royal Air Force Waddingtonand at the Lincolnshire Police Force Headquarters. The results,when analysed, showed a statistically significant (P<0.05)lower absence rate amongst RAF personnel, independent of theparameters used for comparison. The study points to the existence of an occupational healthservice as a major contribution to lower sickness absence ratesamongst RAF personnel. Accepted        1 January 1982 Flight Lieutenant R. Guest, Medical Centre, United Kingdom Support Unit, Ramstein Air Base, BFPO 109     

Impairment of nasal mucociliary clearance in woodworkers in the furniture industry

Black, A., Evans, J. C., Hadfield, Esme H., Macbeth, R. G., Morgan, A., and Walsh, M. (1974).British Journal of Industrial Medicine,31, 10-17. Impairment of nasal mucociliary clearance in woodworkers in the furniture industry. Measurements of mucociliary clearance from the anterior end of the middle turbinate were made using technetium-99m-labelled particles in nine woodworkers from the furniture industry and in 12 controls, none of whom had been occupationally exposed to wood dust. Clearance rates in the controls ranged from 1·9 to 18·5 mm min^-1 with a mean of 6·8. These values are in good agreement with measurements reported elsewhere for normal subjects. Only one of the woodworkers had a clearance rate which fell within the normal range and he had been occupationally exposed for the shortest period (6 years). In four woodworkers clearance was very slow (< 1 mm min^-1) and in three there was almost complete stasis. The results of this preliminary investigation suggest that nasal mucociliary function is significantly impaired in workers who have been exposed to wood dust in the furniture industry for more than 10 years.     

'Only connect': the centrality of doctor-patient relationships in primary care

EM Forster's call in A Passage to India to ‘only connect’is a shorthand for the hundreds of ways in which doctor–patientrelationships have been discussed in the literature. As Chew-Grahamstates, in the parallel editorial, this relationship, and thepatient-centred ideology which underpins it, is seen as intrinsicallytherapeutic. The evidence base for such an assumption is wellestablished, most notably in the literature on quality and continuityof care. The centrality of relationship-based primary care There is a strong association between personal continuity, enablementand patient satisfaction.¹ Since personal continuity impliesboth empathy and personal responsibility,^2,3 the studies overallshow a strong correlation between quality relationships andpatient satisfaction. Reviews of     

Respiratory disability in ex-flax workers.

Acute respiratory effects occur in a high proportion of subjects exposed to textile dusts. The extent to which these lead to permanent respiratory symptoms and loss of lung function is unknown. A survey of random population samples was therefore conducted in ten towns in Northern Ireland in which flax processing had been a major source of employment. The MRC questionnaire on respiratory symptoms was administered and Vitalograph tracings recorded on subjects aged 40 to 74 inclusive. An occupational history was taken at the end of each interview. Lung function in ex-flax workers was slightly lower than in control subjects never exposed to flax dust, but the presence of a positive interaction with age meant that differences were apparent only in the younger subjects. Over about the age of 65 the lung function in the ex-flax workers was comparable with that of the controls and overall the loss was at most about half that due to light smoking (1-14 cigarettes a day). The association between a "dust exposure score" and lung function was inconsistent in the two sexes. In men there was a small decrement with increasing dust exposure. In women there was also a small decrement, but a positive interaction with age meant that the women with the highest dust exposure scores had a lower loss with increasing age than the women with the least dust exposure. There was an excess in symptoms in the ex-flax workers but the size of the excess was greater than would be expected from the lung function results. It is possible that, although the survey was conducted without explicit reference to the flax industry, knowledge throughout Northern Ireland that many flax workers have been awarded compensation on the grounds of respiratory disablement may have led to an increased reporting of symptoms in the ex-flax workers.     

Respiratory disability in ex-flax workers

Acute respiratory effects occur in a high proportion of subjects exposed to textile dusts. The extent to which these lead to permanent respiratory symptoms and loss of lung function is unknown. A survey of random population samples was therefore conducted in ten towns in Northern Ireland in which flax processing had been a major source of employment. The MRC questionnaire on respiratory symptoms was administered and Vitalograph tracings recorded on subjects aged 40 to 74 inclusive. An occupational history was taken at the end of each interview. Lung function in ex-flax workers was slightly lower than in control subjects never exposed to flax dust, but the presence of a positive interaction with age meant that differences were apparent only in the younger subjects. Over about the age of 65 the lung function in the ex-flax workers was comparable with that of the controls and overall the loss was at most about half that due to light smoking (1-14 cigarettes a day). The association between a "dust exposure score" and lung function was inconsistent in the two sexes. In men there was a small decrement with increasing dust exposure. In women there was also a small decrement, but a positive interaction with age meant that the women with the highest dust exposure scores had a lower loss with increasing age than the women with the least dust exposure. There was an excess in symptoms in the ex-flax workers but the size of the excess was greater than would be expected from the lung function results. It is possible that, although the survey was conducted without explicit reference to the flax industry, knowledge throughout Northern Ireland that many flax workers have been awarded compensation on the grounds of respiratory disablement may have led to an increased reporting of symptoms in the ex-flax workers.     

Translation problems of the Spanish version of the Readiness to Change Questionnaire

The Readiness to Change Questionnaire instrument by Rollnicket al. (1992) has become a standard in assessing stages of changeamong substance users. It has found such widespread acceptancethat recently it has been translated into Spanish by Rodriguez-Martoset al. (2000). . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Occupational Allergic Contact Dermatitis in Lodz: 1990 1994

Occupational skin diseases in Poland constitute about 9% ofall occupational diseases. Occupational allergic contact dermatitis(OACD) account for 95% of diagnosed occupational skin diseases.During 1990–1994 we have diagnosed 332 OACD cases (159men, 173 women). OACD was most frequent in health care workers(25.6%), the metal-working and machine-building industry (19.6%),and the house-building industry (13.9%). Occupational allergywas most frequently due to exposure to chromates (38.8%), cobalt(38.8%), nickel (30.7%), and also formaldehyde (18.1%) and epoxyresins (9.1%). When comparing our present results with thoseobtained in 1972–1987, we note an increased overall numberof OACD cases (the number of diagnosed OACD cases at that timewas 34 per annum, compared with 66 cases per annum at present)and increased OACD cases in women. There was an increase ofOACD among health care workers. Recently, there has been anincrease in the number of patients with allergies to nickeland formaldehyde, and a decrease of the patients hypersensitiveto turpentine. Received       18 December 1995 Accepted        2 April 1996     

Peak Expiratory Flow Rate and Blood Histamine in Textile Mill Workers

Byssinosis is an asthma-like condition in cotton-mill workersand is related to blood histamine and respiratory function.In a preliminary study the peak expiratory flow rate (PERF)values and blood histamine (measured by bioassay method) levelswere compared in workers exposed to cotton dust, i.e. byssinotics(n = 12) and non-byssinotics (n = 12), and unexposed workers(n = 15). The PEFR showed a negative relationship with the histaminelevels of blood in the cotton-dust exposed workers and whencompared to control subjects (P <0.001). The PEFR was maximalwhen blood histamine levels were in a range of 0 to 5 µg/mland dropped down to the lowest level when the blood histaminewas more than 10 µg/ml. This exact relationship was demonstratedby a correlation coefficient and regression equation. This observationis in confirmation with the lung function test of these subjects. Requests for reprints should be addressed to: Dr H. Venkatakrishna-Bhatt, Scientist and Head, Division of Agricultural Health, National Institute of Occupational Health, Meghani Nagar, Ahmedabad 380016 (Gujarat), India.     

Effect of Helicobactor pylori eradication therapy on dyspeptic symptoms in primary care

OBJECTIVE: The aim was to explore the effect of eradication therapy ondyspeptic symptoms in patients with known peptic ulcer disease(PUD). METHOD: A total of 164 known dyspeptics and 147 non-dyspeptic attendersat six UK general practices were recruited. The Helisal RapidBlood test was performed in the practices and eradication therapyleft to the preference of the general practitioner. Patientswere followed prospectively by a Likert scaled symptom questionnaireand record review. The symptom questionnaire distinguished betweenpatients known to have dyspepsia and those not. RESULTS: There was a statistically significant decrease in dyspepticsymptoms in patients with known PUD who received eradicationtherapy (n = 43, Z = –2.63, P = 0.009). CONCLUSIONS: Eradication of Helicobacter pylori in primary care can leadto a reduction in consumption of H2 receptor antagonists andhence cost savings. This study demonstrates that dyspeptic symptomsalso decrease. The questionnaire could be used in further studiesto evaluate the effect of management on dyspeptic symptoms inthe primary care setting. Keywords. Dyspepsia, Helicobactor pylori, primary care, therapy, outcome measures.     

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.     

Suprarenal Cortical Function in Asthmatic Welders

This work comprises the study of a group of 23 workers, workingas welders for 10–30 years. Clinically, they show a pictureof bronchial asthma. Pulmonary function tests reveal a pictureof obstructive lung disorder. This group has been compared with12 control subjects whose clinical examination, pulmonary functiontests, radiological examination of the chest and other examinationsrevealed no abnormality. Investigation of the suprarenal corticalfunction in these workers shows a high basal plasma cortisol,normal diumal rhythm but a significant depression in the corticalreserve capacity. This can be attributed to stress, which ispartly due to physical factors and partly due to the repeatedepisodes of coughing and dyspnoea caused by bronchial asthma. Requests for reprints should be addressed to: Dr N. I. Ebeid, 99, 26 July Street, Cairo, Egypt.