SWORD '98: surveillance of work-related and occupational respiratory disease in the UK

The SWORD surveillance scheme, now 10 years old, uses systematic reporting from physicians to provide a picture of the incidence of occupational respiratory disease in the United Kingdom. An estimated total of 2966 incident cases was derived from reports by chest and occupational physicians during the 1998 calendar year. Occupational asthma continues to be the most-reported respiratory condition, with an estimated 822 cases (27% of total cases). The proportion of cases of mesothelioma (23%), benign pleural disease (21%) pneumoconiosis (7%) and inhalation injuries (6%) remain similar to those estimated in past years, although fewer cases overall were reported. The most commonly identified agents causing asthma in 1998 were enzymes, isocyanates, laboratory animals and insects, colophony and fluxes, flour, latex, and glutaraldehyde. An increased incidence of respiratory diseases of short latency was seen in mining, whilst cases in chemical, mineral products and motor vehicle manufacture remained high; lower rates were noted in wood products and textile manufacture when compared with 1997 figures. Inhalation accidents over the past 3 years were reviewed; gaseous agents and combustion products accounted for nearly half of cases. High rates for inhalation injuries were seen in coal miners, fuel production, motor vehicle manufacturing, water purification, and chemical manufacturing.     

SWORD '96: surveillance of work-related and occupational respiratory disease in the UK

Chest and occupational physicians who report to the SWORD surveillancescheme are estimated to have seen some 3,300 new cases of work-relatedrespiratory disease in 1996. This total has regained the levelrecorded prior to a low in 1995, probably because of improvedchest physician participation and the introduction of a samplingsystem for occupational physicians. Trends in disease incidencehave remained fairly constant with some changes only in pneumoconiosisand inhalation accidents. It is of concern that there has beenno evidence of a decrease in frequency of occupational asthmaor in any of the incriminated agents since the scheme beganin 1989. Comparison with other sources of data shows that, forasthma, SWORD records a relatively high frequency in women,a substantial proportion of whom do not appear to receive compensation.For mesothelioma, rates based on death certificates continuefor understandable reasons to run at about twice the level reportedto SWORD or as reflected by successful claims to the DSS forindustrial injuries benefit. The SWORD programme is now oneof six clinically-based reporting schemes which, by the endof 1997, are planned to cover all types of occupational diseasein the UK.     

SWORD '99: surveillance of work-related and occupational respiratory disease in the UK

Systematic reports from chest and occupational physicians under the SWORD and OPRA (Occupational Physicians Reporting Activity) surveillance schemes continue to provide a picture of the incidence of occupational respiratory disease in the UK. An estimated total of 4393 incident cases (comprising 4530 diagnoses) were reported during the 1999 calendar year, an increase of 1427 cases over the previous year. Benign pleural disease was the single most frequently reported condition (28% of all diagnoses reported). Occupational asthma cases (1168; 26%) remained high, as did mesothelioma (1032; 23%). Analysis of trends over the past 8 years shows an increase in mesothelioma cases, but little change in asthma. The annual incidence per 100,000 employed people, 1996-1999, for mesothelioma, lung cancer and pneumoconiosis was high amongst construction workers (28.7), miners and quarrymen (26.5), woodworkers (18.9) and gas, coal and chemical workers (15.2). Trends in mesothelioma incidence by birth cohort continue to show an increase in construction workers and a continuing decline in shipyard and insulation workers. The relative proportion of pneumoconiosis cases attributed to coal mining has fallen steadily in workers born since approximately 1920 and most cases are now in men who have been employed in quarrying and rock drilling.     

Health and employment after a diagnosis of occupational asthma: a descriptive study

The objectives of this study were to describe changes in asthmaand employment after diagnoses of occupational asthma reportedto the SWORD project. Questionnaires were sent to 312 physiciansfor all 1,940 cases of occupational asthma reported from 1989–92;1,769 (91%) were returned but information was available foronly 1,317 (68%). Of patients reported by occupational physicians,45% had recovered from asthma compared to only 14% of thosereported by chest physicians (excluding medicolegal cases),presumably because of differences in severity. Proportions withthe same employer were 49% and 48% respectively. Patients exposedfor a year or more after diagnosis recovered from asthma lessfrequently but were more often employed than those exposed forless than a year. Among those whose asthma was attributed tohigh molecular weight agents, smokers had developed asthma earlierafter exposure began than others but had the best prognosis.Asthma developed following a single high exposure in 18 cases(2%), of which 13 were to irritants and five to known sensitizers.     

Increased risk of asthma among Finnish construction workers

AIM: To determine the risk of asthma among 7891 Finnish construction workers in the Pirkanmaa Region of southern Finland. METHOD: Retrospective cohort study of hospital records of the Tampere University Hospital. A population of Pirkanmaa paper mill workers (n=2686) and the Pirkanmaa working age population (n=252,500) served as reference populations. RESULTS: There were 147 new cases of asthma among the construction workers in 1991-1995. The annual rate was 37 per 10,000 workers and the odds ratio was 2.1 [95% confidence interval (CI)=1.2-3.6] for the women and 1.8 (95% CI=1.5-2.2) for the men when compared with the general working age population. In general, the risk of asthma among the paper mill workers did not differ from the risk of asthma among the general working age population. The construction workers had an increased risk for asthma, although the number of reported cases of occupational asthma was lower for the construction workers than for the paper mill workers or for the working population. CONCLUSION: Construction work, especially dusty tasks, was associated with an elevated risk of asthma. Thus the effect of exposure to irritant agents may have a role in the development of asthma among construction workers. For the most part, these cases of asthma do not meet the criteria for occupational asthma because the specified causal agent can not be defined. The aetiologic agents and mechanisms of asthma in construction work should be clarified for preventive measures.     

Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project

The objective of this project is the creation of a reliableand cost-effective national system of surveillance for work-relatedrespiratory disease as a basis for control and simple epidemiologicalresearch. With the voluntary participation of almost 800 chestand occupational physicians from throughout the UK, newly diagnosedcases of respiratory illness thought to be due to occupationalfactors have been reported regularly since January 1989. SinceJanuary 1992, reports from chest physicians have been submittedmonthly by a core group with special interest in occupationallung disease (n=32) and rotating random samples of the remainder. Between 1989 and 1991, 5576 new cases were reported, of whichhalf were diseases of long latency mainly due to asbestos, 28%were occupational asthma, and the rest were divided betweeninhalation accidents (10%) and a variety of other acute diseases(14%). Disease incidence rates, with denominators from the LabourForce Survey, showed a very high risk of asthma among paintsprayers, chemical and food processors, laboratory staff, plasticsand metal treatment workers, and in welding and electronic assembly.Some of the same groups also experienced high rates of inhalationaccidents and bronchitis. The risk of diseases of long latency,using denominators from the 1961 census, was highest in shipyardand dock workers, miners and construction workers. The SWORD scheme has provided estimates of disease incidencenot previously available, has encouraged awareness of occupationalfactors among chest physicians, has assisted those responsiblefor prevention and control, and has demonstrated the feasibilityof this approach to surveillance.     

Occupational injuries to fisheries workers in Norway reported to insurance companies from 1991 to 1996

Fisheries work is one of the occupations at highest risk for occupational accidents in many countries. It is necessary to understand the injuries in order to prevent them. This study of occupational injury claims by fisheries workers in Norway made to insurance companies from 1991 to 1996 analysed the workers' age, time of injury, injury type, part of the body involved, injury event and cost. The highest injury incidence rates were among the younger fisheries workers and during the winter months. Bruises and fractures were the most frequent injury types, and fingers and hands were most often affected, whereas falls and accidents related to machines were the most common causes. Safety measures should be taken on board to prevent falls and machine-related injuries, and young fisheries workers should have better on-the-job training.     

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.     

Incidence by occupation and industry of acute work related respiratory diseases in the UK, 1992-2001

Aims: To summarise incidence rates and epidemiological characteristics of new cases of work related respiratory disease reported by specialist physicians in thoracic and occupational medicine, with particular reference to occupation, industry, and causal agents for asthma, inhalation accidents, and allergic alveolitis. Methods: Cases reported 1992–2001 to the SWORD and OPRA national surveillance schemes, in which almost all UK chest and occupational physicians participate, were analysed by age, sex, cause, occupation, and industry, with incidence rates calculated against appropriate denominators. Results: Excluding diseases of long latency, infrequently seen by occupational physicians, the distribution of diagnoses in the two specialties was similar, but with rates generally much higher in occupational than chest physicians. Occupational asthma was responsible for about 25% of cases overall, affecting mainly craft related occupations and machinists, and most often attributed to isocyanates, metals, grains, wood dusts, solders, and welding fume. These same occupations were those at highest risk from inhalation injuries, most frequently caused by irritant gases, vapours, and fume. Among medical technicians and nurses, however, glutaraldehyde and latex were the main causes of occupational asthma. Allergic alveolitis was seldom reported, with almost all cases in agriculture, forestry, and fishing. Conclusion: During the 10 year period studied, there were few changes in level of reported incidence, apart from some decline in occupational asthma and inhalation injuries. These results and their implications should be distinguished from much higher estimates of asthma made worse by work derived from population surveys, based on prevalence rather than incidence, and self-reported symptoms rather than diagnoses made by specialist physicians. Even so, the reported incidence of new cases of acute respiratory illness caused by work remains substantial.     

Fragrance as an occupational allergen

Sensitization to fragrance is believed to occur mainly outside the workplace. This study addresses the frequency of fragrance allergy in patch test patients of differing occupations during a 15 year period. The occupation most strongly associated with fragrance allergy in both sexes was health care work (positive tests in 11.7% of males and 10.4% of females). Retired individuals also had high rates of fragrance allergy (11.6% of males and 14.5% of females), and the prevalence of sensitization increased with advancing age. Health care workers and metal workers had statistically significantly higher rates of allergy to eugenol than did workers in other occupations. Food handlers had significantly higher rates of allergy to cinnamal and cinnamic alcohol. These findings suggest that sensitization to fragrance occurs more frequently in an occupational setting than is generally understood and could have implications for preventive measures.     

Specific IgE to colophony?

BACKGROUND: Colophony (rosin) is a natural product obtained from coniferous trees. It is used in a diverse range of products such as adhesives, ink, paints and soldering fluxes. Some workers exposed to colophony during soldering can develop occupational asthma; at present, no specific IgE test is available to assess sensitization to colophony. METHODS: Serum samples were obtained from exposed symptomatic individuals (n = 7), some with a likely diagnosis of occupational asthma, exposed asymptomatic individuals (n = 10) and unexposed individuals (n = 11). Serum was tested for specific IgE antibodies against a protein extract produced following in vitro challenge of mono-mac-6 cells with colophony extract. RESULTS: Serum from exposed symptomatic individuals showed increased binding of specific IgE antibodies to a range of colophony-cell protein conjugates [29% (2/7) of samples tested when cut-off > 0.1 or 86% (6/7) of samples tested when cut-off > 0%] compared with both the exposed asymptomatic [0% when cut-off > 0.1, or 20% when cut-off > 0% (2/10)] and the non-exposed control populations [0% when cut-off > 0.1, or 27% when cut-off > 0% (3/11)]. CONCLUSIONS: This novel approach for the production of conjugates to assess sensitization to colophony was able to detect specific IgE in colophony-exposed workers with a likely diagnosis of occupational asthma.     

Occupational health in the Andalusian Fisheries Sector

BACKGROUND: The conditions of work in the fisheries sector are arduous with high rates of occupational accidents. Numerous factors are known that can directly influence the health of the sailor or fisherman both in fishing and merchant fleets. AIM: To evaluate the health status, safety and working conditions in the Andalusian fishing sector. METHODS: Cross-sectional questionnaire study with proportional sampling of the health and lifestyles of fishery workers in 19 of the 23 Andalusian ports. RESULTS: A total of 247 workers employed on 202 craft fishing boats responded. In all 87% of workers reported a current medical condition. The main problems reported were musculoskeletal disorders, respiratory diseases, diseases of the digestive system, eye problems and skin problems. A total of 72% reported taking some self-prescribed medication, and 60% of fishery workers smoked. Nine per cent of fishery workers admitted taking illicit drugs and 3% reported using illicit drugs on board. Diets on board were poorly balanced. While on board, 62% of crews reported a subjective significant worsening of previous health. The lifetime prevalence of accidents was 76%. CONCLUSIONS: Fishery workers had a high prevalence of self-reported medical problems, a high prevalence of self-medication, poor diets and frequently smoked. Self-medication and some medical conditions (diabetes, angina and depression) may reflect a potential failing of health checks and pre-employment checks. National health services and insurance companies dealing with occupational health should focus more on appropriate health checks, illness prevention and health promotion activities for this population.     

Absenteeism and mortality of workers exposed to electromagnetic fields in the French Electricity Company

The objective of this study was to describe the health status of electricity workers exposed to electromagnetic fields during their job. Two groups of exposed workers were studied from 1978 to 1993: the live line workers (n = 121) and the substation workers (n = 232.7) of the French Electricity Company (EDF). A control group was randomly selected from all the company non-management male employees; one control for each exposed subject was matched for the first year of employment. Absenteeism indices and mortality rates were computed and compared in the exposed and control groups. The absence rates were 1.98% in the substation workers and 2.5% in the control group (p < 0.001) and 2.7% in the live-line workers and 2.8% in the control group (NS). No effect of the length of exposure was found. However the medical causes of sickness absence were different: exposed employees had less psychiatric and respiratory diseases but more accidents at work than their control group. Relative risks of accidents at work were 1.2 95% confidence interval (CI) = 1.08-1.33[ for substation workers and 3.22 (CI = 1.78-5.88) for live line workers. EDF electromagnetic field exposed workers seemed not to be affected by any specific health problems except for an excess of accidents at work.     

An audit of occupational health care for employees with low-back pain

Guidelines for occupational rehabilitation of workers with low-backpain were developed as part of a larger study. We have formulatedcriteria for good practice of occupational rehabilitation onthe basis of these guidelines. To assess the quality of occupationalrehabilitation in the Netherlands, these criteria were subsequentlyused in an audit of medical records. The number of patientswho received care consistent with the guidelines was comparedto the number of patients eligible to receive that kind of care(performance rate). Six performance rates were calculated fromthe medical files of 40 workers with 48 new episodes of low-backpain. Two performance rates proved to be below 25% and two almost50%. The highest performance rate, that for curative policy,was 90%. These results are discussed in the light of the reliabilityof the original data. We recommend construction of guidelinesas well as reliable registration of the occupational rehabilitationprocess to increase the possibilities of auditing and to raisethe quality of occupational health care.     

An analysis of the causes of mortality among seafarers in the British merchant fleet (1986-1995) and recommendations for their reduction

This study was designed to establish the manner and causes of all fatalities among seafarers who were serving in British merchant shipping between 1 January 1986 and 31 December 1995. Other main aims were to compare mortality rates with workers in other industries and with seafarers in other merchant fleets, and to discuss recommendations for the prevention of occupational mortality. This study was based upon official mortality files with a population of 253 919 seafarer-years at risk. There was a total of 252 fatalities in British merchant shipping during the study period. One hundred and seven of the 252 deaths were due to natural causes, of which 93 (87%) were caused by cardiovascular disease. The relative risk of mortality due to accidents at work (96 fatalities) was 23.9 times higher than for all workers in Great Britain during the same time period (95% confidence interval = 14.0-40.7). The risk of a fatal accident in merchant shipping was also much higher than in other British industrial sectors, such as agriculture, forestry and fishing (relative risk = 4.5), construction (5.5), and manufacturing (22.0). Seafaring was identified as a dangerous occupation compared with shore-based employment. Many of the fatal accidents at work were caused by hazardous working practices and were often preventable, as were the many off-duty accidents and drowning that were caused by seafarers falling into docks when encountering hazardous access to their ships from the shore. Seafarers are also at special risk from acute illnesses since they lack direct access to specialist medical care.     

Demographic and lifestyle predictors of body mass index among offshore oil industry workers: cross-sectional and longitudinal findings

BACKGROUND: Significant overweight among offshore workers on North Sea oil and gas installations has been linked to high calorie intake, lack of active leisure-time pursuits, and environmental factors conducive to weight gain. However, the prevalence of overweight among offshore workers has not been examined in recent data, and no longitudinal studies of body mass index (BMI) in this occupational group have been reported. Aims The present study sought to examine BMI levels in a sample of UK offshore personnel, and to evaluate demographic factors, smoking and work-related physical activity as predictors of BMI, and 5 year change in BMI. METHODS: Survey data (including age, education, marital status, work-related physical activity and height/weight) were collected in 1995 from male workers on 17 North Sea installations (n = 1581, 83% response rate); follow-up data were obtained in 2000 (n = 354, 34.9% of the potential sample). RESULTS: Overall mean BMI was 25.6 (2.8) kg/m(2): rates of obesity (BMI > 30) and overweight (BMI = 25-30) were 7.5 and 47.3%, respectively. Mean age was 38.7 (8.9) years; linear and quadratic age terms predicted BMI. Age-adjusted BMI values were very similar to those reported from other offshore studies over the past 15 years. Age, marital status, education, smoking and physical activity significantly predicted baseline BMI, but only age (and some interactive effects) predicted 5 year BMI change. CONCLUSIONS: The present age-adjusted BMI values were closely similar to those found offshore in the mid-1980s, but also to recent national data; thus, North Sea personnel do not appear to reflect current population trends towards increased BMI levels. This result accords with the emphasis now given to health promotion (particularly dietary change) on offshore installations; the present findings also highlight the need to focus these initiatives on workers with sedentary jobs and/or low education.     

Asthma following inhalation accidents reported to the SWORD project

A follow-up study in 1994 of all inhalation accidents reported to the Surveillance of Work-related and Occupational Respiratory Disease project (SWORD) found that in 11 (3%) of 406 cases reported by occupational physicians and in 39 (18%) of 217 cases reported by chest physicians the patients had developed asthma-like symptoms. In a further follow-up in 1995, physicians who had reported these 50 cases were asked whether they still considered that their patients had developed asthma as a consequence of the inhalation accident and further details were sought. Of the 11 cases reported by occupational physicians, seven were considered due to the inhalation accident, compared with 27 of 39 from chest physicians. The majority (88%) of diagnoses were supported by respiratory function tests. Accidents with prescribed sensitizing agents more frequently resulted in asthma than those with other agents. Of 34 cases, only six had recovered when last seen, so it was unlikely to have been due to transient bronchial hyperreactivity. The positive predictive value of respiratory symptoms increased with the number and duration of symptoms but was low for occupational physicians.     

Estimating the incidence of occupational asthma and rhinitis from laboratory animal allergens in the UK, 1999-2000

We report a survey of the number of persons handling laboratory animals in the UK in 1999-2000. This estimate has allowed us to calculate annual incidence rates of allergic asthma and rhinitis attributable to laboratory animals, insects, and birds using numerators derived from cases reported to a national surveillance scheme (SWORD). The number of exposed employees has almost halved since the early 1980s. From these data, the estimated annual incidence rate of occupational asthma among persons working with small mammals is 1.56/1000 employees. Although reported cases are rare, estimated incidence rates of asthma attributable to birds (23.9/1000/year) and insects (2.35/1000/year) are high.     

Prevention of occupational asthma--practical implications for occupational physicians

BACKGROUND: Occupational factors have been estimated to contribute to approximately 10% of adult-onset asthma and occupational asthma (OA) is one of the most common occupational lung diseases in industrialized areas. Persistent asthma frequently occurs with significant socio-economic impacts. METHODS: A literature search was performed using PubMed. The key term searched was occupational asthma combined with prevention. RESULTS: Primary prevention has been effective for OA related to natural rubber latex, and may have reduced the incidence of diisocyanate-induced asthma. Medical health surveillance has been effective in settings such as the detergent enzyme industry, workers exposed to complex platinum salts and likely for diisocyanate workers in Ontario. Tertiary prevention is still required for workers with OA and can improve prognosis. CONCLUSIONS: OA is potentially preventable. Sufficient studies have demonstrated the rationale and benefit of primary preventive strategies. Medical health surveillance programs combined with occupational hygiene measures and worker education have been associated with improved outcomes but further studies are needed to understand the optimum frequency and measures for such programs and to identify the separate contribution of the components. Until primary and secondary prevention is better understood and implemented, there will also remain a need for tertiary preventive measures.     

Health care workers' exposure to blood-borne pathogens in Lebanon

Background Accidental exposure to blood-borne pathogens (BBPs)is a risk for health care workers (HCWs). Aim To study the pattern of occupational exposure to blood andbody fluids (BBFs) at a tertiary care hospital. Methods This study reports a 17-year experience (1985–2001)of ongoing surveillance of HCW exposure to BBFs at a 420-bedacademic tertiary care hospital. Results A total of 1590 BBF exposure-related accidents werereported to the Infection Control Office. The trend showed adecrease in these exposures over the years with an average ±standard error of 96 ± 8.6 incidents per year. In thelast 6 years, the average rate of BBF exposures was 0.57 per100 admissions per year (average of needlestick injuries alonewas 0.46 per 100 admissions). For 2001, the rates of exposurewere found to be 13% for house officers, 9% for medical student,8% for attending physicians, 5% for nurses, 4% for housekeeping,4% for technicians and 2% for auxiliary services employees.The reason for the incident, when stated, was attributed toa procedural intervention (29%), improper disposal of sharps(18%), to recapping (11%) and to other causes (5%). Conclusions The current study in Lebanon showed that exposureof HCWs to BBPs remains a problem. This can be projected toother hospitals in the country and raises the need to implementinfection control standards more efficiently. Similar studiesshould be done prospectively on a yearly basis to study ratesand identify high-risk groups.