Irritant contact dermatitis due to 1-bromo-3-chloro-5,5-dimethylhydantoin in a hydrotherapy pool. Risk assessments: the need for continuous evidence-based assessments

A physiotherapist working in hydrotherapy presented to occupational health with irritant contact dermatitis. Subsequent investigation revealed that the likely causative agent was 1-bromo 3-chloro 5,5 dimethylhydantoin which was used to disinfect the hydrotherapy pool. A COSHH risk assessment had been performed which failed to take full account of current knowledge and this agent had been introduced into the workplace. The development of adverse health effects among staff and other pool users lead to a review of this risk assessment and eventually a return to less hazardous chlorine-based disinfection. Had an evidence-based approach been combined with an appropriate COSHH assessment prior to and following changes in the workplace then unnecessary risk to employees would not have occurred.     

Ergonomic methods for assessing exposure to risk factors for work-related musculoskeletal disorders

BACKGROUND: This review provides an overview of the range of methods that have been developed for the assessment of exposure to risk factors for work-related musculoskeletal disorders. METHODS: Relevant publications and material on exposure assessment techniques have been gathered for inclusion in this review. RESULTS: The methods have been categorized under three main headings: (1) self-reports from workers can be used to collect data on workplace exposure to both physical and psychosocial factors by using methods that include worker diaries, interviews and questionnaires; (2) observational methods that may be further subdivided between (a) simpler techniques developed for systematically recording workplace exposure that enable an observer to assess and record data on a number of factors using specifically designed pro-forma sheets for establishing priorities for workplace intervention; and (b) advanced techniques developed for the assessment of postural variation for highly dynamic activities that record data either on videotape or are computer analysed using dedicated software; (3) direct measurements using monitoring instruments that rely on sensors attached directly to the subject for the measurement of exposure variables at work. CONCLUSIONS: The choice between the methods available will depend upon the application concerned and the objectives of the study. General, observation-based assessments appear to provide the levels of costs, capacity, versatility, generality and exactness best matched to the needs of occupational safety and health practitioners (or those from related professions) who have limited time and resources at their disposal and need a basis for establishing priorities for intervention.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Work activity analysis of Finnish occupational health professionals

BACKGROUND: Some Finnish studies have dealt with how occupational health nurses divide their working hours but other occupational health professionals have not been evaluated. AIMS: This study describes how occupational health professionals allocate their working hours between main tasks. METHODS: Questionnaires were sent to 250 occupational health professionals, of whom 176 (70%) returned the completed forms. The data were analysed by using frequencies, means and one-way analysis of variance test. RESULTS: Employee-oriented tasks accounted for roughly 50% of working hours from all occupational health professionals. The remaining working hours were shared between workplace visits, co-operation with partners, other occupational health care responsibilities and tasks in other health care fields, especially in the health care centres. These working hours varied greatly between the different occupational health professional groups. All units employed full-time occupational health nurses, but the services of physicians, physiotherapists and psychologists were usually provided part-time or even restricted to a few hours each week because these services were difficult to obtain. Occupational health nurses working in the municipal health care centres spent more time on workplace visits than other nurses. Employee-oriented tasks were emphasized more in physicians', physiotherapists' and psychologists' work, especially in private medical health care units and in the jointly owned health care units. CONCLUSIONS: The amount of time occupational health professionals are able to spend on workplace activities appears to be determined by the type of their employer.     

Disease clusters in occupational medicine: a protocol for their investigation in the workplace.

Disease clusters have been an important source of epidemiologic and medical information in the history of occupational medicine. Many accepted disease-exposure linkages were first observed and investigated as disease clusters in the workplace setting. Recent interest in disease cluster methodology has focused on traditional environmental settings. There has been very little work on a similar methodology for the investigation of disease clusters in the workplace, despite the many advantages of workplace cluster investigations for recognizing new etiologic associations. In this paper, a protocol is proposed and discussed which can be implemented in both acute and chronic disease cluster outbreaks in the workplace, where no obvious previously recognized cause is identified. A standardized approach to occupational disease cluster investigation will lead to increased efficiency, decreased social-political tensions, and a greater yield of scientific information.     

Developing programmes to achieve a healthy society: creating healthy workplaces in Northern Ireland

Healthy workplaces help to prevent occupational disease and injury as well as promoting positive healthy lifestyle behaviours. The concept of creating healthy workplaces through workplace health promotion has been identified as a legitimate area of activity for public health policy in Northern Ireland, supporting as it does, the settings approach as a means of improving the health and well-being of the population at large. Benefits accrue to businesses, organizations and individuals from the enhancement of positive healthy lifestyle messages in addition to reinforcing the principles of good occupational health practices. Developing a framework for the creation of healthy workplaces is part of a joint initiative between the Northern Ireland Health Promotion and Health and Safety Agencies. Commitment to delivering the concept is required from all the key players who include: employers, employees, trade union groups and health and safety professionals. A healthy workplace model needs to be created which is flexible and adaptable to suit all types of business and in particular the needs of small businesses which predominate in Northern Ireland. The principles underpinning the Business Excellence Model may be a useful vehicle for delivering workplace health promotion onto an organization's agenda.     

The calculation of accident risks in fitness for work assessments: diseases that can cause sudden incapacity.

Risk equations have been developed to assist in determining fitness for work of people with diseases that may cause rapid loss of control. The four equations calculate the frequency of fatal injury to the person with the disease, the frequency of fatal injury to colleagues in the workplace, and the cost of fatal injury and property damage to the employer. It is suggested that the additional risk of fatal injury to the person with the disease should not exceed the fatal injury rate in high-risk industries such as forestry, fishing and mining. It is also suggested that the additional risk of fatal injury to each colleague should be no more than one-tenth of the fatal injury rate due to motor vehicle accidents in the community. Two hypothetical case examples are given, demonstrating the use of the equations. The equations highlight the need to examine the risks associated with individuals, their specific jobs and their workplaces. They also highlight significant uncertainties in the determination of fitness, which perhaps have been underestimated in the past. Wherever possible, redundant defences should be utilized to prevent accidents in the event of sudden incapacity.     

Future advances in work-related asthma and the impact on occupational health

Work-related asthma (WRA) and WRA-like conditions refer to all situations in which asthma or asthma-like syndromes occur or worsen in the workplace. This occurs in approximately 10% of all adult-onset asthma subjects. Occupational asthma (OA) is a specific type of WRA that is 'caused' by the workplace, being mediated either by an allergic process with a latency period or by a non-allergic irritant-induced mechanism. Personal asthma can also 'worsen' at work (work-aggravated or exacerbated asthma), the reasons, mechanisms, extent and consequences of this situation being unknown. The author reviews various aspects of WRA with an emphasis on OA (about which more is known) and proposes key issues that need to be further studied, proposed and applied in at-risk workplaces in order to improve recognition, diagnosis and management of this condition. OA represents a unique situation that, unfortunately, is only very rarely provided to health-care providers: affected workers can be cured with minimal impact on quality of life. All efforts should be made to achieve this goal at an affordable socio-economic cost.     

Minor injuries, cognitive failures and accidents at work: incidence and associated features

BACKGROUND: There is a dearth of information examining minor injuries and cognitive failures in the workplace. AIMS: This study aims to describe the incidence of, and characteristics associated with, minor injuries, cognitive failures and accidents in the workplace. METHODS: The study was a community based postal questionnaire survey of people selected at random from the Electoral Registers of Cardiff and Merthyr Tydfil; 7980 questionnaires were returned. RESULTS: Frequent/very frequent minor injuries were reported by 9.8% of the workers and frequent/very frequent cognitive failures (e.g. problems of memory, attention or action) by 10.5%. Work accidents requiring treatment were reported by 5.6% of the workers. Minor injuries, cognitive failures and accidents were associated with a number of demographic and health factors. In addition, minor injuries, cognitive failures and accidents were found to be related to each other. CONCLUSIONS: A large number of workers experience accidents and minor injuries at work. Minor injuries are not recorded by official sources but could have implications in productivity and worker health. Factors identified in this study, as associated with injuries or accidents, could be addressed by specific workplace policies or by raising individual awareness of the risks.     

Preliminary report: symptoms associated with mobile phone use

Mobile phone use is ubiquitous, although the alleged health effects of low level radio-frequency radiation (RFR) used in transmission are contentious. Following isolated reports of headache-like symptoms arising in some users, a survey has been conducted to characterize the symptoms sometimes associated with mobile phone usage. A notice of interest in cases was placed in a major medical journal and this was publicized by the media. Respondents were interviewed by telephone using a structured questionnaire. Forty respondents from diverse occupations described unpleasant sensations such as a burning feeling or a dull ache mainly occurring in the temporal, occipital or auricular areas. The symptoms often began minutes after beginning a call, but could come on later during the day. The symptoms usually ceased within an hour after the call, but could last until evening. Symptoms did not occur when using an ordinary handset, and were different from ordinary headaches. There were several reports suggestive of intra-cranial effects. Three respondents reported local symptoms associated with wearing their mobile phone on their belts. There was one cluster of cases in a workplace. Seventy-five per cent of cases were associated with digital mobile phones. Most of the respondents obtained relief by altering their patterns of telephone usage or type of phone. Cranial and other diverse symptoms may arise associated with mobile phone usage. Physicians and users alike should be alert to this. Further work is needed to determine the range of effects, their mechanism and the possible implications for safety limits of RFR.     

Report of a system for diagnosis, categorizing and recording occupational mental ill-health

BACKGROUND: UK statutory systems for occupational disease recording do not include mental illness resulting from occupational stress. The issue is included within physician reporting systems, but there is no agreed set of criteria for diagnosis of occupational causation and no agreed system of categorization in terms of type of causation by workplace factors. METHOD: A multidisciplinary group of occupational health professionals, in conjunction with human resources staff, developed a system for the diagnosis, categorization and recording of occupational mental ill-health. RESULTS: The developed system was applied as a pilot and the outcome from its first year of use is presented. CONCLUSIONS: The system is considered to have operated well in pilot, and has now been adopted as a standard operating procedure by the occupational health provider who developed it. The system is proposed as a tool in the development of standardized NHS or UK national systems for the recording of occupational mental ill-health.     

Prevalence, management and impact of urinary incontinence in the workplace

BACKGROUND: The few prior studies of urinary symptoms in the workplace have been small investigations of women in specific occupations (e.g. nursing) or industries (e.g. pottery manufacture). In this study, the aims were to describe the prevalence, management and impact of urinary incontinence for a large cross-section of employed women in the USA. METHODS: Five-page questionnaires were mailed to 5130 American households selected from the National Family Opinion survey panel during the spring of 2004. Usable questionnaires were returned by 3364 women in the target age range of 18-60 years. RESULTS: About 37% of the 2326 employed respondents reported urine loss during the last 30 days. The most common strategies for managing incontinence at work included frequent bathroom breaks and wearing pads. The use of urine control methods increased with the severity of urine loss. The effect of incontinence on workplace activities also increased with the severity of urine loss: 88% of employed women with the most severe symptoms reported at least some negative impact on concentration, performance of physical activities, self-confidence or the ability to complete tasks without interruption. CONCLUSION: Urinary incontinence is prevalent among employed women. Those who experience severe symptoms report that it has a negative effect on aspects of work. Programs on the prevalence and impact of urinary incontinence would help educate both employers and employees, and may lead to the development of better management techniques in the workplace.     

Occupational groups at risk of voice disorders: a review of the literature

BACKGROUND: Occupational voice health is becoming more important as more people rely on their voices for their work. A number of studies have identified certain occupational groups at increased risk of developing occupational voice disorders, namely teachers, singers and aerobics instructors. Aim The paper aims to review the literature on occupational groups at risk of voice disorders and identify areas for future research. METHOD: A literature review of key databases using key words such as 'occupational', 'voice health', 'voice loss', 'dysphonia' and 'work related' was undertaken. RESULTS: The review identified case reports, studies of attendees at hospital voice clinics and a few cross-sectional studies of occupational groups in the workplace. There were no longitudinal studies found or intervention studies looking at reduction of risk. CONCLUSION: Further research on occupational voice disorders needs to be based in the workplace, and to look at the risk factors for the development of voice problems and for the efficacy of controls.     

The assessment of fitness to travel

The majority of health problems encountered in association with travel stem from pre-existing, perhaps latent, illness in the individual which may be exacerbated by the rigours and hazards of travel. It is essential that the advising physician understands the hazards that are likely to be encountered during travel in order that they may develop informed decisions regarding fitness for travel and give appropriate advice. In an occupational health setting, the employer has a responsibility to safeguard the health of their employees whilst travelling on behalf of the organisation and will also have to fund any treatment abroad or the cost of repatriation. The dictating factor in determining fitness to travel will often be fitness to travel by air, consequent to the reduced partial pressure of oxygen and pressure changes in-flight. The majority of significant health problems encountered during travel are attributable to coronary heart disease and detailed guidance exists to determine fitness for travel. For many health problems little if any evidence based guidance exists and decisions will therefore have to be based on an understanding of the hazards likely to be encountered during travel. Access to appropriate standards of medical care abroad and the difficulties and expense of repatriation, should this be necessary, are also important factors to consider in addition to the basic determination of fitness for travel itself. This paper outlines the main factors to be considered when assessing fitness to travel and also examines available guidance for some of the more commonly encountered conditions.     

Strategies for prevention: occupational contact dermatitis

The economic consequence of occupational contact dermatitis (OCD) is considerable and impacts on an individual's quality of life. There are a range of prevention strategies, which include: elimination or substitution of harmful exposures; technical control measures; personal protection; identification of susceptible individuals; and education, training and health surveillance. Each one has been shown to have varying degrees of success in reducing OCD, but further work is required to evaluate the effectiveness of preventive measures in the workplace. OCD is not considered a high priority in most affected industries and therefore the development of health and safety policies to reduce its prevalence should be encouraged, although guidance and assistance would be required, because all employees are entitled to a safe working environment.     

Low back pain interventions at the workplace: a systematic literature review

OBJECTIVE: To assess the effect of controlled workplace interventions on low back pain (LBP) through a review of controlled studies. The rising costs of employees with LBP have resulted in an abundance of offers to society and organizations of interventions to prevent and/or treat the problem. Little is known of the effect of the different interventions. METHODS: A systematic literature search based on the inclusion criteria: controlled trial, work setting and assessment of at least one of the four main outcome measures: sick leave; costs; new episodes of LBP; and pain. Effect of the interventions was reported for the four main outcome measures. RESULTS: Thirty-one publications from 28 interventions were found to comply with the inclusion criteria. Exercise interventions to prevent LBP among employees and interventions to treat employees with LBP have documented an effect on sick leave, costs and new episodes of LBP. Multidisciplinary interventions have documented an effect on the level of pain. CONCLUSIONS: The results show that there is good reason to be careful when considering interventions aiming to prevent LBP among employees. Of all the workplace interventions only exercise and the comprehensive multidisciplinary and treatment interventions have a documented effect on LBP. There is a need for studies employing good methodology.     

Occupational toxicology and the control of exposure to pharmaceutical agents at work

BACKGROUND: The pharmaceutical industry employs >350 000 people worldwide in operations including research and development (R&D), manufacturing, sales and marketing. Workers employed in R&D and manufacturing sectors are potentially exposed to drug substances in the workplace that are designed to modify physiology and also to chemical precursors that are potentially hazardous to health. Pharmaceutical workers are at risk from adverse health effects, including occupational asthma, pharmacological effects, adverse reproductive outcomes and dermatitis. AIM: This study aimed to describe the approaches taken by pharmaceutical companies for identifying and communicating potential adverse health effects that may result from workplace exposures and in setting 'in-house' exposure control limits and to highlight the challenges in controlling workplace exposures to increasingly potent compounds. METHOD: The literature was reviewed by searching the Medline and HSELine databases. RESULTS: The findings are presented in five sections, covering: test methods and approaches to occupational toxicology; hazard communication; approaches to setting health-based occupational exposure limits for pharmaceutically active agents; recent approaches to risk control; and occupational hygiene and exposure controls. CONCLUSION: Significant efforts have been directed at predicting and evaluating potential occupational health hazards in the pharmaceutical industry. The pharmaceutical industry has provided leadership in controlling exposure to hazardous substances. Much of this work has been driven by a real need to control occupational exposures to substances that can have profound adverse health effects in exposed employees and that are becoming increasingly more potent.     

Olfactory sensitivity in medical laboratory workers occupationally exposed to organic solvent mixtures

BACKGROUND: Published epidemiological information relating the effects of occupational exposure to organic solvents (OS) to olfaction is limited. AIMS: The objectives of this pilot study were to measure the chemosensory abilities of medical laboratory employees occupationally exposed to OS mixtures, to compare these with control workers employed within the same occupational setting and to correlate chemosensory performance with OS exposure history and with employees' hedonic (pleasantness) perceptions about workplace OS odors. METHODS: Twenty-four medical laboratory employees (OS-exposed technicians plus control workers minimally exposed to OS) completed a health-related questionnaire, a test of pyridine odor detection threshold, along with a gustatory detection threshold test involving aqueous quinine solutions. Estimates of cumulative hours of OS exposure (CSI) were calculated from self-reports. RESULTS: OS-exposed laboratory technicians detected weaker concentrations of pyridine odor. Positive correlations were detected between CSI estimates to both pyridine detection and the degree that participants reported that OS odors were present in the workplace. However, no association was detected between pyridine detection and how unpleasant workplace OS odors were perceived. The OS-exposed participants were able to detect weaker concentrations of quinine. Compared to controls, OS-exposed workers complained more of experiencing several symptoms while working, including headaches, nasal irritation and mild cognitive impairment. CONCLUSIONS: The results of this cross-sectional pilot study indicated that, compared to controls, medical laboratory technicians exposed to low-level OS mixtures displayed evidence of elevated olfactory sensitivity (hyperosmia) to pyridine odor. The relation of this study's results to chemical intolerance warrants further investigation.     

Falls and fractures in women at work

BACKGROUND: Older women have been observed to have more serious injury particularly fractures after slips, trips or falls at the workplace. It is unclear whether this excess reflects a greater likelihood of falling or a greater proportion presenting with fractures once the fall has occurred. METHODS: Two studies were carried out: Study A, of 130 women who fell at work and matched referents, and Study B, of 120 women who fell at work and sustained a major fracture and 314 matched referents who fell but for whom no fracture was recorded. In Study A, the workplace of the case and referent was observed, questionnaires completed and objective health measures carried out. Study B relied on information obtained from the subject by postal questionnaire. RESULTS: Women who fell were older than referents matched on workplace and occupation, but age did not continue to be a significant factor after allowing for bodyweight and use of spectacles. Fractures were more common in older women who fell, particularly post-menopausal women with low body mass. The risk of fracture increased steadily with age without an obvious discontinuity around the likely age of menopause. CONCLUSIONS: The observed excess of fractures in older women falling at work appeared to be explained by the greater risk of fracture among those who fell.     

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.