Dehydroabietic acid as a biomarker for exposure to colophony

BACKGROUND: Colophony (rosin) is a natural product derived from the resin of coniferous trees with many industrial applications including soldering fluxes. Exposure to colophony fume through soldering is one of the leading causes of occupational asthma in the UK. AIMS: To assess occupational exposure to colophony from solder fume at selected workplaces in the UK and to investigate the use of dehydroabietic acid (DHA) as a biomarker of exposure. METHODS: Six companies in the UK electronics industry were visited and occupational hygiene assessments of extent and control of exposure to rosin-based solder flux fume were undertaken. Urine samples were analysed for one of the main constituents of rosin, DHA. RESULTS: There was a positive linear relationship between airborne exposure to solder fume and urinary DHA level. The levels of urinary DHA measured in UK workers were significantly lower than those previously measured in African workers because of the use of appropriate exposure control measures, for example, local exhaust ventilation with fixed ducting and flexible hose, tip extraction, etc. It is suggested that good occupational hygiene practice would result in urinary DHA levels of <3 micromol/mol creatinine in a post-shift urine sample. CONCLUSIONS: Urinary DHA is a valid biomarker of exposure to colophony in solder fume. Further work on the excretion kinetics of urinary DHA, the possibility of skin absorption and further occupational hygiene surveys would be beneficial.     

Toothless tests: associations between the results of routine screening medical examinations and ill-health retirement of firefighters in west central Scotland

The final routine medical examinations (RME) of 526 full-time firefighters, all male, retiring from Strathclyde Fire Brigade in the decade beginning 1 January 1985 were studied to determine differences between the results of the 328 taking ill-health retirement (IHR) and the 198 completing maximum service (MS). Mean ages at IHR and MS were 48 and 54 years/respectively. This was statistically significant (P = 0.0000), so the results of the third RMEs, performed after the subjects' 46th birthdays, were also analysed. The findings were also reduced into quinquennia. Since the RMEs were weighted towards cardiovascular disorders, the outcomes of the 37 IHRs from arterial disease were sought and compared to the final results of those with MS. In both final and third RMEs, those completing MS were more likely to be non-smokers (60.9 vs 41.4%; 51.6 vs 42.6%; P = 0.01 and 0.015). In the final RME, subjects with MS generally had normal lung function (abnormal results 4.8 vs 10.4%; P = 0.002), abnormal chest X-rays and near vision (22.4 vs 7.6%; 91.1 vs 51.6%; P = 0.000 for both). In the third RME, firefighters with IHR were more likely to have hypertriglyceridaemia (39.6 vs 22.4%; P = 0.004), and reduced distance vision (32.2 vs 21.2%; P = 0.03). Where IHR resulted from arterial disease, sufferers had raised mean cholesterol (6.76 vs 6.20 mmol/l; P = 0.049), raised median triglycerides (2.1 vs 1.55 mmol/l; P = 0.0236), hypertriglyceridaemia (44.4 vs 21.2%; P = 0.008) and less likely to be non-smokers (32.4 vs 60.9%; P = 0.001). Differences between body mass index, systolic and diastolic blood pressure, fasting and HDL cholesterol, electrocardiogram abnormalities, urinary abnormalities and total numbers of risk factors did not reach statistical significance, apart from isolated quinquennial episodes. These results suggest that, except for highlighting known health hazards, current RMEs are ineffective in identifying those at risk of ill-health retirement in this group.     

Rationalization as a key stressor for public sector employees: An organizational case study

Public sector organizations throughout Europe have been subjectto cuts in Government spending, allied to demands for enhancedefficiency and effectiveness. Consequently, many have embarkedupon radical programmes of change which potentially have anadverse effect upon the psychological well-being of employees.This study aimed to assess linkages between organization changeand the psychological well-being of employees within the Swedishsocial insurance organization Försäkringskassan. Acase study approach was adopted for the investigation whichwas carried out within the Halland region between February andJune 1995. A questionnaire which included the Cultural Auditand the General Well Being Questionnaire was distributed tothe organization's 456 employees in Halland. Questionnaireswere returned by 246 employees (54.6%), reflecting the employmentstructure of the organization. The findings revealed that manyissues associated with the process of rationalization and changewere of concern to employees. Statistical analyses revealedthat these were linked to their relatively high levels of ‘anxiety’and their symptoms of being ‘worn out’. This studyindicates that the process of organization change is stressfulfor employees within Försäkringskassan. As publicsector organizations throughout Europe are subject to similarpressures and are being forced to embark upon change programmes,it is suggested that they take cognizance of the findings ofthis investigation when making decisions regarding the planningand implementation of organization change.     

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.     

Audit in occupational medicine: an audit of fitness to drive among voluntary drivers in an NHS trust

BACKGROUND: A health surveillance programme, to assess fitness to drive, was initiated for voluntary drivers in an NHS Trust because of reports of increasing frailty and slow reactions among some drivers. After discussion between the occupational health department, voluntary services manager and personnel department it was considered appropriate to apply Driver and Vehicle Licensing Authority (DVLA) Group 2 fitness to drive standards to those voluntary drivers who drove the Trusts minibuses. RESULTS: An audit of the initial health surveillance of 47 drivers is presented. The mean age of the voluntary drivers was 66.4 years. A large number of medical problems with the potential to affect driving were discovered (average of 1.9 medical problems per driver).The outcome was that five voluntary drivers were found unfit to drive the hospital minibus and one voluntary driver was found unfit for car driving. CONCLUSIONS: A fitness assessment form for drivers is presented. This form is primarily for the use of occupational health nurses, to help them to decide when referral to an occupational health physician is indicated.     

Dog noise as a risk factor for hearing loss among police dog handlers

AIM: To determine the sources of noise exposure among police dog handlers and to examine whether these levels might lead to noise-induced hearing loss. METHODS: We conducted a cross-sectional study at four Royal Air Force bases using a noise survey, a postal questionnaire and medical record review. The noise survey was conducted following task analysis. We surveyed police dog handlers and a comparison group of police who had never been dog handlers, using a postal questionnaire on noise exposures and confounders. Audiometric and otological data were extracted from medical records. RESULTS: The noise survey revealed significant exposures due to dogs, travelling in vans and aircraft noise during foot patrol. The overall response rate to the questionnaire was 56% (29 police dog handlers, 24 police officers). Five subjects (9.4%) had age-corrected hearing loss exceeding 10 dB, averaged over the 4 and 6 kHz frequencies, affecting the left ear only, but there were no differences between dog handlers and controls. CONCLUSION: Although the measured noise exposures of police dog handlers did not exceed current legal limits, the noise levels at times are such that the proposed Physical Agents (Noise) Directive has implications for employers who use dogs for security purposes.     

Ill-health retirement: a survey of decision making by occupational physicians working for local authority fire and police services

AIMS: To investigate the effect of qualifications, experience and service on ill-health retirement decisions made by police force and fire brigade medical advisers. METHODS: Doctors advising UK fire and police authorities attending a conference were given 16 case summaries from experienced fire and police advisers and asked to predict the outcome in terms of return to work or ill-health retirement. The answers were scored by assessing whether the outcome predicted by the participant agreed with the case setter. Correlation coefficients were calculated and a kappa coefficient was determined for assessing inter-participant variation. RESULTS: Forty-seven doctors attended, 44 participated and the responses of 39 (86%) were analysed. Over half the doctors participating had held their post for less than 5 years. The majority (>50%) agreed with the case setter in 11 case summaries and in five cases the agreement was strong (>75%). The majority disagreed in five cases, with < or =80% dissenting in three cases. There was wide variation in the inter-participant variation (kappa = -0.333 to +0.5) but the total agreed score correlated significantly (P < 0.05) with experience and service as a fire or police adviser (kappa = 0.33) and ill-health retirement agreement correlated significantly with experience (kappa = 0.49). There was no correlation between the level of qualification and total correct decisions. CONCLUSIONS: Whilst we found general agreement overall, our results suggest that there is inconsistency in ill-health retirement decision making by police and fire service medical advisers in certain cases. Experience appears to improve the likelihood of agreement in decision making.     

Aggression in boat builders: a search for altered mood states in boat builders exposed to styrene

Published reviews and industrywide anecdotal reports have suggested an association between exposure to some volatile organic compounds (VOCs) and altered mood states. In this paper we report a unique study of boat-builders exposed to styrene. Two hundred and thirteen employees exposed to solvents and 144 who were not exposed completed questionnaires related to mood states. Additionally, for 23 of the 213 employees, the air concentrations of styrene were measured at their workplaces, and urinary concentrations of mandelic acid (a metabolite of styrene) were determined in order to assess biological exposure. Special features of this study included the use of the Prolife of Mood States (POMS) questionnaire and the availability of sound historical data. A weak association is demonstrated between styrene exposure and aggression/hostility. That this is found to be most marked in the earliest years of exposure suggests that selection characteristics might be a more important association than solvent exposure.     

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.     

Medical students and congenital colour vision deficiency: unnoticed problems and the case for screening.

The results are given of a questionnaire study to determine the range of difficulties that doctors notice in their work due to congenital colour vision deficiency (CCVD). The study is primarily qualitative. A questionnaire was sent to 40 self-selected doctors, 35 of whom were general practitioners (GPs). All were administered a number of colour vision tests to assess the type and severity of their deficiency. Many difficulties and some ways of overcoming them were reported. Those with a mild deficiency reported fewer difficulties and this relationship was significant. Twenty-three of the doctors also reported difficulties as medical students and their answers are given verbatim. The results are discussed in relation to other studies and data on colour vision. The reasons for and against screening medical students for this deficiency are considered and it is concluded that there is a strong case for screening.     

Medical students' evaluation of a teaching session in occupational medicine: the value of a workplace visit

BACKGROUND: Undergraduate teaching in occupational medicine in UK medical schools is in decline. We developed a teaching programme for the new curriculum at our medical school, and then used student evaluation to tailor it to students' perceived learning needs. AIMS: To examine medical students' perception of a teaching session in occupational medicine after changes made in the light of earlier student evaluation, and in particular their views on the inclusion of a workplace visit. METHODS: Questionnaire evaluation feedback completed immediately after teaching sessions, triangulated with a student focus group session conducted by an external facilitator to explore what students valued most and least and why. Comparison of student evaluations before and after changes introduced in the light of student evaluations. RESULTS: Students' perception of the usefulness and relevance of the session significantly improved after the changes. Students consistently identified the use of case scenarios as helpful but demonstrated a dichotomy of opinion about the value of a workplace visit. Overall, students valued the brevity of the session that resulted from removing the workplace visit. CONCLUSIONS: It is possible to enhance students' perception of the value of a teaching session by modifying the session in the light of student-based evaluation.     

Good medical practice: guidance for occupational physicians

Following a catalogue of serious, highly publicized medical misdemeanours, the General Medical Council (GMC) has introduced plans for a new system of medical licensing in the UK called 'revalidation'. Under this, the onus will fall on individual doctors, including occupational physicians, to demonstrate their continuing fitness to practice. Doctors will need to show that they meet basic minimum standards in terms of the care they provide, their own continuing professional development, and other aspects of professional life like probity and ethical behaviour. As part of the process, the Faculty of Occupational Medicine, Royal College of Physicians, has produced its own guidance on good medical practice for occupational physicians, following an extensive consultation exercise. This paper summarizes the background to the initiative, the development process and the standards that have been recommended to aid professional accountability.     

Preventable exposure to trimethyl tin chloride: a case report

Trimethyl tin chloride (TMTC) is a highly toxic organotin compound that affects four main target organs: the brain, liver, immune system and skin. Exposure can occur by inhalation, ingestion or direct skin absorption. Trimethyl tin is but one of many hazardous substances with potentially serious health consequences to which individuals working in research laboratories may be exposed. We report a preventable case of TMTC exposure. Better understanding of the Canadian Workplace Hazardous Materials Information System (WHMIS) legislation and its applicability to the research laboratory situation would prevent such unnecessary exposure to hazardous substances.     

The construction flagperson: A target for injury

A road construction ‘flagger’ is a constructioncrew member whose responsibility it is to safely co-ordinatevehicle traffic through road worksites. Flaggers are sufferinginjuries and fatalities at the worksite as a result of beingstruck by moving vehicles, both construction and commuter. Theseincidents are largely preventable with a more defensive flaggertraining programme. A cross-Canada provincial survey of occupationalhealth and safety organizations revealed no national co-ordinationand standardization in flagperson training. Statistics concerningflagger injury and fatality are disjointed and incomplete, andas such are not useful for evaluating and validating trainingand job performance. We recommend a revisiting of flagpersontraining standards and that greater effort is taken in gatheringdata specifically on flagger injuries and fatalities.     

Ethical issues in occupational medicine practice: knowledge and attitudes of occupational physicians

Views on ethical conduct in occupational medicine practice canvary from country to country and even between occupational healthpractitioners. However, there are many areas of common agreement,and this is apparent on comparing guidance documents on ethicsproduced by several different organizations. The usefulnessof these documents will depend in part on how aware practitionersare of their existence. A standardized questionnaire administeredto 70 occupational physicians in the Netherlands, UK, and Singaporeshowed that there was a lack of awareness of guidance documentson ethics, even for publications from their own countries. Onlyfive of the 70 respondents consulted an ethics document in thepast year. In addition to publications, other avenues were usedfor advice on ethical issues. There was a difference in opinionbetween the physicians from Singapore and those from the twoEuropean countries on whether specific occupational health activitieswere ethical. These findings reinforce the need for internationalguidance on ethics to take into account differences in attitudesand practice between countries. On many issues there was nounanimity of opinion, even between occupational physicians fromthe same country. This may be an indication of the complexityof ethical matters, and provides a rationale for publishingguidance on ethics in occupational medicine.     

Factors influencing return to work after surgical treatment for carpal tunnel syndrome

Background Controversy exists regarding the factors influencingthe duration of work incapacity after surgically treated carpaltunnel syndrome (CTS). Aim To determine relevant factors related to return to work. Methods Surgical technique, clinical factors, demographic factors,other medical problems, psychosocial factors, work-related andeconomical factors were reviewed in patients operated on forCTS. Statistical multivariate analyses were performed to identifythe baseline factors influencing the work incapacity period. Results A total of 107 cases were reviewed. Professional exposureto repetitive movements and heavy manual handling activity wereassociated with a longer return-to-work interval. The durationof work incapacity period was not significantly related to thesocioprofessional category of the patient (self-employed oremployee) or to the type of the procedure (open versus endoscopicsurgery). Conclusion Work-related features have a more important influenceon return to work than personal, pathological or surgical features.     

The interaction between general practitioners and occupational health professionals in relation to rehabilitation for work: a Delphi study

BACKGROUND: Anecdotally, communication between general practitioners (GPs) and occupational health professionals is poor and acts as a barrier to successful rehabilitation for work. It is not known how widely this view is held by the many stakeholders in rehabilitation for work, or how important the observation is in its effect. METHODS: A Delphi study was conducted by initial semi-structured telephone interview, followed by a three-round collation and feedback of opinion by e-mail. The 25 participants were identified by suggestion within the study process for their position as key informants within a wide range of stakeholders. RESULTS: The process generated a consensus statement which identifies the extremely important nature of rehabilitation for work, the crucial role by GPs, the central role of occupational health professionals in case management and the barrier represented by the often very poor communication between them. CONCLUSION: The way forward is to improve communication by mutual education and understanding and a team approach to rehabilitation strategy. This may be facilitated by the GPs who work in occupational health and disability assessment and the involvement of other health professionals to great benefit for all stakeholders.     

Fitness for work: the need for conducting a job analysis

Ensuring that employees are both physically fit for work by matching their capabilities with the physical requirements of their job, and physically fit for life by promoting health-related physical activities, are important and under-utilized tools in a company's arsenal for reducing absence and ill-health retirement (IHR). Both the Health and Safety at Work Act (1974) and the Disability Discrimination Act (1995) require evidence-based approaches to setting physical and medical employment standards. Proven fitness-related strategies include redesigning the most demanding tasks, selecting and training personnel who possess the necessary physical attributes, and assessing and redeploying personnel to jobs within their capability. An essential precursor to pursuing these strategies is to conduct a job analysis to quantify the physical demands of the job.     

Occupational exposures to metals, solvents and pesticides: recent evidence on male reproductive effects and biological markers

This review is based primarily on the recent epidemiological studies conducted in occupational settings in order to explore the relationship between exposures to chemical agents and the possible effects on male reproductive function. The paper examines evidence of the effects of metals, solvents, pesticides and dioxin. The effects considered are primarily the possible alterations of sperm quality and reduction of fertility. Many studies have identified small groups of workers with exposures to these agents, presenting some alteration in the spermatological or fertility profile, but the results are difficult to replicate in other settings with different individuals and different levels of exposure. From examination of the concentrations of environmental and occupational pollutants in the blood and in the seminal fluid of exposed individuals, it appears that, in general, the concentrations are much lower in the seminal fluid and in sperm cells, making this a less useful marker of exposure.