Compliance with follow-up after occupational exposure to hepatitis C

BACKGROUND: Accidental percutaneous exposure to blood containing hepatitis C virus (HCV) is reported by health care workers more frequently than exposure to human immunodeficiency and hepatitis B virus. The transmission rate following such an exposure is approximately 1.9%. Little is known about the attendance rate of such staff for follow-up testing following exposure to HCV. AIM: To determine whether our follow-up programme for staff exposed to hepatitis C would allow the early detection and treatment of infected staff members. METHOD: We reviewed all staff exposures to hepatitis C reported to the occupational health department of a London teaching hospital over a 8-year period. RESULTS: Of 105 exposures, 21% of staff attended for early (6 or 12 weeks) and late (26 weeks) post-exposure follow-up. Thirty-seven per cent attended early follow-up only and 1% attended late having not attended early follow-up. Forty per cent did not attend any follow-up appointments with us. CONCLUSION: With the availability of effective treatment for early HCV infection, it is vital that occupational health departments encourage staff to attend at least for early follow-up. Access to HCV-RNA testing at this early stage should allow detection and early treatment of the small proportion who seroconvert.     

Chickenpox ARDS in a health care worker following occupational exposure

A case is described of chickenpox acute respiratory distresssyndrome in an ambulance driver after the inter-hospital transferof a patient known to have chickenpox pneumonia. Following thisexposure, he neither avoided patient contact nor received varicellazoster immune globulin. He subsequently required 13 days ofventilatory support before making a full recovery. The casedescribed supports the contention that health care workers shouldbe screened by serology for immunity to chickenpox before patientcontact occurs, with subsequent vaccination of those who arenon-immune, when the vaccine becomes available.     

Algae-induced occupational asthma in a thalassotherapist

BACKGROUND: Algae powders have been increasingly used in therapeutic preparations. Their potential as inducers of occupational asthma (OA), however, remains to be demonstrated. METHODS: A 33-year-old woman developed asthma following exposure to algae powder used for thalassotherapy. She had positive patch tests to nickel and cobalt in an evaluation for intermittent skin rash. At work, she had a normal forced expiratory flow in 1 s (FEV(1)) but moderate airway hyperresponsiveness. Bronchial provocation tests (BPT) were obtained. RESULTS: On BPT, an isolated early response was observed after a 1-min inhalation of dry algae powder, with a 50% fall in FEV(1) after exposure; the control BPT with lactose powder was negative. CONCLUSIONS: We report a case of algae-powder-induced OA. Such responses could be due to a sensitization to algae proteins or metal contaminants bioabsorbed by the vegetal particles.     

Occupational hygiene science and its application in occupational health policy, at home and abroad.

This paper examines the role of occupational hygiene in the overall framework of occupational health. It draws attention to the unique combination of required individual science subjects, and to the way in which occupational hygiene science contributes to the practice of occupational hygiene in the real world. It focuses in particular on occupational exposure standards. The paper provides, as an example, the specific case of occupational aerosol exposures. It is here that scientific research has made a notable impact on standards and led to a considerable degree of international harmonization. Finally, some broader insights into occupational exposure standards are given, based on experience gained during visits to a number of contrasting countries. The similarities and differences between the various national approaches help indicate what is generic in how standards are set. Such insights provide a basis for further international harmonization in the future. It is concluded that occupational exposure standards appear to be most effectively applied in countries where there are strong occupational hygiene cultures.     

Socioeconomic and occupational groups and risk of asthma in Sweden

AIM: To investigate possible associations between hospitalization for asthma and socioeconomic status and occupation. METHODS: A nationwide database was constructed by linking Swedish Census data to the Hospital Discharge Register (1987-2004). The hospital diagnoses of asthma were based on the International Classification of Diseases. Standardized incidence ratios were calculated for different socioeconomic and occupational groups. Ninety-five per cent confidence intervals were calculated assuming a Poisson distribution. RESULTS: A total of 13,202 male and 11,876 female hospitalizations for asthma were retrieved at ages >30 years. The socioeconomic groups with < 9 years of education were associated with a significantly increased risk of hospitalization for asthma. Among male occupations, increased risks were noted for farmers, mechanics and iron and metal workers, welders, bricklayers, workers in food manufacture, packers, loaders and warehouse workers, waiters and chimney sweeps with prolonged exposures in two censuses. For female occupations, increased risks were observed among assistant nurses, religious, juridical and other social science-related workers, drivers, mechanics and iron and metalware workers and wood workers. CONCLUSIONS: The present study suggests that socioeconomic status (low educational level) and occupation have an effect on the population's risk of hospitalization for asthma.     

Analysis of the clinical state of patients with occupational asthma following cessation of exposure to allergens

The purpose of this study was to evaluate the health state of patients with occupational asthma after cessation of occupational exposure to bakery allergens. A follow-up study of 56 subjects with occupational asthma was carried out. Subjects were examined twice: 1-6 months after removal from occupational exposure and 36 or 48 months later. Clinical state analysis both at diagnosis and re-examination was performed with the use of a questionnaire. Functional spirometric tests and skin prick tests and/or specific serum IgE were carried out during both examinations at points of time at which the subjects regarded their asthma symptoms as least severe. According to the subjective evaluation of the patients' clinical state, some improvement could be noticed 36 or 48 months after removal from work. Forced expiratory volume in one second (FEV1) and peak respiratory flow (PEF) did not change significantly. Total serum IgE concentration decreased in only two subjects, but the mean value of total IgE level did not significantly differ at the first and second examination after the cessation of occupational exposure. There was no significant difference in the number of positive skin prick tests to common and occupational allergens between the first and second examination. The majority of patients with occupational asthma reporting subjectively on their symptoms indicated an improvement in their clinical state 2-3 years after removal from occupational exposure. The intensity of skin prick tests was not reduced in the studied group. Non-specific bronchial hyper-responsiveness was not reduced in the majority of subjects with occupational asthma at least 2 years after cessation of occupational exposure.     

The influence of occupational exposure on male reproductive function

Recently, many studies have found a decrease in semen quality which has increased the focus on male reproductive health. Occupational hazards are by far the best documented in reproductive epidemiological research. Generally, occupational exposures have been divided into physical exposures (heat and radiation), chemical exposures (solvents and pesticides), psychological exposures (distress), exposure to metals and welding. The recent and/or most important epidemiological studies exploring the effect of occupational exposures on semen quality and fecundity, the ability to conceive, are reviewed. The evidence for an adverse effect on male reproduction of several occupational and environmental exposures and toxicants, such as heat, ionizing radiation, inorganic lead, dibromochloropropane, ethylene dibromide, some ethylene glycol ethers, carbon disulfide and welding operations, is strongly supported in well-designed epidemiological studies. For other agents, the association is only suspected or suggested and needs further evaluation before conclusions can be drawn. It is also important to bear in mind that many workers in the non-Western world still are exposed to substances that are banned in the Western world, sometimes in high concentrations.     

Meta-analysis in occupational epidemiology: a review of practice

OBJECTIVES: To describe past practice in meta-analyses found in occupational epidemiology, identifying the major issues that should be considered by researchers planning a meta-analysis in this setting. METHODS: An electronic search of relevant online databases was undertaken. Papers were included in the review if they contained a statistical synthesis of risks in an occupational health setting. RESULTS: Sixty reports of meta-analyses were identified, mostly in cancer. The number of meta-analyses has increased consistently over the last 20 years. A majority of studies focused on a mean overall effect, although more than half of them also investigated heterogeneity of results. Both fixed effect and random effects meta-analysis models were employed, the former more often, and in eight studies used despite a statistically significant test for heterogeneity. A large proportion of the meta-analyses included different effect measures in the statistical synthesis, for example, including standardized mortality ratios (SMRs) and standardized incidence ratios. Most meta-analyses limited to a single type of effect measure focused on SMRs. The vast majority of meta-analyses combined all studies regardless of variation in the extent of information on exposures. CONCLUSIONS: Meta-analyses in occupational epidemiology should properly explore and incorporate heterogeneity among studies. The meta-SMR is an important construct in this field, evidenced by a large proportion of cohort studies in the meta-analyses we identified. Controversy remains over the definition and validity of the meta-SMR. In addition, several other issues, notably dealing with heterogeneity in exposure, warrant further consideration.     

Activity profiles of the occupational health services in a multinational company

The management of the European division of a multinational company was aware of possible differences in the occupational health services (OHS) at their different locations. The objective of this study was to carry out a baseline assessment of these OHS. Structured interviews with representatives of the OHS were conducted at 20 locations in 11 countries. The OHS Recommendation from the International Labour Organization (ILO) was used as a standard for the organization and functions of the OHS. Considerable differences in the activity profiles of the OHS were detected. The inter-enterprise, multidisciplinary OHS spent most of their time on surveillance of workers' health in relation to work and on preventive activities in the working environment. Little time was spent on curative services for individual workers. OHS made up of individual physicians and nurses generally spent much of their time on treatment of occupational and non-occupational diseases. This study has clarified the status of the OHS providers and the potential for improvements in order to meet the needs of the company's locations and to comply more closely with the ILO recommendation.     

Renal cell carcinoma and occupational exposure to chemicals in Canada

This study assesses the effect of occupational exposure to specific chemicals on the risk of renal cell carcinoma in Canada. Mailed questionnaires were used to obtain data on 1279 (691 male and 588 female) newly diagnosed, histologically confirmed renal cell carcinoma cases and 5370 population controls in eight Canadian provinces, between 1994 and 1997. Data were collected on socio-economic status, smoking habit, alcohol use, diet, residential and occupational histories, and years of exposure to any of 17 chemicals. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived using unconditional logistic regression. The study found an increased risk of renal cell carcinoma in males only, which was associated with occupational exposure to benzene; benzidine; coal tar, soot, pitch, creosote or asphalt; herbicides; mineral, cutting or lubricating oil; mustard gas; pesticides; and vinyl chloride. Compared with no exposure to the specific chemical, the adjusted ORs were 1.8 (95% CI = 1.2-2.6), 2.1 (1.3-3.6), 1.4 (1.1-1.8), 1.6 (1.3-2.0), 1.3 (1.1-1.7), 4.6 (1.7-12.5), 1.8 (1.4-2.3) and 2.0 (1.2-3.3), respectively; an elevated risk was also associated with exposure to cadmium salts and isopropyl oil. The risk of renal cell carcinoma increased with duration of exposure to benzene, benzidine, cadmium, herbicides and vinyl chloride. Very few females were exposed to specific chemicals in this study; further research is needed to clarify the association between occupational exposure to chemicals and renal cell carcinoma in females.     

Perception and provision of occupational health services in the UK

BACKGROUND: There is difficulty in defining occupational health services among stakeholders of the service. Concurrently, there are concerns about the state of occupational health provision in the UK. AIMS: To determine stakeholders' perception of the services that occupational health encompasses and the level as well as the rationale behind the provision of these services. METHODS: The research was undertaken as a postal questionnaire survey of the FTSE 350 companies and selected public sector organizations in the UK. This was followed up by telephone calls to a random selection of non-respondents to obtain non-respondent data. RESULTS: There is a difference in opinion among managers and occupational health professionals about the services provided by occupational health. Taking into account non-respondent data to partially adjust for overestimation biases, the level of provision of occupational health services among the FTSE 350 companies is 69% and in public sector organizations is 95%, giving an average provision of 72%. Sixteen per cent of respondents thought there was a trend towards outsourcing of services. The most frequently cited reason for provision of an occupational health service was that it was for the benefit of employees. CONCLUSIONS: There remains room for improvement in the level of occupational health services provision in large UK private sector organizations. By bridging the gap between the different stakeholders' perceptions of the remit and benefits of the service, a higher level of provision in the private sector similar to that of public sector organizations can be achieved.     

Decreased carotid artery distensibility as a sign of early atherosclerosis in viscose rayon workers.

Carbon disulphide (CS(2)) is known to accelerate atherosclerosis and to increase the risk for cardiovascular diseases. To assess the effect of CS(2) on the functional (distensibility and compliance) and the structural (intima media thickness) properties of the common carotid artery, and blood pressure and lipid metabolism parameters, a cross-sectional study on 85 workers from a viscose rayon factory and 37 controls was carried out. Exposure to CS(2) was assessed by personal monitoring and was well below the threshold limit value-time weighted average. Carotid arterial wall properties were determined using a non-invasive ultrasound wall movement detector system. No significant effect of CS(2) on blood pressure, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol or triglycerides was found. Among the vascular parameters studied, only distensibility was significantly lower and heart rate was significantly higher in exposed subjects compared with the controls. In conclusion, occupational exposure to CS(2) may cause early alterations in arterial elastic properties in young individuals, and even before lipid and clinical findings have occurred, important functional changes in the vessel wall are present.     

Survey of occupational health problems in an operational military environment

16 Armoured Field Ambulance provided primary and secondary medicalcare to British troops in Bosnia from April to October 1996.Patients presenting at both levels were reviewed and categorizedinto occupational illness, non-occupational disease and non-occupationalinjury. The results show that occupational illness was a smallbut significant component of primary care (8%) with non-occupationalinjury accounting for < 1%. In secondary care, the more seriousnature of the occupational disease seen is shown in that itaccounted for 38% of all admissions and 44% of the 149 patientswho had to be evacuated from theatre for further treatment. Non-occupational injury represented 8% of admissions and 13%of evacuations.     

Occupational asthma and rhinitis caused by 1,2-benzisothiazolin-3-one in a chemical worker

We report a case of occupational asthma and rhinitis causedby inhalation of 1,2-benzisothiazolin-3-one, an additive usedas a microbicidal in detergent production, in a 26-year-oldman employed in a chemical factory producing detergents. Thesubject's task consisted of pouring raw materials into the recipientof a machine which mixed the substances. Two months after thebeginning of this job the patient complained of rhinitis andasthma at the workplace. The specific challenge test with 1,2-benzisothiazolin-3-one,one of the raw materials to which the subject was exposed, provokedan immediate prolonged asthmatic response and nasal symptoms,whereas exposure to other agents (e.g., -amylase, alcalase orbezalkonium chloride) to which the patient was also exposedat work did not. To our knowledge this is the first case ofoccupational asthma and rhinitis caused by this compound.     

Continuing professional development of occupational medicine practitioners: a needs assessment

OBJECTIVE: The aim of this study was to identify elements of occupational medicine practice used on a frequent basis which are considered to be of high priority for continuing professional development (CPD). METHODS: A postal questionnaire covering 28 areas of knowledge or practice was sent to all members of the Society of Occupational Medicine in September 2000. Respondents were asked to allocate scores to the 28 items for both CPD priority and frequency of use. RESULTS: The return rate for questionnaires was 29.5%. There was reasonable agreement between frequency of use and CPD priority ratings for the elements covered in the questionnaire. CONCLUSIONS: Despite the low return rate for questionnaires, this survey has helped identify themes which are important to physicians practising occupational medicine and has also highlighted those which are less important for inclusion in a CPD programme. Some differences in responses were identified between accredited specialists, specialist registrars and non-specialist practitioners of occupational medicine. The findings from this survey should be useful to providers of continuing medical education in planning courses, study days and electronic or distance learning educational packages.     

Occupational exposure to HIV and the use of post-exposure prophylaxis

The use of antiretroviral therapy as post-exposure prophylaxis against human immunodeficiency virus (HIV) is now routine following high-risk exposure to the HIV virus. This article summarizes the management of health care workers and others exposed to HIV in an occupational setting, and the evidence behind it.     

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.     

Incidence of occupational skin conditions in a food manufacturing company: results of a health surveillance programme

BACKGROUND: The food industry has been associated with a high risk of work-related skin problems. Aim To examine the incidence of work-related skin conditions and the likely causative agents in a single large food company. METHOD: Analysis of a health surveillance programme, conducted over a 7 year period, in a food company with 21 000 employees working in diverse manufacturing processes. RESULTS: The mean incidence of skin conditions, taking all of the different food manufacturing operations together, was 1310 per million employees per annum. The mean incidence was greatest in the manufacturing sector whose operations involved chilled or frozen product (3180 per million employees per annum). Most of the cases reported (184/192 = 96%) were due to primary irritant dermatitis. The two commonest suspected causes of the dermatitis were contact with ingredients and hand washing. Taken together, these factors accounted for 58% of all cases. Although the wearing of gloves is often considered necessary to prevent dermatitis from exposure to ingredients and to lessen the need for hand washing, this factor itself was responsible for 9% of all cases. CONCLUSION: Analysis of a company health surveillance scheme showed the average incidence of work-related skin problems to be lower than previously reported in the food industry.     

Design and trial of a new questionnaire for occupational health surveys in companies

In this article we present an example of our method for instrument development. This method is called the Development Cycle. It consists of four main stages: (1) defining the requirements for an instrument; (2) research, design and pilot testing; (3) implementation and (4) evaluation. An application of the Development Cycle was realized within a project for the development of a basic questionnaire about work and health, to be used at periodic health surveys. This questionnaire had to identify work and work-related health problems in employees with divergent occupations and working conditions. The design of the instrument and the results of its trial in 517 employees is presented. The evaluation of the test results and the modification of the questionnaire are discussed. From 1995, the questionnaire has been implemented in the Dutch OHS services quite successfully.     

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.