Incidence by occupation and industry of work-related skin diseases in the United Kingdom, 1996-2001

BACKGROUND: Work-related skin disease is common but few cases are documented in statutory reports or disability systems. Voluntary reporting by specialist physicians provides more complete information. AIMS: To summarize incidence rates of work-related skin diseases reported by consultant dermatologists and occupational physicians, with emphasis on contact and allergic dermatitis by occupation and industry. METHODS: Cases reported in 1996-2001 to the EPIDERM and OPRA national surveillance schemes were analysed by causal agent, occupation and industry, with incidence rates calculated against appropriate denominators. RESULTS: Average annual incidence rates based on data from dermatologists were 97 per million overall, 74 for contact dermatitis and 14 for neoplasia. The corresponding rates for occupational physicians were 623 overall, 510 and 2, respectively. For infective disease, the rates for occupational physicians were 28 compared to 2 for dermatologists. Contact dermatitis was most frequently attributed to rubber chemicals, soaps and cleaners, wet work, nickel and acrylics; most cases of contact urticaria were attributed to rubber chemicals or foods and flour. The pattern of incidence rates by occupation and industry was complex, but correlated with the probable type of exposure. Rates of contact dermatitis were highest among skilled workers in the petrochemical and rubber and plastic manufacturing industries, with machine operators and technical workers in metal and automotive industries also at increased risk. High proportions of cases attributed to rubber chemicals were in nurses and technicians in the health and social services. CONCLUSIONS: These findings identify jobs and types of work where contact with causal agents is common and potentially preventable.     

Occupational dermatitis and allergic respiratory diseases in Finnish metalworking machinists

AIM: To investigate the incidences and trends of occupational skin diseases (OSDs) and allergic respiratory diseases (ARDs) in machinists working in the fabrication of metal products. METHODS: Data from the Finnish Register of Occupational Diseases during 1992-2001 were analysed. Incidence rates for skin and respiratory diseases of machinists were calculated and compared to the total working population. The patients investigated at the Finnish Institute of Occupational Health in the same period were described in detail. RESULTS: A total of 279 dermatoses and 34 ARDs were reported. Skin diseases accounted for 27% of all occupational diseases. The incidences of the skin and respiratory diseases were 1.6 and 0.2 cases per 1000 person-years, respectively. This represents a 3-fold risk for getting an OSD compared to the total working population. The number of allergic contact dermatitis (ACD) increased 3-fold during the study period. The most common causes of ACD were metalworking fluids (MWFs) and their ingredients such as formaldehyde, ethanolamines and colophony. Eighty-five per cent of ARDs were asthmas. The commonest causes of asthma were metal dusts and fumes, epoxy resins and hardeners and MWFs and their components. CONCLUSIONS: Contact dermatitis is a common occupational health problem in metalworking machinists, whereas occupational respiratory disease is rare. Only a few specific chemicals in the metalworking have thus far been identified as respiratory allergens. Specific skin tests and inhalation challenge tests with MWFs and their ingredients are recommended if an OSD or a respiratory disease is suspected.     

Occupational skin conditions in the food industry

The study presents the findings of a questionnaire survey of skin conditions in a selective sample of the UK food industry, covering companies who employ occupational physicians. The mean incidence of skin conditions in food manufacturing operations was 2103 per million employees per annum. The mean incidence in retail or catering organizations was 1414 per million employees per annum.     

Self-reported skin problems among physical processors in the chemical industry in Great Britain

Contact dermatitis is common in the chemical industry. A cross-sectional study was conducted to investigate the prevalence of self-reported skin problems in employees involved in the drying, blending, milling, grinding and filling/bagging end of chemical manufacture in small- to medium-sized contract manufacturing/processing chemical companies in Great Britain. There were several secondary aims. Twenty-three per cent of the employees interviewed reported having had a skin problem in the previous 12 months. Of those reporting problems, 46% were always/nearly always involved in blending and 56% were always/nearly always involved in filling and bagging. These same processes were also more commonly associated with continuous or recurring skin problems. Seventy-five per cent reported a problem involving the upper limbs; most had more than one body area affected. Forty-three per cent had consulted a doctor (67% their general practitioner) and 9% took time off work as a result of their skin condition. Skin problems seemed to peak (34% employees) in those who had spent between 1 and 2 years in their current job. Solvents, known skin irritants, were the most frequent, single category of chemicals encountered in the study. Over 92% had been told how to avoid skin problems; 85% reported that they always/almost always wore protective clothing. Despite these measures, a significant number had reported having had a skin problem related to their work in the previous 12 months. Particular attention to control measures based on risk assessment is recommended for these physical processors in the chemical industry. Further research is also recommended into the whole area of personal protective clothing and the individual worker's perception of risks to health in the workplace.     

A cross-sectional study of employer and employee occupational health needs and priorities within the Irish Civil Service

BACKGROUND: This study aimed to establish how important an occupational health unit (OHU) is to its clients, and to identify the perceived needs and priorities for such a service. METHODS: A cross-sectional postal survey of a stratified, randomly selected group of employees (n = 760) and all human resources (HR) managers (n = 34) was conducted in the Irish Civil Service. Each participant was requested to rate the overall importance of the OHU and to prioritize eight proposed functions for the unit: medical surveillance, general health education, pre-employment/promotion medical assessments, ill-health retirement assessments, return-to-work (after sick leave) assessments, occupational health education, research, and general medical screening. The results were analysed according to age group, gender, grade and occupation. RESULTS: There was a response rate of 69% from employees and 74% from personnel managers. Significantly more HR managers than employees (92 versus 81%) thought an occupational health service was either important or very important. There were also differences in prioritization of functions by employees and HR managers. HR managers prioritized those functions concerned with assessing individuals' fitness for work, notably pre-employment/promotional health assessments, whereas employees consider group-directed 'preventative' functions to be more important, i.e. general medical screening, health education and medical surveillance. Both sets of opinions are not mutually exclusive, and considerable overlap exists, notably in the areas of occupational and general health education.     

Screening for pre-diabetes and diabetes in the workplace

BACKGROUND: Diabetes is an increasingly prevalent and burdensome disease in working populations. In settings with established occupational medical programmes, there may be opportunities to intervene in a positive way to reduce the burden of this disease. AIM: To integrate diabetes screening and prevention into an existing occupational medical programme. METHODS: Screening to detect potential cases of pre-diabetes and diabetes was conducted in a large working population using differing criteria to define risk groups over a 2-year period. Classification of new cases was based on fasting plasma glucose, random plasma glucose or oral glucose tolerance test (OGTT). RESULTS: Among 13,086 employees screened via fasting or random glucose, there were 96 diabetes and 650 pre-diabetes cases detected. Among high-risk employees, 20 new cases of pre-diabetes and 8 cases of diabetes were detected in 84 employees assessed by OGTT. The percentage of employees with new findings increased with increasing age (2.3%, under age 40 compared to 11.4% for age 50 years and above) and body mass index (2.6, 6.1 and 11.4% among normal weight, overweight and obese employees, respectively). CONCLUSIONS: Given the likely magnitude of unrecognized diabetes and pre-diabetes cases, further interventions are being implemented targeting all employees and not just those who require routine occupational medical examinations.     

Blood Pressure Variability at Annual Periodic Health Examination for Employees and Cardiovascular Risk Factors

The employees with hypertension at the annual periodic healthexamination (HE) for employees in Japan usually receive a re-examinationof blood pressure (BP) on another day and are often found tobe normotensive. In this study, we analyzed data from the HEat the workplace to determine whether or not such employeesshould receive medical care. Two groups of subjects were selected.One group (group 1) was composed of 50 subjects with normotensionat the HE (controls). Another group (group 2) was composed of33 subjects with hypertension at the annual HE but with normotensionin re-examinations. Cardiovascular risk factors were significantlyhigher in group 2 than in group 1: mean values of the body massindex (group 1, 22.2±2.7 vs. group 2, 24.3±3.1kg/m² p<0.01), total cholesterol (group 1, 197±36vs. group 2, 222±42 mg/dl, p<0.01), and low densitylipoprotein (group 1, 118±32 vs. group 2, 137±38mg/dl, p<0.05). The proportion of the employees with high-normalBP in group 2 (42.5%) was significantly higher than that ingroup 1 (28.0%) (p<0.01). These indicate that the employeeswith hypertension at the annual HE but with normotension inthe re-examination require further medical attention and shouldreceive medical supervision. The occupational physician shouldsupervise these employees.     

Reducing occupational exposure to chemical carcinogens

Strategies for controlling occupational exposure to chemicalcarcinogens are set out in the European Union Carcinogens Directiveand in national legislation such as the British Control of SubstancesHazardous to Health Regulations. While such legislative requirementsmust apply to all occupational chemical carcinogens, it is arguedthat priority should be given to controlling those agents thatcontribute most to the cancer burden. Examples of possible strategiesto reduce exposure to two agents (diesel exhaust particulateand paint emissions) are discussed. It is concluded that thereare no real technical difficulties in controlling exposuresto chemical carcinogens; however, for many of the key agents,we need to change attitudes to the potential risks and clearlydemonstrate to employers and employees how to reduce the exposures.     

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.     

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.     

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.     

Surveillance of work-related diseases by occupational physicians in the UK: OPRA 1996-1999

The Occupational Physicians' Reporting Activity (OPRA) surveillance scheme for occupational physicians has now been in place for 4 years. During this period, an estimated 43,764 new cases of work-related disease have been reported. Musculoskeletal conditions make up nearly half (49%) of all cases; mental ill-health and skin disease account for 20% each, with respiratory conditions (8%) and hearing loss (5%) seen in lower proportions. Overall, eight of 42 diagnoses made up four-fifths of the new cases reported by occupational physicians. These were hand and arm disorders (8052 estimated cases), contact dermatitis (7104), disorders of the lumbar spine (6000), anxiety and depression (4788), work-related stress (3336), hearing loss (2100), elbow disorders (2040), and asthma (1680). Dermatitis and hearing loss were most frequent in manufacturing industries, lower back complaints in health care, and upper limb disorders in automotive manufacture. Psychiatric illnesses presented a different pattern, mainly affecting those in health, education and social service.     

Occupational asthma prevention and management in industry--an example of a global programme

Isocyanates are widely used in the manufacture of polyurethane foams, plastics, coatings and adhesives, and are known to cause occupational asthma in a proportion of exposed workers. Substitution as a prevention strategy is not currently a feasible option. For this reason, health and safety professionals working together in an automotive coatings business created a proactive global programme to address the known potential effects of isocyanates on its workers. The goals of the programme are prevention, early detection and mitigation of effect of key endpoints, especially asthma and to a lesser degree dermatitis, in people who are occupationally exposed, or potentially exposed, to isocyanates and products containing isocyanates. The surveillance programme for isocyanates has several important components, which include assessment of exposure, pre-placement questionnaire and spirometry, training and education of employees, regularly administered periodic questionnaires, medical assessment for abnormal questionnaire responses, process for early reporting and investigation of symptomatic employees and incidents, group data review and management reporting. Although regional differences exist regarding availability of specialized services, we have successfully implemented this programme in parts of North America, Europe and Latin America, and are currently implementing elsewhere. These simple control measures are relatively inexpensive and can be applied in even small business settings. It is recommended that all employers who manufacture, handle or use isocyanate-containing products consider such a strategy.     

Occupational Health Services in Manufacturing Industries in Nigeria

The provision of adequate health care facilities to cater forthe health of workers is an important consideration in the managementof manufacturing industries, since productivity is dependenton the health status of the workers. There are very few studiesevaluating the health care provision in Nigerian industries.This study elucidates such health care services in Edo and DeltaStates of Nigeria. One hundred and thirty-five (56%) of the241 registered manufacturing industries in Edo and Delta Statesof Nigeria were randomly selected and investigated. The responserate was 91.1% and the result showed that the medical staffcomprised 2.5% of the total workforce, with the large scaleindustries contributing the highest proportion of these. Fourpoint five per cent of the medical staff had formal trainingin occupational health and 15.6% of them visited the factoryshop floor. The doctor:staff ratio in the medium and large scaleindustries were 1:819 and 1:618 respectively. It was found thatall the industries used the health care facilities providedby the government, there were no clinics in all the small scaleindustries and group practice was not used by any of the industriesstudied. Pre-employment medical examinations were carried outin each of the groups of industries (100%, 39.4% and 5%) respectively,as were periodic medical examinations during employment, althoughto a lesser extent (100%, 13.2%, 0%) for the large, medium andsmall scale industries respectively. These finding suggest theavailability of a reasonable standard of health care provisionfor large scale industries and somewhat less availability formedium and small scale industries. Health education of boththe employers of labour, and the employees and the enforcementof existing laws are needed to improve the existing standardof occupational health services.     

The application of Ontario human rights legislation to the practice of occupational medicine

Although human rights legislation has important implications for occupational physicians, these implications may be overlooked in the practice of occupational medicine in other countries where human rights legislation may be different. The potential for significant oversights becomes greater as organizations continue to centralize international business support functions, such as occupational health services, operating from a single site. Human rights legislation has important implications with respect to policy decisions upon which an occupational physician has influence. This includes decisions about whether to conduct drug and alcohol testing; the performance of medical examinations; evaluating issues related to health and safety concerns of pregnant employees; and the need to work accommodate those with handicaps as defined by human rights legislation. This article examines the application of the Ontario human rights legislation in these areas.     

Dermatoses among automobile mechanics in Mansoura,Egypt

This cross-sectional study was carried out in Mansoura, Egypt to assess the prevalence of occupational dermatoses and their possible risk factors on a convenience sample of car mechanics. Sociodemographic and occupational data were collected, and clinical examination was done. Prevalence of skin diseases was 45.4% and that of exclusively occupational skin diseases was 9.2%. Irritant contact dermatitis, eczema, and tar/oil acne were the most common types (4.6%, 3.1%, 3.1%, respectively). The logistic regression analysis revealed that the risk of occupational dermatoses increased significantly with lack of use of personal protective equipment, longer duration of work, and presence of workplace chemicals (adjusted odds ratio [95% CI] were 7.2 [2.7, 19.0], 4.3 [1.7, 10.9], and 3.7 [1.3, 10.5], respectively). Health education and safety measures are essential for prevention and control of hazardous workplace practices and exposure.     

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.     

A Comparison of Cardiovascular Risk as Measured by Compound Blood Lipid Indices and Two Indices including Lifestyle Factors in Occupational Health Service

Healthy employees in a non-manufacturing firm (n = 252) weredivided into low and high cardiovascular risk subjects in orderto compare different indices of cardiovascular risk for usein occupational health service. The levels of total cholesterol(TC), a compound index of blood lipid components, the ‘atherogenicindex’ (ATH-index) defined as ([TC-HDLc] x [apoB])/(HDLc]x [apoA]), and two other compound indices, one Norwegian (Westlund)and one Scottish (Dundee score) were compared. Information onsmoking habits and blood pressure were part of the two lastindices. Out-off values to separate between low and high risksubjects were defined with TC = 6.5mmol/l, HDLc = 0.9mmol/l,apoA = 1.8g/l and apoB = 1.3g/l, all values based on clinicalguidelines in Norway. No smoking and a systolic blood pressure< l50mmHg was included as cut-off of the combined indices.According to the three indices (ATH, Westund and Dundee) 102,25 and 116 employees were allocated to the increased risk group.Persons allocated to the increased risk group by the combinedindices and not by the compound index were practically all smokers.Systolic blood pressure differed between indices only for personswith extreme pressures. A compound blood lipid index of CV risk,which may be drawn easily in an occupational health settingin an unfasting state and sent by post to a laboratory, mimicsthe allocation of persons to an increased risk group using combinedindices. Smokers with normal lipid values would be allocatedto increased risk by the combined indices, but not necessarilyby the compound index. The use of the compound index togetherwith advice to stop smoking is suggested as a time-saving strategy.     

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.     

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.