Occupational Health and Safety in the National Health Service: The Present and The Future

In this paper we review the type and extent of occupationalhealth services provided by the National Health Service forits own and Local Authority employees. We also enquired intothe extent of occupational hygiene services and safety officersin the National Health Service both in the North Western Regionand in the rest of the country. We consider ways of improvingNational Health Service Occupational Health Units includingthe provision of specialist occupational physicians to eachDistrict. Our conclusions are that future services should be consultantled. Based on our calculations for the North Western Region,this need not cost more than the present arrangements. An occupationalhygiene service should be planned to meet the needs of NationalHealth Service employees. Requests for reprints should be addressed to: Dr Malcolm Gatley, Consultant Occupational Physician, North Manchester General Hospital, Crumpsall, Manchester M8 6RB.     

AIDS/HIV Infection and Employment: the Role of Occupational Health Services

Occupational health services need to be active in the developmentof local policies about AIDS/HIV and employment. Employmentissues include the possible hazards from HIV infected employees,which are more fears than real risks, and the problems facedby HIV infected employees. Pre-employment HIV screening doesnot eliminate HIV from the workforce and involves much extrawork. The occupational health service can be a source of confidentialcounselling for HIV infected individuals and will need to adviseon work fitness. HIV as a bar to certain jobs is difficult tojustify. The problems relating to HIV infection at work arebest dealt with by education of staff at all levels. Requests for reprints should be addressed to: Dr Anne Cockcroft, Consultant in Occupational Medicine, Occupational Health Unit, Royal Free Hospital, Pond Street, London NW3 2QG, UK     

Acute toxicity of boron,molybdenum, and selenium to fry of chinook salmon and coho salmon

The acute toxicities of boron, molybdenum, and various forms of selenium, individually and in environmentally relevant mixtures, to swim-up and advanced fry of chinook salmon (Oncorhynchus tshawytscha) and coho salmon (O. kisutch) were determined in site-specific fresh and brackish waters. Boron and molybdenum were relatively non-toxic (96-hr LC50s > 100 mg/L) to both life stages of both species. Selenite was significantly more toxic than selenate to both species. Swim-up fry tested in fresh water were significantly more sensitive than advanced fry in brackish water to selenate and selenite. No mortalities occurred in any concentrations tested of seleno-DL-methionine; however, in the highest concentration (21.6 mg Se/L), at least 50% of the fish showed pronounced surfacing behavior. Coho salmon were more sensitive than chinook salmon to both selenate and selenite at either life stage; only the swim-up fry of coho salmon were more sensitive than chinook salmon to boron. In additional tests with swim-up chinook salmon, differences in the characteristics of the dilution water did not significantly modify the relative toxicities of boron, selenate, and selenite. In binary mixture studies, the joint acute toxic action of selenate and selenite, combined in various ratios, was additive to both species. Based on a comparison of the individual acute values for chinook salmon to the expected environmental concentrations, the margin of safety for boron was only 56 in fresh and 46 in brackish water. The margins of safety for selenate and selenite exceeded 275 in both fresh and brackish waters. However, the margin of safety for both selenate and selenite in the mixture test was 145 in fresh water and 220 in brackish water.     

Childhood Farm Accidents: a continuing Cause for Concern

Farms in Ireland remain a dangerous environment for childrendespite increasing publicity about farming hazards based oninternational research. A one year prospective study on farmaccidents was carried out in four Irish accident and emergencydepartments. During this time, four deaths and 62 cases of injuryaged 15 years and under were seen. Half the cases required admissionto hospital; tractor accidents were common and serious. Mostinjuries occurred to the extremities but 13 (21 per cent) hadmultiple injuries. Forty-three (69 per cent) of the childrenrequired outpatient follow-up and twenty-seven of these (63per cent) had more than one outpatient re-visit. The Irish farming community is still unappreciative of the risksto their children on the farm, and urgent attention needs tobe directed towards educational and legislative measures toimprove the safety profile of Irish farms. Requests for reprints should be addressed to: Mr Ronan Conroy, Department of Community Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

A model for safety and health promotion among Danish farmers

In 1999, a project concerning the prevention of accidents and occupational diseases was started in Vejle County, Denmark. The aim of the project was to increase the safety and health in farming. The project was based on a participatory strategy. The main principles were local involvement in designing the project, multifaceted activities for defined target-groups and respect for occupational skills and integrity. This multilevel approach involved individuals, groups and organisations. Activities were initiated and adjusted throughout the project. This interactive work remodeling the activities throughout the project period and method encouraged empowerment leaving experiences among the participants. Target groups included farmers, farmers' wives, agricultural advisors, agricultural school teachers, employees and part-time assistants. Activities included dialog-meetings, information meetings in larger and smaller groups, as well as designing of educational safety material, e.g., for children and employees. The project is run with a very low degree of central organisational activities, and is also a so called "bottom-up" project with a low budget. Evaluations are undertaken throughout the project period. If this concept can be implemented in Denmark, it may well be useful in other developed as well as less industrialized countries.     

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.     

A study of South Korean casino employees and gambling problems

Background Casino employees are exposed to disproportionatelyhigh levels of gambling, drinking and smoking compared to otheroccupations. Because of their occupation, they have the opportunityto detect and prevent pathological gambling (PG). Aims To identify differences in the mental health status andsocial attitudes towards PG among casino workers in South Koreadepending upon whether they report any gambling problems. Methods Data were collected from 388 full-time casino employees.This data provided information about the prevalence of gamblingproblems, alcohol and tobacco use and depression. Employeeswere grouped according to their scores on the Korean versionof South Oaks Gambling Screen (SOGS), and those employees whogambled without experiencing any gambling problems (Group NP:SOGS = 0) and those who reported any gambling problems (GroupP: SOGS > 0) were compared. An exploratory factor analysesidentified the domains of casino employee social attitudes towardsgambling. Results Employees who reported gambling problems (Group P) reporteda higher prevalence of smoking, alcohol problems and depression(P < 0.01) compared to employees who did not report gamblingproblems (Group NP). The primary employee social attitude towardsgambling was identified by the factor of ‘Disease concept/socialawareness’. Group NP reported more positive attitudesin this domain than Group P (P < 0.01). Conclusions Employees who reported any gambling problems reporteda less positive attitude towards developing the public healthsystem to be responsive to gambling problems. These findingsindicate a need to develop health education programmes thatfocus more specifically on casino employees with gambling problems.     

Health and safety practices among farmers and other workers: a needs assessment.

The development of appropriate health and safety interventions for farmers and agri-workers is important world-wide but data on present practices and attitudes to change are lacking. A representative quota sample (n = 1,938) of the Irish population was surveyed on lifestyle practices and workplace risk assessment and control measures, in relation to chemical exposure, manual handling and machinery. Focus group discussions were conducted also with 47 representatives of national farming organizations. As compared with the general workforce, farmers had a significantly (p < 0.01) lower level of assessment of risk hazards associated with manual handling and machinery. Both farmers and employees in workplaces with less than 20 employees reported a significantly lower level of safety training. Male farmers had a particularly negative health profile with only 18% reporting regular dental checks, 26% practising skin protection and 29% taking regular exercise. Discussions indicated that barriers to change included low perceived susceptibility, lack of time and resources. Mental health issues were particularly highlighted. We conclude farmers differ significantly in many instances from the rest of the workforce in regard to occupational health and safety issues and specific interventions in key areas are required for the agri-sector.     

Farm tractor fatalities: the failure of voluntary safety standards.

There are no governmental standards for operator protection which require compliance by farm tractor manufacturers. To see how the Wisconsin farming population fares under voluntary safety standards, death certificate data were used to determine rates of tractor-associated fatal injuries. The injury deathrate associated with tractors on farms increased from 10.9 per 100,000 male farm residents during 1961-1965 to 13.6/100,000 during 1971-1975 (p less than .05). Deaths associated with overturning tractors were most common; with death rates of 6/100,000 male farm residents for 1961-1975. The rise in tractor-associated death rates shows that voluntary safety standards are not protecting the farm population. Rollover protective structures (ROPS) are designed to protect operators when tractors overturn but under voluntary safety standards these ROPS are sold only as optional accessory devices. Current Occupational Safety and Health Administration regulations which require ROPS for employees operating tractors do not protect self-employed farmers and their families. It is recommended that the government require all tractors sold to be equipped with ROPS as is currently the case in England and Sweden.     

What Happens to the Farm? Australian Farmers’ Experiences after a Serious Farm Injury

Objectives: To investigate the experiences of farmers on returning to farming following a serious farm-related injury.

Methods: Patients who had sustained major trauma on a farm in Victoria, Australia, were identified using the Victorian State Trauma Registry (VSTR). In depth, semistructured phone interviews were conducted with 31 participants. Interview data were subjected to thematic analysis to identify important recurring themes. Interviews continued until data saturation was achieved.

Results: Interviewees included self-employed full-time farmers, part-time farmers with a supplementary income, and agricultural employees. Analysis of participant responses connected to returning to farming after a serious farm-related injury identified five major interconnected themes: (i) effect on farm work, (ii) farming future, (iii) safety advocacy, (iv) changes to farming practices, and (v) financial ramifications.

Conclusion: Farmers who have sustained a serious farm-related injury are an important resource; their experiences and perspectives could assist in the development of educational and transitional support services from recovery back to working at a preinjury level, while ensuring farming production is sustainable during this period. Furthermore, farm safety programs can be enhanced by the engagement of farmers, such as participants in this study as advocates for improved farm safety practices.     

Infant Mortality Rates for Farming and Unemployed Households in the Japanese Prefectures: An Ecological Time Trend Analysis, 1999–2017

BackgroundRecent research suggests that Japanese inter-prefecture inequality in the risk of death before reaching 5 years old has increased since the 2000s. Despite this, there have been no studies examining recent trends in inequality in the infant mortality rate (IMR) with associated socioeconomic characteristics. This study specifically focused on household occupation, environment, and support systems for perinatal parents.MethodsUsing national vital statistics by household occupation aggregated in 47 prefectures from 1999 through 2017, we conducted multilevel negative binomial regression analysis to evaluate occupation/IMR associations and joinpoint analysis to observe temporal trends. We also created thematic maps to depict the geographical distribution of the IMR.ResultsCompared to the most privileged occupations (ie, type II regular workers; including employees in companies with over 100 employees), IMR ratios were 1.26 for type I regular workers (including employees in companies with less than 100 employees), 1.41 for the self-employed, 1.96 for those engaged in farming, and 6.48 for unemployed workers. The IMR ratio among farming households was 1.75 in the prefectures with the highest population density (vs the lowest) and 1.41 in prefectures with the highest number of farming households per 100 households (vs the lowest). Joinpoint regression showed a yearly monotonic increase in the differences and ratios of IMRs among farming households compared to type II regular worker households. For unemployed workers, differences in IMRs increased sharply from 2009 while ratios increased from 2012.ConclusionsInter-occupational IMR inequality increased from 1999 through 2017 in Japan. Further studies using individual-level data are warranted to better understand the mechanisms that contributed to this increase.Key words: infant mortality, health inequality, occupation, farmer, unemployed worker     

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.     

Health and Safety in Australian Agriculture - Linking Research,Data and Action

ABSTRACT

Almost every week the rural media provide farming communities around Australia with information about health and safety hazards on farms. The results of the increasing research and data collection are being made broadly available. But are we just adding yet another worry to already stressed farmers, farm workers and farm families by this approach?

Until recently, there was little information or support available to farmers to assist them to identify the hazards on their own workplace, to assess the relative risk to health and safety of the many hazards identified, or to plan adoption of effective solutions to reduce risk based on the cash flow of the farming enterprise.

Managing Farm Safety is a program which has been developed through integration of data findings, research findings, farmer responsibilities under OHS Occupational Health and Safety legislation, farm management practicalities, farm cash flow and farmer aspirations. The program will be incorporated into rural education, training and extension services.

The services to farmers and farm families include access to training in farm OHS management, provision of a management tool or kit which includes and on-farm audit, record of education and training for employees, record of farm chemicals usage, and information about risk reduction solutions are available, their relative effectiveness and the cost of each option. The program will be provided in commodity specific format as more of the major industry groups in Australian agriculture move to adopt the approach.

This paper describes the data flow system used in the development and maintenance of this program.     

Occurrence and Distribution of Deltamethrin and Diflubenzuron in Surface Sediments from the Reloncaví Fjord and the Chiloé Inner-Sea (~ 39.5ºS –43ºS), Chilean Patagonia

Surface sediments from Reloncaví Fjord and the Chiloé inner sea in Chilean Patagonia were extracted and analyzed to estimate deltamethrin and diflubenzuron levels. These antiparasitary pesticides have been used for decades in the salmon industry. Relationships were determined between pesticide concentrations and organic carbon percent in sediments. Deltamethrin (0.39–1.05 µg g^?1 dw) was found at all sampling sites but diflubenzuron (0.06–0.09 µg g^?1 dw) at only five. Diflubenzuron levels were similar for sediments from other fjord areas. However, deltamethrin concentration was 2–3 fold higher than other studies on this area. The organic carbon percent was correlated positively and significantly with diflubenzuron, but not with deltamethrin. Our results suggest that the high deltamethrin concentrations in sediments are due to the increased use of pyrethroids around salmon farming areas. But, the diflubenzuron levels can be explained by degradation processes.     

A Nine Year Retrospective Mortality Study of Workers in a British Pharmaceutical Company

Hazards associated with work in the pharmaceutical industryare not clearly defined. To investigate this problem during1973–1981, 672 deaths were identified among present andpast employees of a large British pharmaceutical company. Initialcomparisons of these deaths with those presenting in the generalpopulation suggested that there was an excess for various cancersand pneumonia among company employees of both sexes. Further comparisons were limited to company employees. Specifically,causes of death were analysed according to likely exposure tohazardous substances. The numbers of cases with adequate workhistories for these analyses were small. Nonetheless, therewas evidence of a possible occupational risk for a range ofcancer sites among males. The finding was not statisticallysignificant, but it was consistent with earlier results. Additionalstudies with a concurrent cohort design are recommended. Requests for reprints should be addressed to: Chris Baker MB, BS Executive Director, Public Health Service, South Australian Health Commission, G.P.O. Box 1313, Adelaide, S.A. 5001, Australia.     

What changed between 2008–2020 about Employees' perception of hygiene in the catering industry in Ankara (Turkey)?

Food safety is a public health concern because foodborne diseases have been increasing in recent years due to several factors such as urbanization, globalization and changes in consumer habits. Many countries in the world, including Turkey have upgraded their laws about food and personnel hygiene in the catering industry and undertaken changes to the organizational structure of their regulatory institutions to protect consumers'' health. In this study, it was aimed to evaluate the perceptions of food processors on food safety and to determine whether there has been a change in this matter over the last 12 years. The data has been collected by conducting face to face interviews and having 500 employees from the sector fill in a questionnaire constructed for this purpose. The responses to the questionnaire have been measured by assigning ‘hygiene perception points’ to each respondent according to their replies. These hygiene perception points have been analysed in terms of gender, age, educational level and work experience of the employees involved. The results have revealed that employees between the ages of 26–34, women, university graduates have a higher level of perception of hygiene than other age groups, men, those with lower education levels, respectively. Hygiene perception points were found to be higher compared to the results obtained 12 years ago. The positive changes observed in the hygiene perception points are thought to result from the differences in the legislation of the years in which both studies were conducted. It is thought that the obligatory of providing hygiene and food safety training to individuals working in the catering sector with law changes leads to positive changes in the employees. Legally compulsory training activities can overcome many sanitation and safety problems that result from misinformed or uninformed employees.     

Rehabilitation after Illness and Injury-A Study of Temporary Alternative Work Arrangements

A study of the allocation of temporary alternative work (TAW)duties for rehabilitating employees after illness or injuryis described. This was conducted in the occupational healthdepartment of a large industrial chemical works with severalthousand employees in a wide variety of occupations. Work relatedaccidents accounted for 32 per cent of episodes. Musculoskeletalconditions formed the largest cause of illness and injury, especiallyin young employees in engineering and craft occupations. Fifty-nineper cent of TAW duties were of less than 1 month duration with7 per cent of TAW duties lasting longer than 6 months. The workforceannual prevalence of 5-5 per cent was comparable to certifiedsickness rates. It is concluded that it is practical to rehabilitateill employees in a wide range of occupations within the contextof their normal workplace by a supervised system of TAW duties. ⁰Requests for reprints should be addressed to: Dr S.P. Deacon, British Petroleum pic, Group Occupational Health Centre, Chertsey Road, Sunbury-on-Thames, Middlesex TW16 7LN.     

Health status and occupation: use of a health status index to measure the health of occupations

A total of 4466 employed persons completed the short AucklandUniversity Health Status Index (AUHSI) questionnaire and a healthscore was assigned to each individual on the basis of theirresponses. This health score was found to have statisticallysignificant associations with a number of health-related measures,including socio-economic status (P<0.001), and with occupationalgroup: administrative, clerical/sales/service, skilled tradesand unskilled labour (P<0.001). Within the occupational groups,3361 employees could be assigned to 42 specific occupationshaving 19 or more members each. After controlling for age andgender, significant differences in mean health score for specificoccupation were found in the clerical/sales/service (P<0.05),skilled trades (P=0.002) and unskilled manual (P<0.005) groups.It is postulated that these differences may be due to the natureof the specific occupation. Some possible reasons are listed.It is concluded that a global measure of health status suchas this may be useful in the planning and evaluation of occupationalhealth services.