Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

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

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.     

La ghréline : seule hormone orexigène connue

Ghrelin is a 28-amino acid acylated peptide predominantly produced by the stomach peripherally as well as the pituitary and the hypothalamus in the brain. Originally discovered as the endogenous ligand of the orphan growth hormone secretagogue receptor, it is also involved in the regulation of food intake and body weight. Ghrelin is the first known orexigenic hormone. Human plasma ghrelin levels sharply increase before and decrease after every meal. Plasma ghrelin levels correlate negatively with the magnitude of energy stores. Obesity is characterized by low ghrelin plasma concentration, conversely patients suffering anorexia or cachexia display high levels. Weight loss triggers an increase in ghrelin levels while the opposite is observed during weight gain. The role for ghrelin in the regulation of appetite and body weight is mediated, at least in part, via the activation of neurons in the hypothalamus that coexpress neuropeptide Y (NPY) and agouti-related protein (AgRP), two anabolic neuropeptides. Ghrelin appears as the hormone that coordinates GH secretion and food intake to assure an optimal growth and a steady energy balance. Due to its role in the regulation of body weight, ghrelin holds promise as a target for both medical and surgical approaches to obesity treatment.     

Le tissu adipeux : un donneur de cellules souches ?

Several laboratories have shown that the cells from the stroma-vascular fraction of the human adipose tissue express, depending on cell culture conditions, biochemical markers of multiple cell lineages including adipogenic, osteogenic, chondrogenic, myogenic, endothelial, neuronal and epithelial cell lineage. Furthermore, various in vivo approaches revealed the ability of the cells derived from the stroma-vacsular fraction of adipose tissue to repair ischemic or damaged tissues. Altogether these data strongly suggest that the stroma-vascular fraction of the human adipose tissue contains cells that exhibit properties like stem/progenitor cells. However, the exact nature of the cells, their potentiality to lead to differentiated cells in vivo as well as the mechanisms involved in their repair capability remain to be characterized to consider their use in regenerative and reparative medicine.     

Health surveillance in milling, baking and other food manufacturing operations--five years' experience.

The objective of this study was to describe the incidence of allergic respiratory disease and its outcome in terms of symptoms and jobs, across different flour-using industries. It uses the findings of a health surveillance programme in a large food organization over a five-year period. The population under surveillance consisted of 3,450 employees with exposure to ingredient dusts, of whom 400 were in flour milling, 1,650 in bread baking, 550 in cake baking and 850 in other flour-using operations. A total of 66 employees with either asthma or rhinitis symptoms attributable to sensitization to allergens in the workplace were identified. The majority of these (48/66) had become symptomatic prior to the commencement of the health surveillance programme in 1993. The incidence rates (per million employees per year) for those who developed symptoms between 1993 and 1997 were 550 for flour milling, 1,940 for bread baking, 0 for cake baking and 235 for other flour-using operations. The agent believed to be responsible for symptoms was most commonly grain dust in flour millers and fungal amylase in bread bakers. Wheat flour appeared to have a weaker sensitizing potential than these other two substances. In terms of outcome, at follow-up 18% of symptomatically sensitized employees had left the company. Two of the ex-employees retired through ill health due to occupational asthma. Of those still in employment, 63% described an improvement in symptoms, 32% were unchanged and 4% were worse than when first diagnosed. Over half the cases still in employment were continuing to work in the same job as at the time of diagnosis.     

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

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

The social and economic effects of manic depressive illness and of its treatment in lithium clinics

Advising about the employment of those who have had manic depressive episodes requires Occupational Health Physicians to obtain, with consent, an objective account of previous episodes and to appreciate the enormous range of manic and depressive manifestations. Familiarity is needed with the likely effects of treatment of episodes and the benefits and problems of prophylaxis--not just in general but in individual cases, for example, where driving is required. This article summarizes research into the effects of lithium preparations on the course of the illness, thyroid and renal function and the risk of suicide. The author found that changing from treatment of episodes to continuous prophylaxis benefited employment and personal relationships without causing body weight problems. Many patients do well in life if supported by an experienced professional team, with 61% requiring no further admissions once on lithium, and with an 86% reduction in admissions achieved in our local clinic.     

Religious and ethnic differences in health: evidence from the Health Surveys for England 1999 and 2004

Objectives. To examine the role of religion in the patterning of health inequities, and how this is related to ethnicity and socioeconomic status.

Design. Multivariate analyses using nationally representative data on self-assessed fair or poor health, longstanding limiting illness, diagnosed diabetes, diagnosed hypertension, waist–hip ratio, body mass index, current tobacco use and participating in no regular physical activity from 14,924 Christians, 4337 Muslims, 656 Sikhs, 1197 Hindus and 2682 people reporting not identifying with any religion with different ethnic backgrounds, who were interviewed as part of the Health Survey for England in either 1999 or 2004, adjusted for age, gender and socioeconomic status and periodicity.

Results. Odds ratios for general health, hypertension, diabetes, waist–hip ratio, tobacco use and physical activity speak to the importance of ethnicity in the patterning of health inequalities. But there is also evidence of an important, independent role for religion, with risks for the different health indicators varying between people with the same ethnic, but different religious, identifications. Adjusting for socioeconomic status attenuated the ethnic/religious patterning of, particularly, self-assessed health, longstanding activity-limiting illness, waist–hip ratio, body mass index and tobacco use.

Conclusions. This evidence enables greater understanding of the complexities of the relationship between ethnicity, religion and health, recognising the need to understand the heterogeneity underlying both ethnic and religious group membership and the processes producing the structural disadvantage facing certain religious and ethnic groups in the mediation of the relationship between health and ethnicity/religion.     

Les phytostérols et les phytostanols: quelle place pour la prévention cardiovasculaire?

Phytosterols are natural plant compounds. Phytostanols are derived from phytosterols’ hydrogenation. Both they inhibit intestinal dietary cholesterol absorption by competition, and they decrease LDL cholesterol by 8-15%, in a dose-dependant manner. They impair carotenoids bioavailability. A very small and variable part of phytosterols and phytostanols is absorbed. No epidemiological data is available for assessing the beneficial of plant sterols intake and cardiovascular risk. In the other hand there are many studies which have shown paradoxically a positive relationship between serum phytosterols concentrations and increase of the coronary heart disease risk. Other studies have established a link between the phytosterols’ absorption and their plasma and arterial plaque levels. Phytosterols and cholesterol hyperabsorbers subjects would be particularly involved in this unfavourable issue. Phytostanols could have a different effect from that point of view. In animal studies, data are less inconsistent with, in most of the studies, a lesser progression of atheroma lesions, perhaps due to an anti-inflammatory effect of phytosterols in atheroma plaque. The place of phytosterols and phytostanols in the therapeutic step for cardiovascular prevention is actually not defined. Many queries are still open. Complementary studies are needed for improving the clinical indications and the efficiency of these compounds.     

How to Meet the Media

Occupational physicians on occasion will have to respond toinquiries from the print and broadcast media, particularly insituations involving the health or death of workers. They mustbe prepared concerning the issue at hand, be factual, be cooperative,and be careful of questions that are ‘just off the record’.As representatives of organizations at times of corporate stress,they must be truthful in the presentation of explanations concerningthe causes of mishaps and the means of averting future repetitionsof comparable hazardous episodes. A set of principles is offeredwhich will aid physicians in their discussion of serious healthand safety issues at the worksite.     

Estimating occupational health events in workers with asthma or diabetes: a comparison of diary and snapshot methods

The study was set up to assess the completeness of reporting different types of work-related health events through 6 month and 1 week diaries and telephone questionnaires relating to individual days. Subjects recruited from hospital asthma or diabetic clinics or from surgical day-case units were randomly assigned to either a full participation arm or to one completing only a 6 month diary. Of the 375 study participants, return rates were 68.8% for 6 month diaries, 81.9% for weekly diaries and 86.5% for researcher-administered questionnaires. Significantly higher rates of self-reported poor work performance, symptoms or changes in medication were estimated by snapshot methods (same-day telephone interviews or one-off weekly diaries) than from diaries completed over a 6 month period. Asthmatics and diabetics attending hospital outpatient clinics were no more likely, however, to report work-related health events in the following 6 months than those attending the same hospital for day surgery.