Occupational respiratory disease in mining

This review is based on research-based literature on occupational lung disease in the mining and related industries, focusing on conditions of public health importance arising from asbestos, coal and silica exposure. Both 'traditional' and 'new' concerns about occupational respiratory disease in miners are addressed, with the inclusion of practical evidence-based findings relevant to practitioners working in developed and developing countries. Mining is not a homogeneous industry since current miners work in formal and informal operations with numerous, and often multiple, air-borne exposures. A further occupational health challenge facing primary care practitioners are ex-miners presenting with disease only after long latency. The sequelae of silica exposure remain an occupational health priority, particularly for practitioners who serve populations with concomitant HIV and tuberculosis infection and even when exposure is apparently below the statutory occupational exposure level. Coal workers' pneumoconiosis, asbestos related diseases, lung cancer and other occupational respiratory diseases remain of considerable importance even after mining operations cease. While mining exposures contribute significantly to lung disease, smoking is a major factor in the development of lung cancer and chronic obstructive airways disease necessitating a comprehensive approach for prevention and control of mining-related occupational lung disease.     

Biological hazards: an overview

Recent developments include new guidance from the UK Department of Health on the management of hepatitis B infected healthcare workers and evidence of the value of antiretroviral treatment in reducing transmission of HIV. The possibility of greater occupational transmissibility of hepatitis C and increasing antibiotic resistance remain of concern.     

Occupational safety risk management in Australian mining

In the past 15 years, there has been a major safety improvement in the Australian mining industry. Part of this change can be attributed to the development and application of risk assessment methods. These systematic, team-based techniques identify, assess and control unacceptable risks to people, assets, the environment and production. The outcomes have improved mine management systems. This paper discusses the risk assessment approach applied to equipment design and mining operations, as well as the specific risk assessment methodology. The paper also discusses the reactive side of risk management, incident and accident investigation. Systematic analytical methods have also been adopted by regulatory authorities and mining companies to investigate major losses.     

Occupational health management: an audit tool

BACKGROUND: Organizations must manage occupational health risks in the workplace and the UK Health & Safety Executive (HSE) has published guidance on successful health and safety management. AIMS: This paper describes a method of using the published guidance to audit the management of occupational health and safety, first at an organizational level and, secondly, to audit an occupational health service provider's role in the management of health risks. The paper outlines the legal framework in the UK for health risk management and describes the development and use of a tool for qualitative auditing of the efficiency, effectiveness and reliability of occupational health service provision within an organization. The audit tool is presented as a question set and the paper concludes with discussion of the strengths and weaknesses of using this tool, and recommendations on its use.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Occupational health in the Andalusian Fisheries Sector

BACKGROUND: The conditions of work in the fisheries sector are arduous with high rates of occupational accidents. Numerous factors are known that can directly influence the health of the sailor or fisherman both in fishing and merchant fleets. AIM: To evaluate the health status, safety and working conditions in the Andalusian fishing sector. METHODS: Cross-sectional questionnaire study with proportional sampling of the health and lifestyles of fishery workers in 19 of the 23 Andalusian ports. RESULTS: A total of 247 workers employed on 202 craft fishing boats responded. In all 87% of workers reported a current medical condition. The main problems reported were musculoskeletal disorders, respiratory diseases, diseases of the digestive system, eye problems and skin problems. A total of 72% reported taking some self-prescribed medication, and 60% of fishery workers smoked. Nine per cent of fishery workers admitted taking illicit drugs and 3% reported using illicit drugs on board. Diets on board were poorly balanced. While on board, 62% of crews reported a subjective significant worsening of previous health. The lifetime prevalence of accidents was 76%. CONCLUSIONS: Fishery workers had a high prevalence of self-reported medical problems, a high prevalence of self-medication, poor diets and frequently smoked. Self-medication and some medical conditions (diabetes, angina and depression) may reflect a potential failing of health checks and pre-employment checks. National health services and insurance companies dealing with occupational health should focus more on appropriate health checks, illness prevention and health promotion activities for this population.     

Occupational health in general practice in an industrial area of Singapore

The aim of this study was to estimate the caseload with regard to the proportion of work-related medical cases in factory workers and to survey knowledge of and attitudes to occupational medicine among doctors in an industrial area in Singapore. To this end, a self-administered questionnaire was given to 74 general practitioners in the industrial district of Jurong in Singapore. Overall, there was an 89.2% response rate. Thirty-three of the 66 respondents were males. Mean age was 40.8 years (range 27-64 years). Twenty-four (36%) had some postgraduate training in occupational medicine (GP-OM) while the rest did not (GP). The caseload for all doctors was similar with regard to the number of adult patients and, more specifically, the number of factory workers seen per day. The majority of doctors (76.6%) felt that <10% of factory workers seen had work-related problems. Most (70%) felt confident in dealing with the occupational problems that arose. However, a large percentage (78% of GPs, 45.8% of GP-OMs) felt that training in occupational medicine was inadequate. This is reflected in the knowledge questions, where GPs did not score as well as GP-OMs. It was concluded that GPs working in this industrial area see a good proportion of factory workers, in a fair number of cases for work-related problems. However, only a third of the GPs are qualified in occupational medicine. These factors highlight the need for more emphasis on occupational medicine training among general practitioners, especially those working in industrial areas.     

Occupational risk factors and reproductive health of women

BACKGROUND: This in-depth review summarizes and interprets the available recent epidemiologic evidence on the relationship between occupational exposures and negative reproductive outcome among women workers. METHODS: The studies examined by the review include those published in the international scientific literature since 1990, and were identified through the search of relevant data banks using selected keywords. RESULTS: From the examination of studies dealing with exposures of women to chemical agents, pesticides, physical agents, ergonomic factors and stress, it appears that at present the evidence is sufficient to warrant the maximum protection of pregnant women to several well-documented occupational risk factors. These include exposures to anaesthetic gases, antineoplastic drugs, heavy metals, solvents, heavy physical work and irregular work schedules. For other work risks, such as exposure to non-ionizing radiation and psychosocial work stress, the evidence is often suggestive but not conclusive. CONCLUSIONS: Policy makers and health professionals should advise women and employers to avoid exposure to the well-known occupational risk factors, while epidemiologic research should pursue methodological improvements and provide more insight into the magnitude of exposures responsible for detrimental effects.     

Occupational mental health: a brief history

This paper describes the development of occupational mental health in the United Kingdom. It looks at the increasing involvement of occupational health staff in this aspect of the workplace and the role played by organizational psychologists in exploring the relationship between work and mental well-being. It provides a background for the reviews of current knowledge described in the other papers in this issue of Occupational Medicine.     

Occupational health in the European Union

Despite extensive legislation in the European Union, employees remain exposed to occupational risks and there is still a significant burden of work-related ill-health. The trend for more people to work in service industries rather than manufacturing has resulted in a change in the nature of risk and pattern of occupational illness. Worker access to occupational health services ranges from 15 to 96% and depends on the country in which employees live and the type of operation in which they work. The increasing number of small enterprises provides a particular challenge when trying to provide occupational health support to the European Union's 158.4 million workers. European law alone is not sufficient to improve the health of those at work and further action is needed at state, employer and professional level. New initiatives seek to improve the health of the Union's workforce, including a drive for better compliance with new law by every member state. Governments are working with key stakeholders through partnering strategies to develop innovative approaches for better access to quality occupational health services. Furthermore, targets for reduction in occupational ill-health have been identified. Where country laws do not mandate the provision of occupational health services, employers need to see the benefit of providing occupational health support. Finally, the medical profession is making procedures for self-regulation more rigorous and professional bodies are actively engaged in issuing professional standards and guidelines. Ultimately, the individual practitioner is responsible for ensuring that he or she develops and maintains the necessary knowledge and skills to provide competent services.     

Age and ageing: an overview

Europe is ageing, as exemplified by the UK population where, in the foreseeable future, more people will be over than under age 50: industry appears slow to recognise and appreciate all that older workers still have to offer: bundling them off into early retirement wastes precious talents. Memory difficulty is not an inevitable part of ageing.     

Occupational stress management programmes: a practical overview of published effect studies

There are many occupational stress management programmes availablewhich are designed to prevent and cure the negative aspectsof job-stress. The focus of the programmes can be directed towardsthe individual worker, the working group, the organization ofthe work or the organization as a whole. Moreover, programmesshow a considerable variation with respect to the type of interventionsthey promote and their underlying assumptions, as well as theirduration and costs. In this paper, effect studies of occupationalstress programmes published between 1987 and 1994 are reviewed.The aim is to give a practical overview of the variety in occupationalstress programmes, their scope, applicability and the evidenceof their effectiveness. The paper updates the review by DeFrankand Cooper published in 1989.     

Occupational health issues affecting the pharmaceutical sales force

BACKGROUND: The sales force forms a significant sub-population in the pharmaceutical industry workforce. Role and organizational characteristics, such as isolation, peripatetic working and car travel and the psychosocial and ergonomic hazards related to work tasks, present particular occupational health risks. AIM: To review the occupational risks associated with peripatetic sales force work and evidence for the effectiveness of preventive interventions. METHODS: We carried out a review of the available literature between 1990 and 2003. RESULTS: The following hazards were identified as significant and worthy of further investigation for this occupational group: driving on company business; violence in the workplace; stress; ergonomic issues; and mobile phone use. CONCLUSION: To ensure effective prevention and management of employee health problems, specific health management strategies and interventions must be developed to meet the occupational health needs of this group.     

Noise-induced hearing loss and hearing conservation in mining

BACKGROUND: Noise exposure is prevalent in mining, and as the prevalence of noise-induced hearing loss has not changed much in the past two decades, hearing conservation is an important issue. OBJECTIVES: To review the literature and highlight important developments in the field. METHODS: A review of the literature using OVID as the primary search engine, using the search terms as: noise, occupational; hearing loss, noise induced; ear protective devices; and mining. RESULTS: A total of 66 articles were found, but only 11 were in the English language and few were published in the past 10 years. This is disappointing, because neither noise exposure nor the consequent risk of noise-induced hearing loss seems to have changed much in the past 20 years. Noise is, however, a generic hazard, and this article reviews current best practice in prevention.     

Occupational health provision and health surveillance in the semiconductor industry

AIMS: To identify the nature of occupational health provision in UK semiconductor-manufacturing plants. To identify the level of industry compliance with legal health surveillance requirements. METHOD: A national inspection programme was carried out by Health & Safety Executive inspectors using a developed protocol. RESULTS: A wide range of occupational health provision was identified from none to use of an accredited specialist. The majority of work was of a reactive nature even where there was specialist occupational health input. Seven companies were identified as not meeting legal compliance and one as having unacceptable compliance for health surveillance. CONCLUSIONS: The spectrum of occupational health provision was very wide. Where health surveillance was provided, it was poorly targeted with limited interpretation and feedback to management.     

Occupational safety and health: A method to test the collection of 'grey data' by line managers

This paper describes and discusses a method for collecting datarelating to the potential for illness or injury to occur inan organization. The reason for using the term ‘grey’is explained and the underpinning philosophy of fuzzy thinkingis also discussed. The method used was an audit which attemptedto measure the degree to which certain types of failure werepresent in one organization. The audit used a team approachin design and execution and was found to be a useful and useabletool for collecting information relating potential causes ofinjury or illness.     

Occupational health services in the UK--challenges and opportunities

BACKGROUND: A small minority of the UK workforce currently has access to an occupational physician. Reduction in the size of enterprises, the emergence of atypical work patterns and problems recruiting and training occupational health specialists risk making this minority even smaller. AIM: This paper considers the challenges currently facing occupational medicine and how we can improve access to occupational health services (OHS). It aims to highlight some of the diverse internal and external factors that restrict the UK's ability to provide all workers access to OHS. METHOD: A literature review was carried out and combined with awareness of current trends in business and new legislation together with provision of occupational medicine in other countries. RESULTS: Potentially controversial solutions that might help to make OHS more widely accessible were identified and are discussed. It is hoped that these will provoke further debate. CONCLUSION: Individually and organizationally, we must examine and improve capabilities if we are to improve worker access to OHS and deliver targets to reduce occupational ill-health. It is suggested that this requires a strategic shift to apply resources differently. There is need to explore delegation of tasks traditionally performed by doctors to nurses and other staff together with the outsourcing of non-core work. The increased use of telemedicine and the enhanced use of information technology for training, risk assessments, wellness programmes and questionnaire-based health assessments are other developments that should be explored.     

Occupational health provision in UK universities

BACKGROUND: Very few studies have been done of occupational health provision across an entire employment sector and universities are particularly understudied. The British government published updated guidance on university occupational health in 2006. AIM: To describe the occupational health services to all the universities in the UK. METHODS: All 117 universities in the UK were included. Detailed surveys were carried out in 2002, 2003 and 2004 requesting self-completed information from each university occupational health service. This paper presents information on general characteristics of the service, staffing, services provided and outcome reporting. RESULTS: There was variation in the type of occupational health provision; half the universities had an in-house occupational health service, 32% used a contractor, 9% relied on the campus primary care or student health service and 9% had ad hoc or no arrangements. In all, 93 of the 117 (79%) universities responded to the detailed questionnaire, the response rate being higher from in-house services and from larger universities. There was a wide variation in staffing levels but the average service was small, staffed by one full-time nurse with one half-day of doctor time per week and a part-time clerical or administrative member of staff. A range of services was provided but, again, there was wide variation between universities. CONCLUSIONS: It is unclear if the occupational health provision to universities is proportional to their needs. The wide variation suggests that some universities may have less adequate services than others.     

Occupational health and safety curricula: the factors that decide -an Australian experience

Societal, economic and other changes in recent years have resulted in both an increased level and diversity of education and training in occupational health and safety in Australia. Consideration has been given to the key skills and knowledge required by those who take tertiary level courses and who practise as specialists and generalists in the field of occupational health and safety. The curricula and mode of implementation of these courses are determined by the needs of employers, increased emphasis on quality management systems, the prevailing work climate including information technology, communication and legislative requirements all in the context of a rapidly changing tertiary education system.     

Ergonomics in mining

Like other areas of occupational health and safety (OHS) ergonomics is evolving and becoming more integrated into overall work management systems. As we learn more about the complex interaction between psychosocial and physical factors in the aetiology of work-related illness and injury the more we rely on managers to 'get it right' if we are to prevent these conditions. Risks to health and safety in the mining industry posed by longer shift lengths, higher work loads, less task variation and decision latitude have not really been well researched. Heavy physical workloads and stresses are still areas of concern, but are likely to be intermittent rather than constant. Recent research confirms current thinking rather than shedding new light on the subject. The contribution of slips, trips and falls and increasing age of miners to manual handling injuries is still not clear. In some cases sedentary work and the operation of machinery has completely replaced heavy physical work. The issues of machinery design for operations and maintenance and whole-body vibration exposures when operating machines and vehicles are becoming more critical. The link between prolonged sitting, poor cab design and vibration with back and neck pain is being recognized but has yet to be addressed in any systematic way by the mining industry. On the plus side some mining companies have well-developed participative approaches to problem solving and these need to be extended to areas such as ergonomics.