Prevention of occupational asthma including medical surveillance

The high figures of occupational asthma worldwide necessitate the intensification of appropriate primary, secondary, and tertiary preventive measures. Based on new scientific data on dose-response relationships as well as our own experience and ethical aspects, we focus on medical surveillance within the framework of secondary prevention. We propose that medical surveillance programs be mandatory for workplaces/occupations with an asthma incidence of > or = 200% than that of the general population. Medical surveillance programs are recommended if asthma frequency is elevated but below 200%. A stepwise approach of monitoring workers at risk for developing occupational asthma including a screening by questionnaire and a personal interview and diagnosis confirmation is presented. In addition, we briefly comment on the management of affected subjects.     

Health On the Net automated database of health and medical information

With the number of World Wide Web sites growing every day, the problem is not just to find information, but to locate the right piece of information. Current World Wide Web search engines have not resolved this problem as they most often return a long list of documents. The search result is then unusable because of the large number of answers from different domains and topics. Only complex queries may, in a given situation, produce a limited number of potentially relevant documents. To make searches more efficient and usable by common users, we now need intelligent and specialised search engines on the Net [1,2]. Health On the Net Foundation and the Molecular Imaging and Bioinformatics Laboratory at Geneva University Hospital have developed Multi-Agent Retrieval Vagabond on Information Networks (MARVIN), a robot that searches sites and documents specifically related to a given specialised field. One such robot has already been implemented and used for the medical and the 2D electrophoresis domains. Health On the Net Foundation has implemented the corresponding search engines, MedHunt (http://www.hon.ch/cgi-bin/find) for the medical field and 2DHunt (http://www.hon.ch/cgi-bin/2DHunt/find) for the 2D electrophoresis field.     

Request for medical evaluation: an approach for on-site occupational health professionals

The role of the occupational health professional in determining fitness for duty is expanding. Proper determination of fitness for duty diffuses acute situations in the workplace. The occupational health professional's role is nonjudgmental and objective. This protocol protects the occupational health service from punitive actions.     

Health administration functions in occupational health

Study of optimum seeking method with orthogonal test for auditory P300 measuring was carried out in healthy adolescents. The result showed that the optimal conbination of parameters was as follows: stimulus sound was Logon, recording electrode site Cz, analysis time 750 ms, average 100, stimulus rate 1 c/s, target stimulus (TS) probability 10%, bandpass filter 1-50 Hz, non-target stimulus (NTS) freqency 1 kHz, target stimulus (TS) frequency 2 kHz, stimuli intensities 110 dB peSPL. The normal values of auditory P300, obtained from 30 healthy adolescents, including latencies and amplitudes, were measured under optimal parameters. P300 latency was about 310 ms, RT about 258 ms, these two values present a significant linear correlation.     

Empirical-Bayes and semi-Bayes approaches to occupational and environmental hazard surveillance

Depression, a complex psychobiological syndrome, has been found to be prevalent among individuals with chronic pain problems. It has been repeatedly recommended that chronic pain patients be routinely screened for depression. Many self-report questionnaires have been used to screen for depression although few have addressed potential limitations of using a self-report questionnaire to identify depressed chronic pain patients. Among the most serious problems is an over-diagnosis since typical neurovegetative symptoms of depression often resemble patients' medical/physical conditions. Some have suggested that the physical items should be replaced and others have suggested that a higher cut-off criteria for diagnosing depression should be used. In this study, the validity of the Center for Epidemiological Studies-Depression (CES-D) scale was examined to determine (a) its sensitivity, specificity, and positive, and negative predictive value with chronic pain patients, (b) the biasing effect of somatic items, and (c) the optimal cut-off score for diagnosing depression. The results support the predictive validity of the CES-D and suggest that a cut-off score of 19 should be used for diagnosing depression in chronic pain patients rather than the standard cut-off point of 16. Interestingly, the removal of the somatic items did not enhance the effectiveness of the CES-D. The discriminatory ability of somatic items with the total assessment of depression is discussed.     

Cancer predictive value of cytogenetic markers used in occupational health surveillance programs: a report from an ongoing study by the European Study Group on Cytogenetic Biomarkers and Health

The relationship between characteristics of irritable bowel syndrome (IBS) and eating disorders (ED) was investigated in a clinical sample of 43 female and 17 male IBS patients who completed the Eating Disorder Inventory (EDI). A diagnosis of IBS was generally unrelated to the Body Dissatisfaction, Perfectionism, and Ineffectiveness subscales of the EDI, but symptom severity was correlated with Perfectionism and Ineffectiveness. Severe bouts of vomiting were significantly associated with desires for lower body weight and reported binge-purge behaviors and cognitions measured by the Bulimia subscale of the EDI. Results suggest the need for a more comprehensive understanding of both types of illness as well as a possible framework for future empirical work.     

Occupational disease surveillance using disability insurance at an automotive stamping and assembly complex

Sickness and accident-insurance (sick leave) claims at an automotive stamping and assembly complex were analyzed using Poisson regression over a 4-year period to identify occupational health problems. The incidence of lower-respiratory disability (excluding asthma) was higher in painting operations (rate ratio [RR] = 2.9, 95% confidence interval [CI] = 1.2 to 6.8), and final assembly and processing areas (RR = 2.7, 95% CI = 1.0 to 7.4) at the assembly plant, and in metal assembly (welding) areas (RR = 2.8, 95% CI = 1.4 to 5.7) at the stamping plant. Disability rates for upper-extremity musculoskeletal disorders were statistically significantly higher (RR = 3.1 to 3.8) in major assembly plant production areas, as were back disability rates (RR = 1.5). During the first 6 months of new work assignments in painting or final assembly, respiratory problem rates were four times higher than in other areas. Upper-extremity musculoskeletal rate ratios ranged from 4.4 to 5.7 for new assignments in body, hard trim, and chassis areas. Higher rates in new assignments appeared to result from assignment changes precipitated by developing health problems, or from routine assignments to new tasks, some of which conferred high risk and were tolerated for less than 6 months. Musculoskeletal disability was consistent with known ergonomic hazards and paralleled that reported on the Occupational Safety and Health Administration log. Work-related musculoskeletal and other problems can be readily identified from disability insurance claims without dependence on plant medical visits or workers' compensation records. Disability insurance appears to absorb considerable work-related medical and absence costs.     

Health status assessment in the occupational health setting

This article discusses the conceptual roots of measuring health- related outcomes based on a biopsychosocial model of health. The selection and applicability of instruments for measurement of health status are discussed and suggestions are made concerning how health-status instruments may be used in the occupational- health setting. The potential value of measuring health status in the occupation-health setting is explored with a brief review of current literature and an example from one investigation in which measurements of health status were used to examine outcomes of common musculoskeletal impairments.     

Analysis of third-party certification approaches using an occupational health and safety conformity-assessment model

The occupational health and safety conformity-assessment model presented in this article was developed (1) to analyze 22 public and private programs to determine the extent to which these programs use third parties in conformity-assessment determinations, and (2) to establish a framework to guide future policy developments related to the use of third parties in occupational health and safety conformity-assessment activities. The units of analysis for this study included select Occupational Safety and Health Administration programs and standards, International Organization for Standardization-based standards and guidelines, and standards and guidelines developed by nongovernmental bodies. The model is based on a 15-cell matrix that categorizes first-, second-, and third-party activities in terms of assessment, accreditation, and accreditation-recognition activities. The third-party component of the model has three categories: industrial hygiene/safety testing and sampling; product, equipment, and laboratory certification; and, occupational health and safety management system registration/certification. Using the model, 16 of the 22 programs were found to have a third-party component in their conformity-assessment structure. The analysis revealed that (1) the model provides a useful means to describe and analyze various third-party approaches, (2) the model needs modification to capture aspects of traditional governmental conformity-assessment/enforcement activities, and (3) several existing third-party conformity-assessment systems offer robust models that can guide future third-party policy formulation and implementation activities.     

Legal aspects of medical confidentiality in the occupational setting

The law of confidentiality of medical information in the occupational setting is undeveloped and subject to change. Nevertheless, when a physician-patient relationship is established, all of the traditional trappings, including the duty to maintain confidences, go along with it. In other settings, such as preemployment physicals, examinees implicitly consent for their "fitness' for the job to be disclosed, but do not assume that specific findings will be disclosed without their informed and written consent. To promote physician automony and worker confidence in the occupational physician, an explicit policy of confidentiality should be developed and agreed to by both management and workers. This policy should spell out the conditions under which specific information will be made available to the employer and should guarantee the confidentiality of all other medical information. Workers should also be given routine access to their medical files, and offered the chance to refute and have amended information in them that they can demonstrate is inaccurate. In short, workers in the occupational setting should, in general, be treated like private patients. Such a policy will satisfy both the law and the ethical standards of physicians, and will promote worker trust in the occupational physician.     

SWORD ''95: surveillance of work-related and occupational respiratory disease in the UK

The authors have examined the behaviour of functional scotomas in the squinting eye in children treated on the static apparatus modelled after the Starkiewicz alteroobturator. They examined 25 children at the age of between 8 and 14 years with convergent squint with macular fixation. Visual acuity of the master eye was equal 1.0 and in the of the squinting eye from 0.4 do 0.8 in correction. The angle of squint was equal from +4 degrees to +26 degrees. The patients were treated in accordance with the localization method-stage II/III. Children were practising on the apparatus 2 x 7-10 minutes for 5 days. In 12 children out of the 25 under examination the functional scotomas were of the same size after exercises, and in 12 children it decreased from 12% to 40%, on average 24.8%. In 1 child the functional scotoma absolutely disappeared.     

Neurobehavioral tests as a medical surveillance procedure: applying evaluative criteria

Neurobehavioral impairment is among the earliest indicators of a toxic insult on the nervous system. Neurobehavioral tests measure behavior impairment by noninvasive procedures that assess various performance and personality changes. Neurobehavioral tests have been used on groups of workers included in epidemiologic research studies; however, their suitability for an ongoing medical surveillance program for workers exposed to neurotoxic agents has not been evaluated. In Ontario, Canada, a set of validity criteria must be met to determine whether a medical procedure may be prescribed for a specific medical surveillance program. The evaluative criteria are standards for judging the desirability of a procedure based on social values and scientific considerations. In this paper, various studies using neurobehavioral tests are reviewed, and the validity of using these procedures for medical surveillance is evaluated by applying the Ontario evaluation criteria. The conclusion is that neurobehavioral tests are useful for well-controlled, cross-sectional studies, but they do not yet meet the validity criteria for procedures prescribed in an ongoing medical surveillance program for workers exposed to neurotoxic agents.     

A report of diphtheria surveillance from a rural medical college hospital

A 5-year sentinel surveillance of diphtheria from 1989 to 1993 was undertaken at a rural medical college hospital. No significant change in the number of diphtheria cases was observed in spite of sustained high level of diphtheria, pertussis, tetanus vaccine-3 doses (DPT3) coverage. Most of the diphtheria cases occurred during July to November. Age distribution of diphtheria cases showed that more than 75% occurred above 2 years age (except in 1989) and around 65% cases above 3 years age. The age shift in diphtheria signified success of primary diphtheria immunisation, as well as indicated the lack of coverage with booster doses at appropriate ages. Because of high coverage with primary diphtheria immunisation there was decrease in circulating toxigenic C diphtheriae resulting in less natural boosting of antibody titre. Thus, in absence of booster immunisation, the older children and adults were more vulnerable to diphtheria. The findings of the study justified the need of emphasising importance of booster diphtheria immunisation at appropriate ages for effective control of diphtheria.     

Clinical utility of an international thyroid database

Assessment of thyroid function is prone to errors from several sources. Confusion is most often due to inappropriate use of tests, especially in patients with acute non-thyroid illness. With these problems in mind we have designed an international prospective thyroid database in three countries, which registers clinical and laboratory data on new patients with suspected thyroid disease. An additional aim was to assess the use of a computerised decision support tool to interpret thyroid data. The database permits rapid access to temporal trends in thyroid tests, which is useful in monitoring therapy and in follow up for hyperthyroidism. Marked contrasts in local clinical practices have highlighted the challenge in providing a valid decision tool to serve all clinical needs. Experience with multi-centre databases such as this hold promise in the drive to coordinate the disciplines of laboratory analysis and clinical decision making.     

Drug utilization review using a Medicaid claims database

A methodology for conducting drug utilization review (DUR) using Medicaid claims data is presented. The DUR allows for calculation of rates and costs of health care utilization among patients with established diagnoses and specific drug regimens; for comparison of results between competing drug therapies; for quantification of the percent market share of pharmaceutical products; and for projection of the duration of a given drug therapy. The strengths and limitations of using Medicaid data for DUR are discussed.     

Acceptance of tuberculosis as an occupational disease

The acknowledgment of tuberculosis as an infection due to employment (i.e. as an occupational disease) in medical service applies only to few infected persons. Most of them must prove how they contracted the disease. Since this is largely impossible, many claims for damage, due to tuberculosis are not entertained. The negative decisions by the Occupational Co-Operative Society of Medical Service (BGW) against its own members are based on: 1. a doubtful judgment by the Federal Social Court of Justice (document no. 7 RU 34/72, 28.9.1972) and 2. untenable statements by occupational physicians on the epidemiology of infectious diseases. To substantiate such sentences, it is stated that tuberculosis is very rare and that therefore the probability of an infection during the job in medical service would not be higher than during leisure hours. However, this is an incorrect conclusion for several reasons. Notwithstanding that the time of working on the job is only 27% and leisure time 73%, nevertheless the risk of contracting tuberculosis during the job in medical service is 10 to 40 times higher than during leisure hours. Furthermore, still unpublished statistics by the Co-Operative Society show that the risk of an infection was higher for medical service jobs by a factor 22 compared to all other jobs during 1976 to 1994.     

Comprehensive evaluation of long-term trends in occupational exposure: Part 1. Description of the database

The regulation of water excretion by the kidney is one of the few physiologic processes that are prominent in everyday life. This process predominantly occurs in renal collecting duct cells, where transcellular water reabsorption is induced after binding of the pituitary hormone arginine-vasopressin to its vasopressin type-2 receptor and the subsequent insertion of aquaporin-2 (AQP2) water channels in the apical membrane of these cells. Removal of the hormone triggers endocytosis of AQP2 and restores the water-impermeable state of the collecting duct cells. Nephrogenic diabetes insipidus is characterized by the inability of the kidney to concentrate urine in response to vasopressin; the vasopressin type-2 receptor and the AQP2 water channel have both been shown to be involved in this disease. This article focuses on mutations in the vasopressin V2 receptor and aquaporin-2 water channel identified in nephrogenic diabetes insipidus patients, and on the effects of these mutations on the transport and function of these proteins upon expression in cell systems.