Current problems of diagnosis and prevention of occupational diseases

Occupational diseases in Far Northern conditions are aggravated by severe climate conditions. The role of allergic diseases becomes higher. The authors suggest ecologic and genetic concept of occupational diseases formation.     

Primary prevention of occupational diseases and compensation for health impairment of those working under harmful conditions

The optimization coefficients for making demands of an employer to grant funds for measures for primary prophylaxis of occupational diseases are proposed. The initial payment is based on the expenses connected with these problems in the past 3 years. An approximate calculating scale for primary prophylaxis is presented.     

Disability, the risk of disability and changes in work capacity-- unacceptable conditions for insurance in occupational injuries and diseases

OBJECTIVE: To identify factors associated with failure to return for HIV post-test counselling in pregnant women in Kigali (Rwanda). SUBJECTS AND METHODS: In the context of a study on the impact of HIV infection on pregnancy, HIV-1-antibody testing was offered to all pregnant women attending the antenatal clinic of the Centre Hospitalier de Kigali from July 1992 to August 1993. Pre-test counselling was performed after verbal informed consent was obtained. Two weeks later, we formally enrolled all HIV-positive women and a corresponding number of HIV-negative women in a cohort. At this visit, post-test counselling was given to those wishing to be informed of their HIV serostatus. Level of knowledge about modes of HIV transmission and condom use were recorded. Four months after delivery, another interview was conducted to determine the proportion of women who used condoms regularly. RESULTS: A total of 1233 pregnant women were screened. The HIV seroprevalence was 34.4% [95% confidence interval (CI), 31.7-37.1]; 271 (63.9%) out of 424 HIV-positive and 577 (71.3%) out of 809 HIV-negative women asked for their HIV serostatus (P = 0.008). In multivariate analysis, the only variable significantly associated with failure to return for post-test counselling was a positive HIV test result (odds ratio, 0.7; 95% CI, 0.5-0.9; P = 0.009), independently of obstetrical history and socioeconomic characteristics. Among the 848 women who had post-test counselling, 50.9% of the HIV-positive women and 94.6% of the HIV-negative women stated that they planned to inform their partner of their serostatus (P = 0.0001). More than 95% of the women interviewed knew about sexual and parenteral transmission of HIV, but half were unaware of mother-to-child transmission. More than 80% of the women had seen a condom before, but 14% only had used it at least once. Among women who were sexually active 4 months after delivery, 8.8% of the HIV-positive and 3.9% of the HIV-negative women reported using a condom (P = 0.04). CONCLUSION: Innovative approaches for HIV testing and counselling programs are needed and the importance of psychosocial and cultural factors associated with HIV testing should be emphasized in African populations.     

Physiologic and hygienic characteristics of work conditions of miners in the Far North

Workers engaged into subsurface extraction of sand containing gold were proved to work in difficult conditions characterized by stable negative temperatures, high concentrations of dust, elevated levels of noise and vibration. The drill operators demonstrated extremely unfavorable changes of physiologic processes within a shift. Those changes were compromised cardiovascular regulation, early occurrence and intensive progress of fatigue. The authors provide recommendations to normalize the work conditions and to create rational scheme of work and rest for the occupations.     

Indications for psychological examination in diagnosis, certification and prevention of occupational diseases

The work is based on the author's clinical experience gained due to her responsibilities as a consultant in the Department of Occupational Diseases, Nofer Institute of Occupational Medicine, Lodz, as well as on the literature dealing with the effect of some chemical and physical occupational hazards on the central nervous system. The author points out that psychological examinations play a significant role in diagnosis and prevention of occupational disease. She suggests that workers should be subjected to periodical psychological examinations during the whole period of employment. Particular indications for these examinations are also discussed.     

Perceived work conditions and work-related symptoms among employed Finns

The aim of the study was to determine the number and nature of perceived harmful work conditions and perceived work-related symptoms among employed Finns by sex and socioeconomic group. The associations between perceived harmful work conditions and perceived symptoms were also investigated. Knowledge of perceived work-related ill health can serve as a basis for health promotion at work. In a computer-assisted telephone interview of 2744 salaried employees and wage-earners, the respondents were asked about perceived harmful work conditions as well as perceived health complaints, and their relatedness to work. At least one harmful factor at work was reported by 94% of the respondents, and half of them reported more than three such factors. The most commonly occurring harmful factors were increased work pace, mental demand, repetitive movements, and noise. Of the symptoms perceived as work-related, musculoskeletal symptoms were the most common. They were reported by 44% of the respondents, followed by mental symptoms (26%), psychosomatic symptoms (19%), and respiratory or sensory symptoms (15%). Both the reporting of perceived harmful work factors and perceived work-related symptoms varied by socioeconomic group and sex. Perceived work-related musculoskeletal symptoms were associated with perceived ergonomic harmful work factors among both the men and the women, with physical or chemical work factors among the men, and with psychosocial or work organizational factors among the women. Perceived work-related respiratory symptoms were associated with perceived harmful physical or chemical work factors among both the men and the women, and both groups also reported mental and psychosomatic symptoms in relation to harmful psychosocial or organizational work factors. Among the women psychosomatic symptoms and harmful ergonomic work factors were also related. Perceived harmful factors at work and work-related symptoms are common among the work force. Even though the degree of work-related ill health was related to socioeconomic group, the reporting of particular symptoms indicated the probability of a particular work factor being considered harmful independently of socioeconomic group, although there was some relationship to sex. The implications for occupational health services are evident; employees' work-related symptoms can serve as an indicator of (preventable) perceived problems at work.     

The organization of automated information systems on occupational diseases and of the hygienic monitoring of working conditions

Creation of automated database "Archive of occupational diseases clinic" is an important task of informational support for occupational pathology centers. Constructing the database, the authors designed an "Accounting chart of patient with occupational disease for diagnostic survey in occupational pathology center" and a "Diagnosis of occupational disease" code book adjusted to X ICD with instruction. Analysis of the information obtained forms a basis for forecasting the course of pathologic process, for justifying a complex of treatment and prophylaxis.     

Challenges for the prevention of communicable diseases

Clinical observations both claim and refute sublingual absorption of salbutamol. To resolve this issue, the capacity of salbutamol to inhibit substantial bronchoconstrictor responses to histamine has been defined for both intravenous injection of saline in the anaesthetized ventilated guinea-pig. Substantial sublingual absorption was observed. It is suggested that low dose sublingual formulations might have advantage over inhalation forms of sympathomimetics.     

Epidemiologic study on physical conditions related to work among the elderly]

The present study was conducted in order to examine the epidemiologic factors related to work capacity among the elderly. As study area, Ogimi Village in Okinawa Prefecture was selected by reason of the long life expectancy of the inhabitants. Medical examination and interview were conducted on 756 inhabitants aged 65 yr and older. Working status was classified into two groups, that is, working group and non-working group. The association between working status and related factors was examined by using multiple logistic regression analysis. The examined factors were as follows: sex, age, history of apoplexy, history of being down, history of falls, history of fracture, chewing ability, pain, exercise habit, hobby, education, number of family members, alcohol, smoking, food intake frequencies and medical indicators (blood pressure, ECG, Quetlet index, skinfold thickness, grip strength, one-leg test with eyes opened, albumin, total cholesterol, hemoglobin and HDL-cholesterol). The results of the analysis revealed that grip strength and one-leg test with eyes opened had a statistically significant correlation with working status (p < 0.01). From the results, maintenance of muscle strength and equilibrium function were found to be the physical conditions related to work among the elderly in the agricultural area.     

Reliability of reported occupational history information for US coal miners, 1969-1977

For estimating reliable exposure-response relations it is necessary that random variation in both the response and the exposure variables be sufficiently small. Variability in cumulative exposures can arise from uncertainties in self-reported work histories from interviews. In most epidemiologic surveys, the information gathered from questionnaires is used without knowing the validity or reproducibility of these data. This paper investigates the reliability of occupational histories reported by the same individuals on two occasions separated by 9 years in the US National Study of Coal Workers' Pneumoconiosis and its implications on the exposure-response relation for simple coal workers' pneumoconiosis. For 480 coal miners, from whom occupational histories were obtained twice (in 1969-1971 and 1977-1981), the reliability (intraclass correlation coefficient) of the cumulative exposures generated from each work history was 87%. Logistic model fitting of simple coal workers' pneumoconiosis prevalence to the cumulative coal dust exposure produced almost identical results. After accounting for intersurvey variability in the occupational histories, the authors found that the exposure-response coefficients estimated from information reported at the surveys were attenuated by 12%. In epidemiologic studies, knowledge of the reproducibility of self-reported occupational history information is important to ascertain whether the true exposure effect is underestimated.     

The decrease of risk of occupational diseases among rail road workers: future strategies

Diagnosis, registration and prophylaxis of occupational diseases among railway workers remain unsatisfactory so far. Thus, creation of the Railway Register of Occupational Diseases is essential. The Register includes several blocks related to each other and covering enterprises, medical and social institutions. Given relatively low primary occupational morbidity in railway transport, the Register's software considers incidence of occupational diseases in Russian Federation among analogous occupations, matched in working environment classes, length of service and occupational hazard. The authors obtained the matched incidences of occupational diseases, and can extrapolate the relationships revealed to railway workers, forecast high risk of occupational diseases among these workers.     

Structure of occupational diseases in patients examined and treated at the Institute clinic of hygiene, occupational diseases and human ecology

The authors analyze data on patients diagnosed as having occupational disease in 1970-1995 and grouped according to age, sex, length of service, occupational hazards. Incidence of various syndromes in occupational diseases is calculated. The authors detail some items obscuring diagnosis of occupational diseases and necessitate referral to various professionals for precise and early diagnosis.     

Current therapy and prevention of malaria and perspectives for the future

At present the basic antimalarial drugs are still the 4-aminoquinolines chloroquine and amodiaquine, the combinations of antifol compounds (such as pyrimethamine and sulfadoxine = Fansidar), and quinine. In South East Asia and parts of Latin America Plasmodium falciparum has become highly resistant to chloroquine, and increasingly so to the antifol combinations. By selecting the antimalarials bearing the lowest risk of resistance, or combinations of them, an attempt can be made to avoid failures of treatment and chemoprophylaxis. The other areas endemic for malaria tropica may still be generally considered "chloroquine sensitive", although sporadic low-grade resistance to chloroquine is reported. It would be a mistake to replace chloroquine systematically by antifol combinations in those parts of the world now as well. The questions when drug resistance is to be suspected, and how individual treatment can be adjusted to it, are likewise discussed. Mefloquine is the best known new compound, with excellent activity against multiresistant Plasmodium falciparum. A combination with Fansidar is now being developed to prevent the former from inducing resistant strains. Despite considerable experimental advances a malaria vaccine is unlikely to be generally available before the end of this decade.     

Assessing the work environment for agents that may cause occupational pulmonary disease

The industrial hygienist is a professional trained in the resognition, evaluation, and control of environmental stresses in the workplace and as such serves as a valuable recourse for medical personnel concerned with occupational lung disease. Knowledge of the precise identity and quantity of workplace hazards is often essential in diagnosing occupational lung disorders. In addition, an industrial hygienist familiar with the process can assess whether there is a likelihood of exposure to levels above the limits which are considered to be safe. This valuable industrial hygiene information can be from government (e.g., OSHA, state agencies), universities or consulting firms.     

Contraception and the prevention of sexually transmitted diseases

Sexually transmitted diseases (STDs) are a major cause of ill health in women and their sexual partners and children. Contraceptive methods alter in various ways the risk of acquiring STD but assessment of the odds ratio is difficult due to the many confounding factors. Spermicides have been reported to kill a wide range of bacteria and viruses including HIV in vitro and to protect in vivo from infection by gonorrhoea, chlamydia and pelvic inflammatory disease (organisms unspecified). Spermicides will not cure pre-existing infections. Condoms and diaphragms will give some protection from bacterial and viral infections in all parts of the genital tract. Hormonal contraception and tubal ligation give protection to the upper genital tract but not the cervix. Carcinoma of the cervix follows the same pattern as STDs. The risk of pelvic infection in intrauterine device users is discussed in the chapter by Bromham (pp 100-123, this issue).     

Adherence to guidelines for the prevention of HIV-related respiratory diseases

In this study we characterized the pattern of use of preventive therapies for specific respiratory diseases within a cohort of homosexual men and assessed the impact of targeted feedback on the level of compliance with guidelines for these diseases. All human immunodeficiency virus seronegative (HIV-) (n=169) and acquired immune deficiency syndrome (AIDS)-free human immunodeficiency virus seropositive (HIV+) (n=154) participants in our cohort, who completed four annual visits between October 1989 and December 1993, were identified. Information about the use of purified protein derivative (PPD) (tuberculin) testing, history of pneumococcal vaccinations, influenza vaccinations, use of Pneumocystis carinii pneumonia (PCP) prophylaxis, symptoms and CD4 counts was obtained yearly for each subject. In 1992, participating physicians were provided with feedback regarding the overall levels of compliance with contemporary guidelines for the prevention of respiratory disease. As part of this exercise, the guidelines were distributed and discussed. The percentage of HIV+ patients who underwent PPD testing increased from 43 to 65% during the study (p=0.001). Significantly more HIV+ than HIV- patients underwent PPD testing (p<0.001). A total of 144 (94%) HIV+ men received at least one influenza vaccination compared to 60 (35%) HIV- men (p<0.001). Utilization of influenza vaccination in the HIV+ group significantly increased from 78% in 1992 to 92% in 1993 (p<0.001). A total of 104 (68%) HIV+ men received pneumococcal vaccination compared to 2 (1%) HIV- men (p<0.001). Among HIV+ individuals whose absolute CD4+ count was less than 200 cells x mm(-3), the percentage of men who received primary PCP prophylaxis was 0, 86, 72 and 88 for the years 1990-1993, respectively. Among HIV+ patients whose only eligibility criterion for PCP prophylaxis was a CD4+ percentage <20%, compliance was 55, 30, 37 and 50% for the years 1990-1993, respectively. Among HIV+ subjects, increases in the compliance level were noted for all preventive therapies after targeted feedback was provided during the last quarter of 1992. However, only utilization of influenza vaccine exceeded a 90% compliance in 1993. These data demonstrate that a suboptimal level of compliance with current guidelines for the prevention of respiratory disease among human immunodeficiency virus-infected individuals can be significantly improved using targeted feedback. Although it is likely that similar effects could be achieved in other populations or the community at large, this remains to be demonstrated.