Surveillance of work-related diseases by occupational physicians in the UK: OPRA 1996-1999

Development and validation of an occupational health triage tool

BACKGROUND

As work and health are closely interlinked, it is important to carefully monitor employees. However, limited resources restrict in-depth follow-up.

AIMS

This study was aimed to develop a low-cost screening instrument for employees' overall health status, that can be used across industries and that allows triaging workers to in-depth health surveillance in case of indications of health or functioning problems.

METHODS

We developed a new questionnaire-based algorithm built on multiple predictors to assess the need for further follow-up. We used a systematic review, Delphi panel (n = 9) and focus group (n = 5) to determine the predictors, tested for language pitfalls in a pilot study and evaluated the questionnaire's validity in two separate studies. Study 1 (n = 60) analysed the discriminatory power of the instrument by comparing it to the assessment of an occupational physician in a sample of employees from diverse occupational settings. Study 2 (n = 869) appraised the factor structure and internal consistency of the screening tool in a sample of employees from the hospital sector.

RESULTS

Risk factors, current physical and mental health, functioning, absenteeism, job satisfaction and lifestyle were identified as the most relevant predictors. Study 1 showed the survey had good criterion validity (area under the curve = 0.72). Study 2 (N = 869, 28% response) demonstrated the internal consistency (Cronbach's α = 0.94), and a factor analysis confirmed a second-order factor structure with adequate model fit (comparative fit index = 0.96, root mean square error of approximation = 0.04 and standardized root mean square residual = 0.07).

CONCLUSIONS

This questionnaire can be used to triage workers for occupational health follow-up and can, additionally, be useful to describe the epidemiology of work-related illness.

Prevalence and incidence of work-related musculoskeletal disorders in secondary industries of 21st century Europe: a systematic review and meta-analysis

OBJECTIVE

Over the course of the twenty-first century, work-related musculoskeletal disorders are still persisting among blue collar workers. At present, no epidemiological overview exists. Therefore, a systematic review and meta-analysis was performed on the epidemiology of work-related musculoskeletal disorders (WMSD) within Europe's secondary industries.

METHODS

Five databases were screened, yielding 34 studies for the qualitative analysis and 17 for the quantitative analysis. Twelve subgroups of WMSDs were obtained for the meta-analysis by means of predefined inclusion criteria: back (overall), upper back, lower back, neck, shoulder, neck/shoulder, elbow, wrist/hand, leg (overall), hip, knee, and ankle/feet.

RESULTS

The most prevalent WMSDs were located at the back (overall), shoulder/neck, neck, shoulder, lower back and wrist WMSDs with mean 12-month prevalence values of 60, 54, 51, 50, 47, and 42%, respectively. The food industry was in the majority of subgroups the most prominent researched sector and was frequently associated with high prevalence values of WMSDs. Incidence ratios of upper limb WMSDs ranged between 0.04 and 0.26. Incidence ratios could not be calculated for other anatomical regions due to the lack of sufficient articles.

CONCLUSION

WMSDs are still highly present among blue collar workers. Relatively high prevalence values and low incidence ratios indicate a limited onset of WMSDs with however long-term complaints.

Occupational and work-related respiratory disease attributed to cleaning products

OBJECTIVES

Exposure to cleaning products has been associated with adverse respiratory outcomes. This study aimed to investigate the medically reported incidence, trends in incidence and occupational determinants of work-related respiratory disorders attributed to cleaning agents and to explore the role of 'Quantitative Structure Activity Relationships' (QSAR) in corroborating the identification of chemical respiratory sensitisers.

METHODS

Respiratory diagnoses attributed to cleaning agents were extracted from The Health and Occupation Research (THOR) surveillance network, 1989-2017. Incidence, trends in incidence and incidence rate ratios by occupation were investigated. Agents were classified by chemical type and QSAR hazard indices were determined for specific organic chemicals.

RESULTS

Approximately 6% (779 cases) of the (non-asbestos) THOR respiratory cases were attributed to cleaning agents. Diagnoses were predominantly asthma (58%) and inhalation accidents (27%) with frequently reported chemical categories being aldehydes (30%) and chlorine/its releasers (26%). No significant trend in asthma incidence (1999-2017) was observed (annual average change of -1.1% (95% CI -4.4 to 2.4)). This contrasted with a statistically significant annual decline in asthma incidence (-6.8% (95% CI -8.0 to -5.6)) for non-cleaning agents. There was a large variation in risk between occupations. 7 of the 15 organic chemicals specifically identified had a QSAR generated hazard index consistent with being a respiratory sensitiser.

CONCLUSION

Specific occupations appear to be at increased risk of adverse respiratory outcomes attributed to cleaning agents. While exposure to agents such as glutaraldehyde have been addressed, other exposures, such as to chlorine, remain important. Chemical features of the cleaning agents helped distinguish between sensitising and irritant agents.

Prevalence of musculoskeletal pains and effect of work-related factors among employees on offshore oil and gas installations in Iran

BACKGROUND

Work-related musculoskeletal pain is usually caused by poor physical conditions, repetitive motion, and adverse environmental and psychological situations.

OBJECTIVE

This study aims to assess the prevalence of musculoskeletal pain and their work-related factors among employees on offshore oil and gas installations in Iran.

METHODS

Standardized Nordic Questionnaire was used to collect data. The relationship of musculoskeletal pain with job type, rest breaks, exercise, shift program, and work period was studied among employees on offshore installations. T-test and ANOVA were used for data analysis.

RESULTS

Employees on offshore installations were exposed to high levels of risk of musculoskeletal pain in their knees and back. Consequently, they reported the highest level of complaints of pain in the neck and lower back areas. Workers in drilling and tour-scheduling jobs reported the highest level of musculoskeletal pain. In the course of seven days and 12 months, the highest level of significant relationship was observed between the limbs and the work periods (tour scheduling or days-off) of the staff.

CONCLUSION

The findings showed that the prevalence of musculoskeletal disorders among employees of offshore facilities was high due to inappropriate working conditions such as repetitive work, lifting heavy loads and limited rest periods. Therefore, strategies must be considered to reduce the effects of disorders.

The Health and Occupation Research Network: An Evolving Surveillance System

Vital to the prevention of work-related ill-health (WRIH) is the availability of good quality data regarding WRIH burden and risks. Physician-based surveillance systems such as The Health and Occupation Research (THOR) network in the UK are often established in response to limitations of statutory, compensation-based systems for addressing certain epidemiological aspects of disease surveillance. However, to fulfil their purpose, THOR and others need to have methodologic rigor in capturing and ascertaining cases. This article describes how data collected by THOR and analogous systems can inform WRIH incidence, trends, and other determinants. An overview of the different strands of THOR research is provided, including methodologic advancements facilitated by increased data quantity/quality over time and the value of the research outputs for informing Government and other policy makers. In doing so, the utility of data collected by systems such as THOR to address a wide range of research questions, both in relation to WRIH and to wider issues of public and social health, is demonstrated.

Ill Health-Related Job Loss: A One-Year Follow-Up of 54,026 Employees

INTRODUCTION

The diagnoses of workers being unfit to work may be a relevant health indicator. Therefore, the aim of this study was to analyze the one-year incidence of an unfit to work diagnosis.

METHOD

This one-year prospective study included all workers undergoing annual work medical examination from occupational health services in Troyes, France.

RESULTS

Twenty-one occupational physicians followed 54,026 employees. The all-cause incidence of being unfit to return to work was 0.772%. The two main causes of being unfit to work were musculoskeletal disorders (61%) and psychopathologies (24%). The relative risk (RR) of being unfit to work, independent of the cause, was higher when employees were aged over 50 years (RR = 2.51), and female (RR = 1.51).

CONCLUSIONS

Prospective results from occupational physicians' medical records may provide significant and cost-effective directions to prioritize actions and target health promotion in the workplace.

Gender specific analysis of occupational diseases of the low back caused by carrying, lifting or extreme trunk flexion--use of a prevention index to identify occupations with high prevention needs

BACKGROUND

Gender specific analysis of the occupational disease of the lumbar spine caused by carrying, lifting, or extreme trunk flexion in Germany (OD No.2108) with the aim to identify areas of focus for prevention and research with a prevention index (PI).

METHODS

Data from the German Statutory Accident Insurance stratified by gender are shown.

RESULTS

From 2002 until 2009 there were 2,877 confirmed cases of an OD No. 2108 (40.1% male and 59.1% female). The PI indicated the highest prevention need for female nursing/midwifery associate professionals and male building frame and related trades workers. Patient transfer and working in extremely bent posture were the most frequent exposures.

CONCLUSIONS

The identified occupations with high need for prevention among men come from nearly all major occupational groups whereas women cluster in occupational groups from the health and care sectors.

Occupational dermatitis in hairdressers: do they claim workers' compensation?

BACKGROUND

Hairdressers are one of the largest occupational groups attending our Occupational Dermatology Clinic. However, few seek workers' compensation for their occupational dermatitis.

OBJECTIVES

To retrospectively analyse and compare workers' compensation claims data and diagnosed disease data for occupational contact dermatitis in hairdressers from 1993 to 2009, for the state of Victoria, Australia.

PATIENTS/MATERIALS/METHODS

Data from the Occupational Dermatology Clinic database, the Compensation Research Database and the Australian Bureau of Statistics were used in this study.

RESULTS

The clinic database identified 157 hairdressers and apprentices with a confirmed diagnosis of occupational contact dermatitis assessed between 1993 and 2009. Forty-six unique claims for occupational contact dermatitis from 46 individuals were identified from the Compensation Research Database over the same time period. Hairdressers in the 15-24-year age group were significantly over-represented in the claims data relative to the diagnosed disease data (p < 0.01). The median cost per claim was AU$1421, and the median time off work per claim was 20 days.

CONCLUSION

Increased efforts are needed to reduce the incidence of occupational contact dermatitis in hairdressers in Australia, and to ensure that hairdressers with occupational contact dermatitis are aware of their compensation entitlements. Reliance on workers' compensation data for disease surveillance may lead occupational health and safety regulators to underestimate the magnitude of the problem of occupational contact dermatitis in the hairdressing profession.

Surveillance for work-related audiological disease in the UK: 1998-2006

BACKGROUND

Noise-induced hearing loss (NIHL) from prolonged occupational exposure to noise continues to rank among the top worldwide work-related ill-health problems.

AIMS

To provide an overview of incident cases based on work-related audiological ill-health data collected over a 9-year period from occupational physicians (OPs), audiological physicians (APs), general practitioners and otorhinolaryngologists.

METHODS

Analysis of numerator data reported by physicians to surveillance schemes within The Health and Occupation Reporting network (THOR). The actual cases were multiplied by the sampling ratio to provide estimated numerator numbers, followed by calculation of incidence rates using denominator data derived from the Labour Force Survey and from surveys of participating OPs.

RESULTS

Two thousand five hundred and eighty-two estimated cases (2584 estimated diagnoses) were received from OPs (Occupational Physicians Reporting Activity [OPRA]), and 2192 estimated cases (3208 estimated diagnoses) of work-related audiological ill-health were received from consultant APs [Occupational Surveillance Scheme for Audiological physicians (OSSA)] from 1998 to 2006. Cases where the causal agent was noise exposure (NIHL and tinnitus) made up of 95 and 97% of all cases reported to OPRA and OSSA, respectively. The annual average incidence rate for noise-induced audiological disorders was 7.9 [95% confidence interval (CI) 4.6-11.1] per 100 000 persons employed (OPRA) and 0.8 (95% CI 0.7-1.0) per 100 000 persons employed (OSSA). Workers with the highest incidence were older males employed in public administration and defence and the manufacture of metals.

CONCLUSIONS

THOR data show that diagnoses related to work-related noise exposure (NIHL/tinnitus), as reported to THOR, remain important health problems, despite preventive measures being in place.

Prevalence of Work-Related Upper Limbs Symptoms (WRULS) Among Office Workers

An analytical cross-sectional study was carried out to determine the prevalence of work-related upper limbs symptoms (WRULS) among office workers and factors associated with it. A self-administered questionnaire was used to collect the information. A total of 463 (87.7%) office workers from selected government agencies participated in this study. The mean age of the respondents was 34.1 years (range = 18-55 years). Majority (91.6%) were Malay and female (72.8%), and 58.1% were from clerical group. Mean duration of work was 8.7 years. This study found that prevalence of WRULS was 33.0% (95% CI [confidence interval] = 28.8%, 37.3%). Computer users at work had 2.0 (95% CI = 1.1, 3.4) higher odds ratio of developing WRULS and those who used it for 5 hours and more per day had 7.5 (95% CI = 2.3, 24.2) higher odds ratio of developing WRULS. Hand-intensive hobbies and higher education were also found to be associated with WRULS.

Occupational disease among non-governmental employees in Malaysia: 2002-2006

In the absence of systematic occupational disease surveillance, other data collected by governmental agencies or industry is useful in the identification of occupational diseases and their control. We examined data on occupational diseases reported by non-governmental employees to the national workers' social security organization in Malaysia, 2002-2006. The overall incidence rate of occupational disease was 2.8 per 100,000 workers. There was an increase in the annual number and rates of occupational disease over time. The most frequently reported conditions were hearing impairment (32%) and musculoskeletal disorders (28%). Workers in the non-metallic manufacturing industry had the highest average incidence rate of hearing impairment (12.7 per 100,000 workers) and musculoskeletal disorders (3.5 per 100,000 workers), compared to all other industries. Preventive measures should focus on safety education, engineering control and workplace ergonomics. Enforcing workplace standards and incorporating an ongoing surveillance system will facilitate the control and reduction of occupational disease.

Work-related ill health in general practice, as reported to a UK-wide surveillance scheme

GPs with training in occupational medicine report cases of work-related ill health and sickness absence to The Health and Occupation Reporting network in General Practice (THOR-GP) using an online webform. This report describes the data reported in 2006 and 2007. GPs mainly reported musculoskeletal disorders and mental ill-health. A much larger proportion of the mental ill-health cases were sickness-absence certified, making up 55.9% of the total days certified. Musculoskeletal disorders are the most frequently reported diagnoses of work-related ill health, but mental ill-health is responsible for most work-related sickness absence.

The incidence of occupational skin disease as reported to The Health and Occupation Reporting (THOR) network between 2002 and 2005

BACKGROUND

Estimated incidence rates for occupational skin disease in the U.K. are provided by voluntary surveillance schemes involving dermatologists and occupational physicians. These rates allow monitoring of occupational dermatoses, and intervention planning aimed at reducing workplace risks.

OBJECTIVES

To summarize occupational skin disease reported to The Health and Occupation Reporting (THOR) network (2002-2005), and to provide baseline information for comparison with future studies of occupational skin disease in the U.K. and beyond.

METHODS

Incidence rates for occupational dermatoses were calculated using THOR data as numerators, and Labour Force Survey data or information from the most recent U.K. survey on provision of occupational physician services as denominators.

RESULTS

In the U.K. (2002-2005) the average annual incidence rate of work-related skin disease reported to THOR by dermatologists was 91.3 [95% confidence interval (CI) 81.8-101.1] per million, and by occupational physicians was 316.6 (95% CI 251.8-381.3) per million. Most reports were of contact dermatitis: dermatologists 68.0 (95% CI 59.8-76.2) per million, occupational physicians 259.7 (95% CI 200.8-318.6) per million.

CONCLUSIONS

Information produced by THOR is an important source for calculating incidence rates of occupational skin disease. A range of reporting groups should also be used when building an overall picture of occupational skin disease incidence in the U.K.

Occupational dermatitis related to chromium and cobalt: experience of dermatologists (EPIDERM) and occupational physicians (OPRA) in the U.K. over an 11-year period (1993-2004)

BACKGROUND

Chromium and cobalt (and their compounds) are well recognized as being important causes of occupational contact dermatitis (OCD), particularly of the hands, although their exact contribution to occupational hand dermatitis varies between different studies. In some European studies, cases of chromium-related dermatitis have decreased following the addition of ferrous sulphate to cement to reduce the amount of available chromium.

OBJECTIVES

To examine, using data from the U.K. occupational skin surveillance schemes, the proportionate reported incidence and changing trends in OCD considered to be related to chromium and cobalt for the 11-year period from February 1993 to December 2004.

METHODS

Surveillance data collected by the two British occupational health surveillance schemes, EPIDERM and OPRA, from February 1993 to December 2004 were studied. These are occupational health surveillance schemes in the U.K. to which physicians voluntarily and anonymously report new cases of skin disease suspected to be work related.

RESULTS

Over the 11-year period, dermatologists reported 22 184 cases of OCD, comprising 77% of all types of occupational skin diseases that were disclosed. Chromium was recorded as being thought to play a role in 1226 (6%) of these, with cobalt identified as being likely to be implicated in 823 (4%). The numbers fluctuated on a year-on-year basis but there were no overall trends during the period of study. The male/female ratio was 5 : 1 for chromium and 1 : 1 for cobalt. Overall, the male/female ratio for OCD was 1.4 : 1. The rates of dermatitis believed to be related to both metals generally increased with age. In women, the highest rate for chromium was seen in the > 60 years age group, whereas conversely, for cobalt the rate decreased with age. For chromium-related OCD the most common occupations were builders and building contractors, bricklayers, construction workers and plasterers. For cobalt-related OCD, the commonest occupations were hairdressers/barbers, builders/building contractors, retail cash/checkout operators, machine operatives and domestic cleaners. Occupational physicians reported 15 016 cases of OCD (82% of all occupational skin diseases reported by them) for the period May 1994-December 2004. Of these, only 38 cases were thought to be related to chromium and 30 to cobalt (25 of the latter were processing labourers).

CONCLUSIONS

In this series, chromium was reported by dermatologists as potentially being involved in 6% of all cases of OCD in the U.K., and cobalt in 4%. Our data support the view that chromium-related dermatitis has an onset in later working life and often affects those in the building trades, whereas cobalt-related dermatitis seems to have an earlier onset and may affect a wide range of employments.

Reported incidence and precipitating factors of work-related stress and mental ill-health in the United Kingdom (1996–2001)

BACKGROUND

Work-related mental ill-health appears to be increasing. Population-based data on incidence are scarce but in the United Kingdom occupational physicians and psychiatrists report these conditions to voluntary surveillance schemes.

AIMS

To estimate the incidence of work-related stress and mental illness reported 1996-2001 by occupational physicians and 1999-2001 by psychiatrists.

METHODS

Estimated annual average incidence rates were calculated by sex, occupation and industry against appropriate populations at risk. An in-house coding scheme was used to classify and analyse data on precipitating events.

RESULTS

An estimated annual average of 3,624 new cases were reported by psychiatrists, and 2,718 by occupational physicians; the rates were higher for men in reports based on the former and for women on the latter. Most diagnoses were of anxiety/depression or work-related stress, with post-traumatic stress accounting for approximately 10% of cases reported by psychiatrists. High rates of ill-health were seen among professional and associated workers and in those in personal and protective services. Factors (such as work overload) intrinsic to the job and issues with interpersonal relations were the most common causes overall.

CONCLUSIONS

The steep increase in new cases of work-related mental ill-health reported by occupational physicians since 1996 may reflect a greater willingness by workers to seek help but may also signify an increasing dissonance between workers' expectations and the work environment. Greater expertise is needed to improve the workplace by adjustment of job demands, improvement of working relations, increasing workers' capacities and management of organizational change.

Incidence and suspected cause of work-related musculoskeletal disorders, United Kingdom, 1996–2001

BACKGROUND

Musculoskeletal conditions are the most common self-reported work-related disease, with high costs incurred from long-term disability. In the United Kingdom, occupational physicians and rheumatologists have been reporting new cases of work-related musculoskeletal disorders to voluntary surveillance schemes since 1996.

AIMS

To estimate population incidence rates for work-related musculoskeletal disorders reported by rheumatologists and occupational physicians by occupation and industry, in relation to tasks and movements suspected as causal.

METHODS

Estimated average annual incidence rates were calculated for nine main job categories and eight industrial groups; Labour Force Survey figures were used as the denominator for rheumatologists, and a special survey for the occupational physicians. These were then related to tasks and movements reported as causal.

RESULTS

Between October 1997 and the end of 2001, an estimated 2,599 new cases/year were reported by rheumatologists, and from January 1996, 5,278 cases/year by occupational physicians. Average annual rates overall were 94 per million for rheumatologists and 1,643 per million for occupational physicians (a 17-fold difference). Jobs at highest risk for the upper limb were primarily clerical, craft-related and machine work. Tasks associated with upper limb disorders and with neck and back problems were predominantly keyboard work and heavy lifting, and in craft-related occupations with gripping or holding tools.

CONCLUSIONS

Jobs at risk and the associate tasks were identified which should assist prevention, but the extent to which these factors were causal or aggravating previous injury requires further study. The much higher rates reported by occupational physicians reflect, in part, the type of industries they served.

Self-reported work-related health problems from the Oslo Health Study

BACKGROUND

Lack of knowledge about the occurrence of work-related health problems in the general population makes it difficult to estimate the potential for their prevention in the workplace.

AIMS

To examine the prevalence of self-reported work-related health problems among adult citizens of Oslo, Norway.

METHODS

The study was part of the Oslo Health Study 2000-2001, in which all individuals in certain age cohorts were invited to a comprehensive health screening. All 30-, 40- and 45-year old subjects who attended the screening were asked if they had experienced any of 11 common health problems in the past month, and whether they considered these to be work-related. Of the 26,074 invitees in these age cohorts, 8,594 (33%) answered the questionnaire.

RESULTS

Nearly 60% of subjects reported one or more work-related health problems, most commonly reported were pain in the neck/shoulders (38%) and low back pain (23%). Neck/shoulder pain was most frequently attributed to working conditions, by 74% of subjects with this problem; followed by arm pain (72%), fatigue (51%) and low back pain (50%). Work-related fractions for eczema and asthma symptoms were 23 and 18%, respectively. There were marked gender differences, but small age differences.

CONCLUSIONS

A substantial proportion of common health problems in the Oslo population were attributed to working conditions. This implies a large preventive potential and call for increased preventive efforts targeted at known risk factors in the workplace.

Intervention development in occupational research: an example from the printing industry

BACKGROUND

Intervention development research is an essential prerequisite of any study that attempts to determine whether specific interventions work to prevent work related injury and illness.

METHODS

Focus groups (n = 5) and direct observational studies (n = 21) of printers were used to elicit key issues that would aid the development of subsequent interventions. Transcripts from these were analysed by standard qualitative methods to identify common and related themes.

RESULTS

The views of managers differed significantly from those of print workers in a number of areas, and working practices did not always follow policy. The majority of printers did not perceive dermatitis to be a major problem, although many complained of dry hands. Other key results included: the lack of skin care policy in most companies; poor understanding of the nature, causes, and treatment of dermatitis; low priority of dermatitis within health and safety concerns; little or no provision of occupational health services, particularly skin checks; variability in provision of and access to appropriate skin protection; and lack of accessible washing facilities.

CONCLUSIONS

As a result it was decided to evaluate the implementation of four

INTERVENTIONS

provision of (1) skin checks and treatment advice; (2) gloves of the correct type and size, and use of an after-work cream; (3) information on dermatitis within the printing industry; and (4) development of best practice skin care policy.

Incidence by occupation and industry of acute work related respiratory diseases in the UK, 1992-2001

AIMS

To summarise incidence rates and epidemiological characteristics of new cases of work related respiratory disease reported by specialist physicians in thoracic and occupational medicine, with particular reference to occupation, industry, and causal agents for asthma, inhalation accidents, and allergic alveolitis.

METHODS

Cases reported 1992-2001 to the SWORD and OPRA national surveillance schemes, in which almost all UK chest and occupational physicians participate, were analysed by age, sex, cause, occupation, and industry, with incidence rates calculated against appropriate denominators.

RESULTS

Excluding diseases of long latency, infrequently seen by occupational physicians, the distribution of diagnoses in the two specialties was similar, but with rates generally much higher in occupational than chest physicians. Occupational asthma was responsible for about 25% of cases overall, affecting mainly craft related occupations and machinists, and most often attributed to isocyanates, metals, grains, wood dusts, solders, and welding fume. These same occupations were those at highest risk from inhalation injuries, most frequently caused by irritant gases, vapours, and fume. Among medical technicians and nurses, however, glutaraldehyde and latex were the main causes of occupational asthma. Allergic alveolitis was seldom reported, with almost all cases in agriculture, forestry, and fishing.

CONCLUSION

During the 10 year period studied, there were few changes in level of reported incidence, apart from some decline in occupational asthma and inhalation injuries. These results and their implications should be distinguished from much higher estimates of asthma made worse by work derived from population surveys, based on prevalence rather than incidence, and self-reported symptoms rather than diagnoses made by specialist physicians. Even so, the reported incidence of new cases of acute respiratory illness caused by work remains substantial.

Occupational asthma

Substantial epidemiologic and clinical evidence indicates that agents inhaled at work can induce asthma. In industrialized countries, occupational factors have been implicated in 9 to 15% of all cases of adult asthma. Work-related asthma includes (1) immunologic occupational asthma (OA), characterized by a latency period before the onset of symptoms; (2) nonimmunologic OA, which occurs after single or multiple exposures to high concentrations of irritant materials; (3) work-aggravated asthma, which is preexisting or concurrent asthma exacerbated by workplace exposures; and (4) variant syndromes. Assessment of the work environment has improved, making it possible to measure concentrations of several high- and low-molecular-weight agents in the workplace. The identification of host factors, polymorphisms, and candidate genes associated with OA is in progress and may improve our understanding of mechanisms involved in OA. A reliable diagnosis of OA should be confirmed by objective testing early after its onset. Removal of the worker from exposure to the causal agent and treatment with inhaled glucocorticoids lead to a better outcome. Finally, strategies for preventing OA should be implemented and their cost-effectiveness examined.

Development of risk filter and risk assessment worksheets for HSE guidance--'Upper Limb Disorders in the Workplace' 2002

Upper limb disorders (ULDs) in the workplace represent a significant cause of ill health in Great Britain. As part of the Health and Safety Commission's strategy for the prevention of musculoskeletal disorders (MSDs), the well known guidance document on ULDs--"Work-related Upper Limb Disorders: a Guide to Prevention" (HSG60), (HMSO, London.), has been extensively revised. This revision (Upper limb disorders in the workplace. HSG60 (rev), HSE Books, Sudbury.) includes the development of new risk assessment tools that can be used by employers to identify ULD risk factors in work activities and more importantly to take action to reduce or eliminate ULD risks. The risk assessment tools form part of a seven stage management approach that underpins the new guidance. This paper outlines the development of the risk assessment tools contained in the revised guidance.

Hazard and risk assessment of industrial chemicals in the occupational context in Europe: some current issues

This paper is about industrial chemicals, the manner in which their toxicity is assessed and the use of such assessments in regulatory decision-making. It begins with general points concerning toxicological data availability and hazard identification, then moves on to risk assessment and occupational exposure limits, and finally looks briefly at three specific toxicological issues, asthma, chronic toxic encephalopathy, and "low toxicity" dust effects on the lung, where the science is far from resolved. The overall purpose of the paper is to raise, or perhaps to act as a reminder of a number of issues of particular relevance to industrial chemicals and the occupational setting, and hopefully to prompt further thinking and perhaps some new initiatives directed at the areas in question.