Occupational medicine in the National Health Service.
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Biomedical subjects
Publications and source records attributed to I S Symington.
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The extent of HBV infection in the staff of a large hospital for the mentally handicapped was investigated. Nurses with direct patient contact were identified as a particular risk group and hepatitis B vaccination was offered to them. Of the 500 who received a full course of vaccination 96% had detectable antibodies 9 months after starting vaccination. High titres (over 1000 IU/l) were found in 59.4%. Females responded better than males and the response was age-dependent. In only 2 of 20 non-responders did lasting immunity develop with a fourth dose of vaccine. Antibody titre decreased rapidly in all vaccinees followed up. In vaccinees with an initial titre above 100 IU/l the decrease in titre could be reversed by a booster dose. Those with a titre below 100 IU/l had a variable response to the booster dose and lasting immunity developed in only a few. A recall system was started that predicts when a booster dose will be required to maintain a protective level of antibody. Servicing such a vaccination programme is not easy.
Coagulation and platelet aggregation to thrombin and adrenaline, before and 10 min after smoking one high nicotine cigarette, were studied in 40 healthy male farmers (40 to 45 years) from the South-West and North-East of Scotland. These tests were conducted in association with detailed dietary studies. In the West group the intake of dairy fats, saturated fats and P/S ratio as well as most of the platelet function tests estimated were significantly higher than in the East group. Serum cholesterol (total and HDL) was similar in the two regions, while triglycerides were lower in the West. Smoking one cigarette considerably enhanced the platelet functions in both areas but the increases were more marked in the West group. The increase in the response of platelets to smoking was additive to that apparently induced by the intake of saturated fat in such a way the response of platelets to thrombin and epinephrine after smoking one cigarette in the West was approximately four times this obtained before smoking (or in a non-smoker) in the East. These additive effects of cigarette and saturated fat might be relevant to the reported higher incidence of coronary heart disease in the West of Scotland.
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The toxic hazard from cyanide produced in fires was assessed in casualties and in firemen exposed to the fire atmosphere. The levels of cyanide and its principal metabolite, thiocyanate, were measured in blood samples from fireman, non-fetal and fatal casualties, and from controls. Although firemen did not differ significantly from controls, casualities showed significant elevation of blood-cyanide, and in a small proportion of fatalities blood-cyanide reached toxic levels.
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Pulmonary thromboembolism developed in eight patients shortly after travel. Preexisting vein disease was present in this group. Possible prophylactic measures are suggested.
Nineteen patients with hay fever symptoms received nine weekly injections of pyridine-extracted alum-precipitated grass pollen vaccine (Alavac P). The results were compared with agroup of twenty patients who received a three injection series of a glutaraldehyde-modified pollen-tyrosine vaccine (Pollinex). In both groups 65% had a subjective improvement in their symptoms and no significant difference in symptom scores was obtained throughout the pollen season. In the Pollinex group a lower incidence of systemic side effects was recorded.
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In an investigation of the relationship between storage mites and symptoms of allergic respiratory disease in farmers exposed to hay and grain dust, the clinical responses suggested an immediate type-I hypersensitivity. This study confirmed that farmers are exposed to large numbers of mites, particularly while feeding cattle. Storage mites may be an important cause of asthma in the farming community and should also be considered in the differential diagnosis of farmers lung.