Prediction of asthma hazard of glutaraldehyde substitutes.
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Aldehydes↗
Biomedical subjects
R M Agius
Publications and source records attributed to R M Agius.
Prediction of asthma hazard of thiamine.
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Asthma↗
The reported incidence of work-related ill-health in Scotland (2002-2003).
BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.
Adolescent↗
The Distance Learning Courses in Occupational Medicine--20 years and onwards.
BACKGROUND: The first Distance Learning Course in Occupational Medicine was set up in 1984 at the Department of Occupational Health, University of Manchester. AIMS: This paper describes the progress of that course and developments within distance learning education in occupational health at The University of Manchester over the subsequent 20 years. It also looks at the future objectives and modes of teaching of occupational health at Manchester via distance learning. METHODS: Analysis has been undertaken of student demographics and matching between original forecasts and actual outcomes. RESULTS: Original forecasts of student uptake have been surpassed. There are indications of increases in the number of female and part-time students, and a corresponding decline in the number of general practitioners enrolling on the Advanced course. Response to developing circumstances has resulted in the Distance Learning Unit setting up additional courses. CONCLUSIONS: The farsightedness of those who predicted the need for academic training in occupational health by distance learning has been proved correct. Further evolution is essential to maintain and improve the value and success of the courses.
Education, Distance↗
The lagged effect of cold temperature and wind chill on cardiorespiratory mortality in Scotland.
AIMS: To investigate the lagged effects of cold temperature on cardiorespiratory mortality and to determine whether "wind chill" is a better predictor of these effects than "dry bulb" temperature. METHODS: Generalised linear Poisson regression models were used to investigate the relation between mortality and "dry bulb" and "wind chill" temperatures in the three largest Scottish cities (Glasgow, Edinburgh, and Aberdeen) between January 1981 and December 2001. Effects of temperature on mortality (lags up to one month) were quantified. Analyses were conducted for the whole year and by season (cool and warm seasons). MAIN RESULTS: Temperature was a significant predictor of mortality with the strongest association observed between temperature and respiratory mortality. There was a non-linear association between mortality and temperature. Mortality increased as temperatures fell throughout the range, but the rate of increase was steeper at temperatures below 11 degrees C. The association between temperature and mortality persisted at lag periods beyond two weeks but the effect size generally decreased with increasing lag. For temperatures below 11 degrees C, a 1 degrees C drop in the daytime mean temperature on any one day was associated with an increase in mortality of 2.9% (95% CI 2.5 to 3.4), 3.4% (95% CI 2.6 to 4.1), 4.8% (95% CI 3.5 to 6.2) and 1.7% (95% CI 1.0 to 2.4) over the following month for all cause, cardiovascular, respiratory, and "other" cause mortality respectively. The effect of temperature on mortality was not observed to be significantly modified by season. There was little indication that "wind chill" temperature was a better predictor of mortality than "dry bulb" temperature. CONCLUSIONS: Exposure to cold temperature is an important public health problem in Scotland, particularly for those dying from respiratory disease.
Adult↗
Attitudes and access to electronic exchange of information on occupational disease.
BACKGROUND: THOR is a network of work-related disease surveillance schemes dependent on volunteer case reporting by medical specialists. Data collection and dissemination has hitherto been paper-based. AIMS: To elicit the opinion of existing reporters in THOR on electronic exchange of information and to assess the practical capabilities of the same reporters to participate in electronic communication. METHODS: A mail-based questionnaire of randomly selected THOR reporters using closed format questions. RESULTS: The response rate to the questionnaire was 66% (253/383). Almost half (47%) of the responders wanted dissemination of information solely in an electronic form, 35% favoured paper-based reports, while 16% wanted both paper and electronic reports. Two-thirds (66%) would make use of electronic archives of reports and 59% would use this facility to resolve questions by accessing accumulated data. The majority (82%) read e-mail more than once a week and 34% browsed the web as frequently. However, 5% did not have e-mail and 6% never browsed the web. Most responders judged their internet connectivity to be rapid (68%) and convenient (83%), and 91% could receive e-mail attachments. CONCLUSIONS: Most responders have the skills and infrastructure required to engage in electronic information exchange, and are favourably disposed to electronic means of communication. However it is also relevant to note that one-third of responders have a preference for the existing paper-based system.
Attitude of Health Personnel↗
Intercomparison of five PM10 monitoring devices and the implications for exposure measurement in epidemiological research.
Five different instruments for the determination of the mass concentration of PM10 in air were compared side-by-side for up to 33 days in an undisturbed indoor environment: a tripod mounted BGI Inc. PQ100 gravimetric sampler with a US EPA certified Graseby Andersen PM10 inlet; an Airmetrics Minivol static gravimetric sampler; a Casella cyclone gravimetric personal sampler; an Institute of Occupational Medicine gravimetric PM10 personal sampler; and two TSI Inc. Dustrak real-time optical scattering personal samplers. For 24 h sampling of ambient PM10 concentrations around 10 microg m(-3), the estimated measurement uncertainty for the two gravimetric personal samplers was larger (approximately +/- 20%) compared with estimated measurement uncertainty for the PQ100/Graseby Andersen sampler (< +/- 5%). Measurement uncertainty for the Dustraks was lower (approximately +/- 15% on average) but calibration of the optical response against a reference PM10 method is essential since the Dustraks systematically over-read PM10 determined gravimetrically by a factor approximately 2.2. However, once calibrated, the Dustrak devices demonstrated excellent functionality in terms of ease of portability and real-time data acquisition. Estimated measurement uncertainty for PM10 concentrations determined with the Minivol were +/- 5%. The Minivol data correlated well with PQ100/Graseby Andersen data (r= 0.97, n = 18) but were, on average, 23% greater. The reason for the systematic discrepancy could not be traced. Intercomparison experiments such as these are essential for assessing measurement error and revealing systematic bias. Application of two Dustraks demonstrated the spatial and temporal variability of exposure to PM10 in different walking and transport microenvironments in the city of Edinburgh, UK. For example, very large exposures to PM10 were identified for the lower deck of a double-decker tour bus compared with the open upper deck of the same vehicle. The variability observed emphasises the need to determine truly personal exposure profiles of PM10 for quantifying exposure response relationships for epidemiological studies.
Air Pollution, Indoor↗
Investigation of factors which might indicate susceptibility to particulate air pollution.
OBJECTIVES: To determine whether previous symptoms or recognized risk factors of cardiovascular ill health, are associated with an increased likelihood of adverse health effects related to particulate air pollution. METHODS: Cardiovascular event rates were studied relative to urban concentrations of particulate air pollution and baseline risk factors. The Edinburgh artery study consisted of a cohort of 1592 subjects aged 55-74 and was followed up to the end of March 1998 for a median of 10 years resulting in about 5 million person-days of observation. Baseline measurements included plasma fibrinogen and blood and plasma viscosity. A nested case-control approach was used to investigate a possible interaction between effects of these selected baseline risk factors and particulate air pollution, on subsequent event rates. RESULTS: During the follow up period there were 343 fatal and non-fatal myocardial infarctions or strokes. Trends in adverse cardiovascular outcomes related to pollution were identified among subjects belonging to the highest baseline quintile of plasma fibrinogen. Evidence for interactions between concentrations of particulate pollution and fibrinogen was not established at conventional levels of significance. CONCLUSIONS: People with high concentrations of plasma fibrinogen might be more susceptible to adverse cardiovascular effects of particulate air pollution, but limitations of power mean that evidence relating to such an interaction is not conclusive. A range of cardiopulmonary risk factors warrant investigation in relation to possible susceptibility to air pollution.
Aged↗
Auditing occupational medicine.
An important challenge facing the quality of practice in occupational medicine is a limited evidence-base, but equally important is the need to translate good evidence into high quality practice. Audit has an important role to play in addressing the determinants of variations in practice. Furthermore where the evidence is good enough to permit the development of valid practice guidelines, audit may help in improving education and standards of practice. External audit may have a role to play in ensuring conformity with service-level agreements and especially in addressing issues of quality which some management systems may fail to address. As more literature is published reviewing and achieving a consensus on the evidence-base for the practice of occupational medicine, and as more experience in audit is described, it can make an important contribution to quality in occupational medicine.
Humans↗
Development and evaluation of the use of the Internet as an educational tool in occupational and environmental health and medicine.
The Internet, and specifically the World Wide Web (WWW), has an important role as a method of learning in occupational and environmental health and medicine. This paper provides a systematic overview of the demands and merits of this approach to learning in a range of higher education courses in these disciplines. Drawing on a relevant theoretical framework for understanding how students learn, it describes the design and evaluation of specific resources developed for students to learn using the WWW. The occupational and environmental health or medicine components of two undergraduate degree courses and of two postgraduate courses were reviewed to determine what learning objectives would be achievable by adapting extant conventional material, or by developing new teaching and learning resources for the WWW. Depending on the objectives, various learning resource formats were developed including descriptive, interactive (such as case study or data-based), reference and self-assessment. One WWW based tutorial consisting of an interactive resource with defined objectives, linked to constantly updated, in-house information and external links, was chosen as a representative for detailed evaluation. Process evaluation was based on student feedback, and outcome evaluation on group reports submitted on completion of the tutorial. Twelve of the 13 students who completed the tutorial returned the feedback questionnaire. All but one student rated it as 'good' or 'very good', with the majority of students reporting that it was easy to follow. Open-ended comments suggested that students valued the flexibility, timeliness, efficiency and breadth of access to relevant information offered by the WWW. The outcome evaluation showed that all the main learning objectives had been achieved. This work indicates that the WWW can be a valuable learning resource for occupational and environmental health and medicine.
Computer-Assisted Instruction↗
Urban air pollution and cardiopulmonary ill health: a 14.5 year time series study.
OBJECTIVES: To examine possible associations between daily concentrations of urban air pollutants and hospital emergency admissions and mortality due to cardiac and pulmonary disease. METHODS: A time series study was conducted in the City of Edinburgh, which has a population of about 450,000. Poisson log linear regression models were used to investigate the relation of the daily event rate with daily air pollution concentrations of sulphur dioxide (SO2) and black smoke from 1981 to 1995, and of nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and particulate matter (PM10) from 1992 to 1995. Adjustments were made for seasonal and weekday variation, daily temperature, and wind speed. RESULTS: The most significant findings were positive associations over the period 1981-95 between black smoke as a mean of the previous three days and daily all cause mortality in people aged > or = 65, and respiratory mortality also in this age group (3.9% increase in mortality for a 10 micrograms/m3 increment in black smoke). For hospital emergency admissions between 1992 and 1995 the two most significant findings (p < 0.05) were for cardiovascular admissions of people aged > or = 65 which showed a positive association with PM10 as a mean of the 3 previous days, and a negative association with O3 as a mean of the previous three days. Analyses of outcomes based on linkage with previous cardiorespiratory emergency admissions did not show substantially different results. CONCLUSION: These data suggest that in the City of Edinburgh, after correction for confounders, there was a small but significant association between concentrations of black smoke and respiratory mortality in the older age group, probably attributable to higher pollution levels in the early part of the study period. There were also generally weak and variable associations between day to day changes in concentrations of urban air pollutants at a single central point and emergency hospital admission rates from cardiac and respiratory disease.
Adult↗
Models of job-related stress and personal achievement among consultant doctors.
The antecedents and outcomes of feelings of job-related stress and personal achievement were studied in a large sample of consultant doctors working in Scotland. In a sample of 333 doctors it was found that a tendency to use emotion-oriented coping strategies and negative appraisals of organizational changes in the practice of medicine mediated the effect of the personality dimension of Neuroticism on reported job stress. Job stress levels predicted the degree of 'burnout' experienced by doctors, i.e. their tendencies to be emotionally exhausted by their work and to dehumanize patients. Higher clinical workloads were related to higher levels of stress but also to higher feelings of personal achievement. A substantial proportion of the variance in many of the variables in the stress model was accounted for by a general tendency to experience negative emotions, closely related to Neuroticism; this general factor appeared to be similar to the recently formulated concepts of 'negative affectivity' and 'somatopsychic distress'. The personality factors of Extraversion and Conscientiousness both contributed to positive feelings of personal achievement (N = 344); the effect of Extraversion was direct, whereas the effect of Conscientiousness was mediated by a tendency to use task-oriented coping strategies. Models of the processes of stress and personal achievement were tested for acceptability using the EQS Structural Equations Program. The implications of the models for transactional theories of stress are discussed.
Achievement↗
Survey of perceived stress and work demands of consultant doctors.
OBJECTIVES: The objectives of this study were to assess the work demands as potential stressors of health service consultants, and to describe the development of tools for measuring stress experiences of consultants. METHODS: A stratified random sample of 500 NHS consultants in Scotland was targeted by a postal questionnaire and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors, and burnout. RESULTS: Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic, and administrative. Their perceived stressors separated into four main factors: clinical responsibility, demands on time, organisational constraints, and personal confidence. These were assessed by 25 questions in the specialist doctors' stress inventory. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the NHS. CONCLUSION: These self reported data characterise and measure the consultants' work demands and their role as potential stressors. These measurements could form the basis for strategies to reduce occupational stress in these workers.
Adult↗
Abdominal pain and vomiting in a paint stripper.
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Abdominal Pain↗
Personality and stress in consultant psychiatrists.
A randomly selected group of consultant psychiatrists (n = 39) working within the NHS in Scotland was compared with a combined group of physicians and surgeons (n = 149) on several variables related to the stress process, including personality traits, coping strategies, psychological distress, burnout, job stress and work demands. Psychiatrists reported fewer clinical work demands (p < .001), and their mean personality scores were significantly different from physicians and surgeons by being high in neuroticism (p = .009), openness (p = .003) and agreeableness (p = .002), and low in conscientiousness (p = .04). Psychiatrists reported higher work-related emotional exhaustion (p = .03) and severe depression (p = .02). However, psychiatrists did not report more work-related stress than physicians and surgeons. Many stress-related variables were highly correlated within the group of psychiatrists, suggesting that there is a very general disposition to experience negative emotion (including job-related stress) in some individuals. Organisational and personal contributions to stress in the practice of psychiatry are considered. There are personality characteristics that might dispose some people toward psychiatry as a career and toward stress. However, there is no evidence to suggest that screening for admission to psychiatry in terms of personality or other psychological factors would be useful or advisable.
Adaptation, Psychological↗
Audit of sickness absence and fitness-for-work referrals.
Since referrals in relation to sickness absence and fitness to continue work constitute an important part of occupational physicians' workloads, a study was carried out to audit this activity. Randomly selected referrals (u = 162) were audited by external peer review in relation to the information provided in the referral request, the consultation records and responses of the occupational physicians, and the response times linking the referral, the consultation and the response. The study showed that the referral record was adequate when specifying or quantifying long-term absences (90% and 84% of relevant cases, respectively) but questions or information regarding other relevant issues were much less frequent, eg only 12% of the referral records provided a description of the job or task. The physicians' response rate was high in relation to likely date of return to work (96%) but lower for other relevant items. In all the issues audited, the frequency of the physicians' responses was higher than the frequency with which the relevant questions were posed to them, thus suggesting 'added value' in the formulation of the problem by the physicians. The response times (often interpreted as a measure of health care quality) did not correlate usefully with the completeness of the responses as determined by peer review audit. Occupational physicians should aspire to achieve a validated standard of assessment and communication which can be audited.
Absenteeism↗
The special study module: a novel approach to undergraduate teaching in occupational medicine.
Difficulties in teaching occupational medicine to undergraduates stem from the reduced availability of teaching time and the perception of the specialty. Recent changes in the General Medical Council curricular framework have permitted the development of a special study module (options course) in occupational medicine, in which a small number of motivated undergraduates elected to participate and which was adequately resourced. This course laid particular emphasis on changing students' attitudes towards the specialty, self-learning techniques, problem-solving and other skills such as workplace assessment. The objectives, content and teaching methods of the course are described, as is a preliminary evaluation. It is suggested that other medical schools should adopt and refine this approach in order to improve the quality of undergraduate training in at least a proportion of the output of medical schools.
Education, Medical, Undergraduate↗
'Health at work'--getting the balance right.
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Humans↗