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Set out from various specific angles, the concept concerning a modern common industrial medicine/safety/ergonomics approach can be fitted into the present legal framework. Adapted according to specific needs, this approach can equally be applied in all areas--health promotion, prevention, cure, rehabilitation. Those involved in the current debate about industrial health policies start out from the premise that industrial medicine could contribute strongly in this respect. While the workmen's compensation scheme, together with the industrial medical profession, is to a considerable extent involved in the subject as a whole on the basis of the industrial safety Act, its competencies are however limited, being in actual fact confined to the field of health maintenance in the occupational context. The examinations they effect in this framework cannot be based on a holistic medical orientation, because our constitution has expressly excluded the private sphere of the individual (self-management domain). Hence, there are very little chances of success for any attempt of changing current health care practice solely via the workmen's compensation administrations. It currently is, rather, the health and pension insurance schemes who hold the potential for influence. The common approach of industrial medicine, safety and ergonomics outlined may be of considerable use also in view of their goals, and holds sufficient justification for their intervening favourably in the ongoing debate about quality and quantity of industrial medical service provision with the ministries in charge.
Thirty-four per cent of 2110 patients with eczema attending a contact dermatitis clinic had hand eczema. Fifty-five per cent (395 of 721) had contact dermatitis and 45% (326 of 721) had endogenous/unclassifiable eczema. Thirty-five per cent of cases (217 of 721) were occupational eczema. An epidemiological comparison of patients with occupational and non-occupational hand eczema (defined as eczema occurring on the hands up to the wrist line) was made. Hand eczema was more common in males in both groups, and there was a significantly larger proportion of males in the occupational group (65%) than the non-occupational group (51%) (P less than 0.001). The prevalence of a personal or family history of atopy was significantly lower in the occupational group (7%) than the non-occupational group (15%) (P less than 0.005). Irritant contact dermatitis occurred in a larger proportion of patients in the occupational group (76%) than the non-occupational group (39%) (P less than 0.0001). There was no significant difference between the proportions of patients with positive patch test reactions in the occupational group (34%) and the non-occupational group (41%). Potassium dichromate, and epoxy resin allergy occurred significantly, more frequently, in the occupational group whereas fragrance-mix allergy was significantly more frequent in the non-occupational group.
This report forms a background paper for a World Health Organization document on "Assessment of the role of lifestyles in influencing workers' health risks". It identifies occupational and non-occupational factors which contribute to occupational mortality and morbidity. Eight categories of mortality and morbidity are identified as priorities for discussion, based on UK data. These are cardiovascular disease; lung cancer; chronic obstructive pulmonary disease; occupational deafness; dermatitis; vibration white finger; tenosynovitis; and suicide. Non-occupational factors associated with these include age, sex, race, smoking, social class, alcohol consumption, diet, exposures in leisure time, exercise, atopy, heredity, personal hygiene, personality type, stress, past or predisposing illness or injury, weather/climate and air pollution. Smoking is identified as the most widely studied non-occupational factor in occupational disease. Smoking interacts with some occupational exposures to produce more disease than the sum of both agents separately. Smoking and asbestos interact multiplicatively in lung cancer causation. The ability to quantify interactions between occupational and non-occupational factors in disease etiology is important in assessing priorities for preventive action. Despite this, only the interactions of smoking have begun to be defined. The many other non-occupational factors mentioned above have each been studied individually but their interactions with occupational factors have not been assessed. This report describes models of quantifying interactions and recommends that further work is carried out to assess the interactions of non-occupational factors other than smoking in disease causation.
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Occupational science is a new scientific discipline that is defined as the systematic study of the human as an occupational being. A doctoral program in occupational science has been established at the University of Southern California, Los Angeles. With its emphasis on the provision of a multidimensional description of the substrates, form, function, meaning, and sociocultural and historical contexts of occupation, occupational science emphasizes the ability of humans throughout the life span to actively pursue and orchestrate occupations. In this paper, occupational science is described, defined, and distinguished from other social sciences. A general systems model is presented as a heuristic to explain occupation and organize knowledge in occupational science. The development of occupational science offers several key benefits to the profession of occupational therapy, including (a) fulfillment of the demand for doctoral-level faculty members in colleges and universities; (b) the generation of needed basic science research; and (c) the justification for and potential enhancement of practice.
The authors analyzed notified occupational diseases at the department of occupational diseases during the 10 past years, focusing attention on workers in the health workers' union. The highest ratio is that of viral hepatitis (64.8%) and skin diseases (14.7%). These are followed by other infectious diseases, tuberculosis, asthma bronchiale, etc. The largest number of occupational diseases was reported in female health workers (74.7%) which is consistent with nationwide data on occupational diseases. The high ratio of women is not surprising with regard to the marked feminization of this occupation. The highest ratio of occupational diseases was reported in women aged 21-30 years, whereby viral hepatitis accounted for 32.6%. Occupational diseases are important not only from the medical but also from the economic aspect. Therefore even a minor reduction of occupational diseases has marked economic consequences. From the investigation ensues that at present it is important to concentrate above all on two groups of occupational diseases, i.e. occupational infectious contagious diseases and occupational skin diseases. A prerequisite for reduction of type B viral hepatitis is immunization of health workers at risk departments against hepatitis B, which is being implemented at present.
A review of the many attempts to establish an association between occupations and alcoholism reveals that most do not deal with data about clinically defined alcoholism but instead use data about cirrhosis mortality, self-reported alcohol problems, and frequent and heavy drinking. The present study establishes an association between occupations and diagnoses of Alcohol Dependence Disorder and Alcohol Abuse Disorder, using data from a large population-based household interview study. Statistical adjustment using logistic methods reveals that apparent associations between occupations and alcohol-related disorders previously reported in the literature are due to characteristics of those employed in various occupations. The prevalence of alcohol dependence and abuse in two high risk industries, construction and transportation, is confirmed. More than one in four construction laborers and one in five skilled construction trades workers received a DIS/DSM-III diagnosis related to alcohol abuse. In the transportation industry one in six heavy truck drivers and material movers received an alcohol diagnosis. Analyses of the data from individuals currently employed and not employed in their occupation reveals reduction in risk for those who leave some occupations and increased risk for those who leave other occupations. Evidence is presented that employment in some occupations may be protective for Alcohol Dependence. The findings support the view that occupation may be associated with Alcohol Dependence and Alcohol Abuse independent of demographic variations. Previously proposed explanatory models for associations between occupations and alcohol problems are called into question because they do not take into account the demographic characteristics and employment status of workers.
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The incidence and mortality rates of primary liver cancer (PLC) among residents of Brooklyn, New York, were studied for 1976 through 1983. Standardized race and sex-specific incidence and mortality rates and rate ratios were computed and compared with overall US rates as reported by the Surveillance, Epidemiology, and End Results (SEER) program. The results indicate a significant excess of PLC among all race and sex groupings. A comparison of the degree of agreement between incidence and mortality data for Brooklyn residents showed excellent agreement among male patients with PLC and adequate agreement among female patients with PLC. Next, the effect of occupation on PLC mortality among Brooklyn residents was assessed. Specific occupations found to be at excess risk for PLC are private household workers (ratio of observed to expected cases [O/E] = 4.34; P less than 0.0001), non-domestic cleaning and food and beverage service workers (O/E = 2.59; P less than 0.0001), protective service workers (O/E = 1.78; P = 0.035), and transport equipment operatives (O/E = 1.52; P = 0.027). Since the distribution of Brooklyn workers employed in these occupations was found to be similar to the distribution of all US workers employed in these occupations, it is unlikely that these occupational risk factors can explain the observed excess of PLC among Brooklyn residents. The effects of non-occupational risk factors for PLC were then assessed using multiple regression analysis. The only non-occupational risk factor found to be associated with PLC among Brooklyn residents was cirrhosis of the liver (P = 0.0072). It is interesting that of the four occupations found to be at excess risk for PLC in this study, three have been previously shown to be at excess risk for cirrhosis mortality. Moreover, Brooklyn residents have cirrhosis mortality rates that are approximately two times higher than US rates. These facts, coupled with the findings of this study, support the hypothesis that the excess of PLC observed among Brooklyn residents might be related to an excess of cirrhosis of the liver in the same population, and thus provide support for an etiologic role of cirrhosis in the pathogenesis of PLC.
The analysis of data on the teaching of occupational medicine in particular medical schools in Poland shows great diversity in presenting the subject to the students of medicine. It relates both to the curriculum and organizational and didactic methods and opinions and postulates expressed by the lecturers . Currently, occupational medicine is a separate subject in the curricula of four medical colleges in Poland, which does not, however, mean that in other colleges the conditions of lecturing on occupational medicine are unsatisfactory. On the contrary, the variety of problems of occupational medicine presented as part of other subjects points to the fact that this particular branch of medical science has been taken seriously. Although the present form of lectures and classes devoted to occupational medicine does enable students to get certain knowledge and competence in this field of science, it does not help shaping a proper attitude toward the subject: still too few students are interested in specializing in occupational medicine and working as industrial health service staff. In such circumstances, some activity must be undertaken to improve the process of pre-graduate studies in occupational medicine.
In most European countries occupational health and public health have developed separately, the reasons behind this are mainly historical and political. Although this may be understandable, even today, due to the political factors involved, it is amazing that the research on the morbidity and mortality of people of working age does not aim at comprehensive analyses of etiological factors behind these types of health outcomes. Our knowledge on the health needs of workers is limited, in most countries we even lack any information on distribution of the major illnesses amongst the various occupational categories. Some information, however, is currently being gathered, based on the need to make operational the concept of work-related diseases which has been put forward by WHO. The US NIOSH programme on work-related diseases, or the Danish TOP-11-Programme, serve as examples for these types of developments. Additional need to study the causes of ill-health, and ways to counteract them amongst the working population, results from the health promotion action that has also been developed as a part of the HFA 2000. The aim of this overview is to study the importance of occupational and non-occupational factors in the etiology of the ill-health of workers. Evidently, such analyses are premature today. However, some anecdotal examples will be mentioned. The major emphasis of the paper is, however, laid on the needs for the coordination and evaluation of occupational health and other health programmes concerning those of working age. Some assumptions will also be made on the development of occupational health and the consequences of this development for those who are occupational health practitioners.
An experienced occupational health nurse with suitable academic qualifications is able to assist in providing a well-rounded education and teaching physicians to be effective members of occupational health teams. Nurses are involved in teaching occupational health to physicians in the academic and practicum phases of occupational medicine residency training programs. However, the involvement of nurses in training physicians is inconsistent among the accredited residencies. Most of the nurses involved in teaching occupational health to physicians are at least master's degree prepared. Nurses are involved in the didactic, clinical, and administrative components of the training programs. Though nurses are involved in residency training programs to an extent, the lack of consistent involvement limits the diversity of points of view and fosters an imbalance in the training of occupational medicine residents.
A voluntary scheme for the surveillance of work related and occupational respiratory disease (SWORD) was established in January 1989 with help from the British Thoracic Society and the Society of Occupational Medicine and support from the Health and Safety Executive. Three hundred and fifty four chest physicians representing 90% of the chest clinics in the United Kingdom and 361 occupational physicians submit reports regularly of newly diagnosed cases of work related respiratory illness with information on age, sex, residence, occupation, and suspected causal agent. In 1989 2101 cases were notified, of which frequent diagnoses were asthma (26%), mesothelioma (16%), pneumoconiosis (15%), benign pleural disease (11%), and allergic alveolitis (6%). Incidence rates calculated against denominators from the Labour Force Survey showed very large differences between occupational groups, especially for asthma and asbestos related diseases. Substantial regional variation in the incidence of asthma was not explained by the geographical distribution of high risk industries and was probably due to differing levels of ascertainment. The results imply that the true frequency of acute occupational respiratory disease in the United Kingdom may have been three times greater than that reported.
Occupational therapy is based on the belief that purposeful activity, or occupation, may be used to generate adaptive skills of children with developmental dysfunction. Developmental activities such as feeding, movement, play, and interaction with others are the primary occupation of infants and young children. By using intrinsic motivation and purposeful activities, occupational therapy personnel encourage the child to acquire an increasing repertoire of developmental skills and coping behavior patterns. Intervention promotes sensorimotor, psychosocial, and cognitive functions and may prevent disability or decrease dysfunction in order for the child to meet personal needs and adapt to the demands of the environment. Occupational therapy facilitates the occupational performance of parents in coping effectively with the challenges of care giving and family life.
The 'Guidelines for the diagnosis of Occupational Asthma' have been written by the Subcommittee on Occupational Allergy of the European Academy of Allergology and Clinical Immunology to give common diagnostic criteria in the evaluation of individual patients with suspected occupational asthma. The suggested diagnostic procedure includes five steps. 1. History suggestive of occupational asthma. 2. Confirmation of bronchial asthma, with demonstration of reversibility of bronchial obstruction, of non-specific bronchial hyperreactivity and of increased diurnal variability of peak expiratory flow rates (PEFR). 3. Confirmation of work-related bronchoconstriction with serial measurements of PEFR and of non-specific bronchial reactivity. 4. Confirmation of sensitization to occupational agents with skin tests and/or in vitro tests to detect specific immunoglobulins. 5. Confirmation of causal role of occupational agent with specific bronchial challenges. Requirements, advantages and limitations are discussed for each of the suggested techniques.