Occupational health in British agriculture.
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Agricultural Workers' Diseases↗
Biomedical subjects
D Coggon
Publications and source records attributed to D Coggon.
Work with pesticides and organophosphate sheep dips.
Pesticides are an important hazard in agriculture. In developed countries their use is strictly regulated. Risk assessment for new pesticides includes comparison of the potential exposures of spray operators and other farm workers with a reference value. Usually, this is derived from toxicological studies in animals with allowance for the uncertainties in extrapolating between and within species. Older pesticides undergo periodic reviews, for which epidemiological data may also be available. Unintentional fatal poisoning by pesticides is extremely rare in Britain. Documented reports of non-fatal acute poisoning are also uncommon, but there may be substantial under-ascertainment of minor incidents. Pesticides have been linked with various chronic diseases, but few associations have been clearly established. A particular concern recently in Britain has been the possibility that organophosphate insecticides can cause chronic neuropsychiatric illness.
Agricultural Workers' Diseases↗
Health status in patients awaiting hip replacement for osteoarthritis.
BACKGROUND: Hip osteoarthritis is a major cause of pain and disability, especially in the elderly. As part of a study investigating factors that could be associated with advanced osteoarthritis of the hip, we compared the health status of patients awaiting arthroplasty for hip osteoarthritis with controls. We further investigated the interaction of hip osteoarthritis with other variables (age, gender, social class and concurrent pain) in relation to health status. METHODS: A case-control study was performed in two English health districts (Portsmouth and North Staffordshire) during 1993-1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period formed the case group and were compared with an equal number of controls selected from the general population and individually matched for age, gender and general practice. Cases and controls completed a structured interviewer-administered questionnaire, which included queries about their medical condition, occupation (from which a measure of social class was derived), and general health status using the SF36. RESULTS: Physical function (t=32.1, P<0.001), social function (t=16.8, P<0.001) and perceived general health (t=4.1, P<0.001) were worse in the case group, but energy/vitality and mental health showed little difference between cases and controls. Cases were more likely to report knee pain than controls, but case-control status was not associated with pain in the fingers or shoulders, or with social class. However, differences in physical and social function between cases and controls did vary with socio-demographic factors and concurrent knee pain status. CONCLUSION: Patients awaiting hip-replacement because of osteoarthritis were more likely to be restricted in their physical and social life than adults in the general population, but mental state and vitality appear unimpaired in this group. This contrasts with findings from other chronic pain disorders. Manual social class is not linked to being on a waiting list for osteoarthritic hip replacement but does add to the burden on health status, particularly social functioning in those with osteoarthritis of the hip.
Aged↗
Reliability of the Southampton examination schedule for the diagnosis of upper limb disorders in the general population.
BACKGROUND: Epidemiological research in the field of soft tissue neck and upper limb disorders has been hampered by the lack of an agreed system of diagnostic classification. In 1997, a United Kingdom workshop agreed consensus definitions for nine of these conditions. From these criteria, an examination schedule was developed and validated in a hospital setting. OBJECTIVE: To investigate the reliability of this schedule in the general population. METHODS: Ninety seven adults of working age reporting recent neck or upper limb symptoms were invited to attend for clinical examination consisting of inspection and palpation of the upper limbs, measurement of active and passive ranges of motion, and clinical provocation tests. A doctor and a trained research nurse examined each patient separately, in random order and blinded to each other's findings. RESULTS: Between observer repeatability of the schedule was generally good, with a median kappa coefficient of 0.66 (range 0.21 to 0.93) for each of the specific diagnoses considered. CONCLUSION: As expected, the repeatability of tests is poorer in the general population than in the hospital clinic, but the Southampton examination schedule is sufficiently reproducible for epidemiological research in the general population.
Adult↗
Occupational exposure to noise and the attributable burden of hearing difficulties in Great Britain.
AIMS: To determine the prevalence of self reported hearing difficulties and tinnitus in working aged people from the general population, and to estimate the risks from occupational exposure to noise and the number of attributable cases nationally. METHODS: A questionnaire was mailed to 22 194 adults of working age selected at random from the age-sex registers of 34 British general practices (21 201 subjects) and from the central pay records of the British armed services (993 subjects). Information was collected on years of employment in a noisy job; and whether the respondent wore a hearing aid, had difficulty in hearing conversation, or had experienced persistent tinnitus over the past year. Associations of hearing difficulty and tinnitus with noise exposure were examined by logistic regression, with adjustment for age, sex, smoking habits, and frequent complaints of headaches, tiredness, or stress. The findings were expressed as prevalence ratios (PRs) with associated 95% confidence intervals (CIs). Attributable numbers were calculated from the relevant PRs and an estimate of the prevalence of occupational exposure to noise nationally. RESULTS: Some 2% of subjects reported severe hearing difficulties (wearing a hearing aid or having great difficulty in both ears in hearing conversation in a quiet room). In men, the prevalence of this outcome rose steeply with age, from below 1% in those aged 16-24 years to 8% in those aged 55-64. The pattern was similar in women, but severe hearing loss was only about half as prevalent in the oldest age band. Tinnitus was far more common in subjects with hearing difficulties. In both sexes, after adjustment for age, the risk of severe hearing difficulty and persistent tinnitus rose with years spent in a noisy job. In men older than 35 years with 10 or more years of exposure, the PR for severe hearing difficulty was 3.8 (95% CI 2.4 to 6.2) and that for persistent tinnitus 2.6 (95% CI 2.0 to 3.4) in comparison with those who had never had a noisy job. Nationally, some 153 000 men and 26 000 women aged 35-64 years were estimated to have severe hearing difficulties attributable to noise at work. For persistent tinnitus the corresponding numbers were 266 000 and 84 000. CONCLUSIONS: Significant hearing difficulties and tinnitus are quite common in men from the older working age range. Both are strongly associated with years spent in a noisy occupation--a predominantly male exposure. The national burden of hearing difficulties attributable to noise at work is substantial.
Adolescent↗
Raynaud's phenomenon, vibration induced white finger, and difficulties in hearing.
BACKGROUND: An association has previously been reported between finger blanching and hearing difficulties, but only in workers with exposure to noise and hand transmitted vibration (HTV). AIMS: To explore the association in a community sample, including cases who lacked occupational exposure to noise or HTV. METHOD: A questionnaire was mailed to 12 606 subjects aged 35-64 years, chosen at random from the age-sex registers of 34 British general practices. Inquiry was made about years of employment in noisy jobs, lifetime exposure to HTV, hearing difficulties and tinnitus, and lifetime history of cold induced finger blanching. Subjects were classed as having severe hearing difficulty if they used a hearing aid or found it difficult or impossible to hear conversation in a quiet room. Associations of finger blanching with hearing difficulties and tinnitus were analysed by logistic regression. RESULTS: Among 8193 respondents were 185 who reported severe hearing difficulty and 1151 who reported finger blanching. After adjustment for age and years of work in noisy jobs, hearing difficulty was about twice as common in men and women who reported finger blanching, including those who had never been importantly exposed to noise and in those never exposed to HTV. CONCLUSIONS: These data support an association between finger blanching and hearing loss, which is not explained by confounding occupational exposure to noise, and suggest that it may extend to causes of blanching other than vibration induced white finger. Further investigations are warranted to confirm the association and explore possible mechanisms, such as sympathetic vasoconstriction in the cochlea.
Adult↗
Risk of hand-arm vibration syndrome according to occupation and sources of exposure to hand-transmitted vibration: A national survey.
BACKGROUND: Although some occupational sources of hand-transmitted vibration (HTV) have been extensively investigated, the risks associated with others are poorly characterized. METHODS: A questionnaire was mailed to a community sample of 12,240 men aged 16- 64 years and 906 men from the armed forces. Questions covered current occupation, sources of HTV, numbness or tingling in the fingers in the past week, and finger blanching. In the 5,364 respondents who had been at work in the past week, associations between symptoms and exposures were examined by logistic regression, with odds ratios converted into prevalence ratios (PRs). RESULTS: Altogether, 513 men (10%) reported cold-induced finger blanching and 769 (14%) sensory symptoms in the fingers. The risk of blanching was increased in builders (PR 2.4, 95% CI 1.0-5.2), carpenters and joiners (PR 1.9, 95% CI 1.0-3.4), motor mechanics (PR 2.3, 95% CI 1.1-4.6), and laborers (PR 2.8, 95% CI 1.3-6.0); while the risk of sensory symptoms was elevated in laborers (PR 4.0, 95% CI 2.3-6.6) and plant operatives (PR 3.5, 95% CI 1.9-5.9). Use of hand-guided mowers, concrete breakers, chain saws, and jig saws was significantly associated with symptoms. CONCLUSIONS: Little attention has been paid to the risks of vibration injury in construction workers, woodworkers, motor mechanics, and laborers, or to the risks from mowers, jig saws and several other common vibratory tools. These should be a focus for further investigation and preventive measures.
Adolescent↗
Knee osteoarthritis and obesity.
OBJECTIVES: To assess the risk of knee osteoarthritis (OA) attributable to obesity, and the interactions between obesity and other established causes of the disorder. METHODS: We performed a population-based case-control study in three health districts of England (Southampton, Portsmouth and North Staffordshire). A total of 525 men and women aged 45 y and over, consecutively listed for surgical treatment of primary knee OA, were compared with 525 controls matched by age, sex and family practitioner. RESULTS: Relative to a body mass index (BMI) of 24.0-24.9 kg/m(2), the risk of knee OA increased progressively from 0.1 (95% CI 0.0-0.5) for a BMI<20 kg/m(2) to 13.6 (95% CI 5.1-36.2) for a BMI of 36 kg/m(2) or higher. If all overweight and obese people reduced their weight by 5 kg or until their BMI was within the recommended normal range, 24% of surgical cases of knee OA (95% CI 19-27%) might be avoided. As a risk factor for knee OA obesity interacted more than additively with each of Heberden's nodes, earlier knee injury and meniscectomy. In comparison with subjects of normal weight, without Heberden's nodes, and with no history of knee injury, people with a combination of obesity, definite Heberden's nodes and previous knee injury had a relative risk of 78 (95% CI 17-354). CONCLUSIONS: Our findings give strong support to public health initiatives aimed at reducing the burden of knee OA by controlling obesity. People undergoing meniscectomy or with a history of knee injury might be a focus for targeted advice.
Aged↗
Use of keyboards and symptoms in the neck and arm: evidence from a national survey.
The objective of this study was to examine the relationship between upper limb symptoms and keyboard use in a population survey. A questionnaire was mailed to 21,201 subjects aged 16-64 years, selected at random from the registers of 34 British general practices. Information was collected on occupation and on regular use of keyboards (for >4 h in an average working day), pain in the upper limbs and neck, numbness or tingling in the upper limbs, headaches, and feelings of tiredness or stress. Associations were explored by logistic regression, with the resultant odds ratios converted into prevalence ratios (PRs). Among 12,262 respondents, 4899 held non-manual occupations. These included 1871 regular users of keyboards (e.g. computer operators, data processors, clerks, administrators, secretaries and typists). Pain in the neck or upper limbs and sensory symptoms were common in the non-manual workers overall (with 1 week period prevalences of 30 and 15%, respectively), and were associated with older age, smoking, headaches and tiredness or stress. After adjustment for these factors, regular keyboard use was significantly associated with pain in the past week in the shoulders (PRs 1.2-1.4) and the wrists or hands (PR 1.4), but not with elbow pain or sensory symptoms over the same period, or with neck or upper limb pain that prevented normal activities in the past year. Disabling symptoms were somewhat less prevalent among symptomatic keyboard users than among other symptomatic workers. We conclude that use of keyboards was associated with discomfort at the shoulder and wrist or hand, but risk estimates were lower than generally reported in workplace surveys. Previous estimates of risk in the occupational setting may have been biased by shared expectations, concerns, or other aspects of illness behaviour.
Adolescent↗
Exposure to hand-transmitted vibration and pain in the neck and upper limbs.
Workers exposed to hand-transmitted vibration (HTV) often experience aches and pains in the upper limbs, but there have been few studies of the pattern and severity of symptoms, or their relationship to the estimated dose of vibration. As part of a wider survey of vibration, we mailed a questionnaire about exposures to HTV and pain in the neck and upper limbs to a sample of men selected at random from the registration lists of 34 British general practices and the pay records of the armed services. Analysis was confined to the 1856 male respondents who had been employed in manual occupations for a year or more and who reported the last week as being representative of their job. Inquiry was made about pain in the neck, shoulder, elbow and wrist/hand over the past week and past year (including pains that limited normal activity). Subjects were classed according to their lifetime exposure to HTV and their estimated average daily vibration dose [A(8) r.m.s.] in the previous week. A total of 283 men had a minimum estimated A(8) greater than a proposed action level of 2.8 m/s(2), and in this group symptoms were about twice as prevalent as in manual workers who had never used vibratory tools. The excess risk was somewhat higher for distal sites than for proximal ones (e.g. the prevalence ratio for hand/wrist pain in the past week was 2.7 versus 1.8 for neck pain). This accords with the pattern of transmission of HTV to the upper limb, although a confounding effect from other ergonomic risk factors cannot be discounted.
Adolescent↗
Ethics in occupational health research.
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Confidentiality↗
Monitoring trends in occupational illness.
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Causality↗
Prevalence of untreated asthma in a population sample of 6000 older adults in Bristol, UK.
BACKGROUND: A study was undertaken to estimate the prevalence of untreated asthma in older adults. METHODS: A cross sectional population based survey of 6000 men and women aged 65 years and over was performed in 21 general practices in north Bristol, south west England. The main outcome measure was untreated asthma as defined by a two stage process comprising a respiratory questionnaire (symptoms suggestive of asthma or doctor diagnosed asthma not receiving respiratory treatment) followed by lung function tests (significant reversibility following bronchodilators or corticosteroids and/or significant within day variability in peak expiratory flow). RESULTS: 4792 of the 6000 participants (80%) completed the respiratory questionnaire and, of those not receiving respiratory treatment, 55 reported a previous doctor diagnosis of asthma and a further 696 had symptoms suggestive of asthma. Lung function testing in 280 of 501 randomly selected individuals from these groups resulted in 38 being defined as having asthma and an estimated population prevalence for untreated asthma of 2.4% (95% CI 1.6% to 3.6%) in men and 1.2% (95% CI 0.7% to 2.1%) in women. Most subjects (84%) with untreated asthma had moderate or severe disease. Untreated asthma was most common in individuals with doctor diagnosed asthma (21%) and those with breathlessness or wheeze (13-20%). CONCLUSION: Untreated asthma in the elderly is a common and important problem. Opportunistic use of appropriate lung function tests in older people with a history of doctor diagnosed asthma or wheeze or breathlessness at rest could identify untreated asthmatics who might benefit from treatment.
Aged↗
Prevalence and occupational associations of neck pain in the British population.
OBJECTIVES: This study determined the prevalence of neck pain and its relation to occupation and occupational activities in the general population. METHODS: A questionnaire was mailed to 21 201 subjects aged 16-64 years, randomly selected from the patient registers of general practices in England, Scotland, and Wales, and to 993 subjects randomly selected from pay records of the armed services. Information was collected on occupation, workplace physical activities, neck pain in the past week and year, headaches, and feelings of tiredness or stress. Associations were explored by logistic regression, the resultant odds ratios being converted to prevalence ratios (PR). RESULTS: Among 12907 respondents, 4348 and 2528 reported neck pain in past year (1421 with pain interfering with normal activities) and week, respectively. Symptoms were the most prevalent among male construction workers [past week and year 24% and 38% (pain interfering with activities 11%), respectively], followed by nurses, armed services members, and the unemployed. Generally the age-standardized prevalence of neck pain varied little by occupation. Work with arms above the shoulders for >1 hours/day was associated with a significant excess of symptoms [PR 1.3-1.7 (women) and 1.2-1.4 (men)], but no associations existed for typing, lifting, vibratory tool use, or professional driving. Stronger neck-pain associations were found with frequent headaches (PR 2.3-2.8) and frequent tiredness or stress (PR 2.2-2.5) than with occupational activities. CONCLUSIONS: The data provide evidence against a strong association between neck pain and the examined occupational physical activities. They suggest that psychosocial factors may be more important.
Adolescent↗
Mortality attributable to work.
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Finland↗
Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years.
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Adult↗
Fluoride in drinking water and risk of hip fracture in the UK: a case-control study.
BACKGROUND: Although the benefits of water fluoridation for dental health are widely accepted, concerns remain about possible adverse effects, particularly effects on bone. Several investigators have suggested increased rates of hip fracture in places with high concentrations of fluoride in drinking water, but this finding has not been consistent, possibly because of unrecognised confounding effects. METHODS: We did a case-control study of men and women aged 50 years and older from the English county of Cleveland, and compared patients with hip fracture with community controls. Current addresses were ascertained for all participants; for those who agreed to an interview and who passed a mental test, more detailed information was obtained about lifetime residential history and exposure to other known and suspected risk factors for hip fracture. Exposures to fluoride in water were estimated from the residential histories and from information provided by water suppliers. Analysis was by logistic regression. FINDINGS: 914 cases and 1196 controls were identified, of whom 514 and 527, respectively, were interviewed. Among those interviewed, hip fracture was strongly associated with low body-mass index (p for trend <0.001) and physical inactivity (p for trend <0.001). Estimated average lifetime exposure to fluoride in drinking water ranged from 0.15 to 1.79 ppm. Current residence in Hartlepool was a good indicator for high lifetime exposure to fluoride. After adjustment for potential confounders, the odds ratio associated with an average lifetime exposure to fluoride > or =0.9 ppm was 1.0 [95% CI 0.7-1.5]. INTERPRETATION: There is a low risk of hip fracture for people ingesting fluoride in drinking water at concentrations of about 1 ppm. This low risk should not be a reason for withholding fluoridation of water supplies.
Aged↗
The prevalence of sensorineural symptoms attributable to hand-transmitted vibration in Great Britain: a national postal survey.
BACKGROUND: Exposure to hand-transmitted vibration (HTV) can cause sensorineural symptoms in the upper limb, but its impact has not previously been assessed in the general population. METHODS: To investigate, we mailed a questionnaire about exposures to HTV, finger blanching and sensory symptoms (numbness or tingling) in the upper limbs to a population sample comprising 21,201 working-aged men and women selected at random from the age-sex registers of 34 British general practices, and a further 993 randomly selected from the pay records of the armed services. Associations were explored using multiple logistic regression models to adjust for confounding, with the resultant odds ratios converted into prevalence rate ratios (PRs). RESULTS: Of 12,907 respondents, 2,607 (20.2%) reported sensory symptoms in the upper limb during the past week. Sensory symptoms were more prevalent in those with blanching, and were commonly associated with exposure to HTV, especially in men. In comparison with men who had never been exposed to HTV, the PR in men exposed both at work and in leisure was 2.2 (95% CI 1.9-2.4). Associations were found even in those who had never blanched. CONCLUSIONS: Sensorineural symptoms in the upper limbs are common. HTV is an important risk factor for such complaints in the general population.
Adolescent↗