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PubMed1995

[Occupational health services in Sweden--Occupational safety and hygiene and control of the working environment].

The authors presented a general characteristics of Occupational Health Services in Sweden, their legislation, functioning, financing and objectives, with special reference to occupational safety and hygiene, and the working environment control. They discussed how the work environment is monitored by the external control bodies (Labour Inspectorate, National Board of Occupational Safety and Hygiene, and Workers' Health) and by employers in individual establishments (internal control). Major factors which have contributed to the success of the Swedish work environment policy were also highlighted.

Employment↗
PubMed1997

[The occupational injury act--an improvement for persons with occupational diseases?].

The aim of the study was to find out what degree employees with occupational injuries and diseases knew about the new Act, and had received compensation in accordance with the provisions. In 1994, 6,755 questionnaires were sent to persons reported to the Labour Inspection as suffering from occupational injury or disease, 3,762 (56%) responded. The study shows that at the time of the investigation only a small minority of the persons who had been reported as having occupational injuries or diseases had received compensation. Even among those who had experienced loss of income, actual expenses, or medical disability, only one subject in four had filed a claim. A number of claims may have been rejected on unlawful grounds.

Adult↗
PubMed1998

Occupational exposure to blood and body fluids: new postexposure prophylaxis recommendations. United States Occupational Safety and Health Administration.

Dental health care professionals continue to suffer exposure incidents from instruments contaminated with blood and/or body fluids from patients. Each of these cases requires that a rigid protocol be followed for their evaluation. New information regarding the risk factors for HIV-seroconversion following an exposure incident have been identified. Recent data has demonstrated that a 79 percent reduction in disease transmission may be possible with a new combination drug therapy. The anti-retroviral drugs included in this new regimen are now standard in the management of occupational exposure to HIV. Several factors set dentistry apart from other health care occupations, and these differences appear to have an effect on the risks associated with occupational exposures. This article explores these risk factors and the new recommendations for postexposure care.

Anti-HIV Agents↗
PubMed1997

Comparison of U.S. Occupational Safety and Health Administration standards and German Berufsgenossenschaften Guidelines for Preventive Occupational Health Examinations.

Thirty-three U.S. Occupational Safety and Health Administration (OSHA) standards contain mandated medical service provisions. The German Berufsgenossenschaften Guidelines for Preventive Occupational Health Examinations currently comprise 38 guidelines, which contain mandated medical service provisions. Based on a previously published method for scoring several medical program elements, the Berufsgenossenchaften guidelines were compared with the OSHA standards. Specific program elements were combined to generate and compare quality control scores, screening scores and surveillance scores. The asbestos standard/guidelines were compared in more detail (e.g., physical examination, laboratory tests, examination schedule, eligibility). The German medical requirements consistently ranked higher than their U.S. counterparts for overall scores and the scoring indices for quality control, screening, and surveillance. However, this comparison also reveals that few surveillance features have been incorporated into the medical requirements of either country, suggesting that neither country is making full use of workplace medical services for primary prevention.

Asbestos↗
PubMedDate not supplied

[Occupational epidemiology and new challenges in occupational medicine].

Epidemiology has greatly contributed in the past to the recognition of work-related ill health. Working life, work organisation and labour markets are now rapidly changing. Does epidemiology still have a relevant role in this evolving context? New exposures at the workplace and related health and behavioural changes currently prevailing in industrialized countries are reviewed. It appears that epidemiology might in the future play an even greater role than in the past, when the mere observation of a few subjects could sometimes lead to the identification of occupation-related risks. In order to examine the relations between complex and low-level exposures and subtle and long-term risks in working populations, epidemiology appears essential. Controlled, longitudinal population studies are especially needed to clarify, for prevention purposes, the meaning and the predictive role of the increasing number of markers of exposure, of effect and of individual susceptibility; to describe and model in quantitative terms exposure-response relations; to assist with risk assessment and evaluation. Although occupational health research has a long tradition of inter-disciplinary co-operation, this remains a major challenge for the future.

Animals↗
PubMed2005

The cost effectiveness of occupational health interventions: preventing occupational back pain.

BACKGROUND: Occupational back pain exacts a toll on society with concomitant economic losses; it is imperative to evaluate the cost-effectiveness of interventions to reduce the relevant ergonomic stressors at work. This study estimates and evaluates the average and incremental cost-effectiveness ratios (CERs) of specific interventions for the prevention of occupationally induced back pain for the World Health Organization (WHO) defined subregions of the world. METHODS: Four back-pain interventions were selected from the literature: training (T), engineering controls (EC), engineering controls and training (EC&T), and a comprehensive full ergonomics program (EP) for evaluation. A simulation model for a 100-year time horizon, developed by the WHO CHOICE initiative project was used to estimate the effectiveness of the interventions in healthy year equivalents. The intervention costs were adjusted for all WHO subregions. RESULTS: In all of the subregions, training was the most cost-effective with CERs varying from 74 dollars per healthy life years gained in the subregion comprising of Egypt, Iraq, Morocco, Yemen (EMROD) to approximately 567 dollars in the subregion covering Canada and the United States (AMROA). Training is considered to be very cost-effective and would be the first choice option where resources are scarce. However, the overall effectiveness of training is low. Although other interventions such as engineering controls and total ergonomic interventions are relatively more expensive, the addition to health outcome through these interventions is much higher. The difference in the CERs for training and other engineering controls and full ergonomic interventions is relatively small for most of the industrialized regions of the world. It is clear from the ranked CERs and incremental CERs over the different subregions that in most of the industrialized regions of the world additional resources, if they become available, should go straight to the full ergonomics program. CONCLUSIONS: The model results based on CERs show that worker training is a low cost, feasible first step toward reducing back pain/injury incidence. However, all of the average CERs for the different interventions, for each of the regions, fall well within their GDP per capita estimates [World Bank, 2001]. According to the WHO Commission on Macroeconomics and Health any intervention that costs less than three times GDP per capita for saving a healthy year equivalent should be considered worthwhile and good value for money [WHO, 2002]. Given this criterion, the engineering controls interventions as well as the full ergonomics program look very cost effective for all of the WHO subregions.

Back Pain↗
PubMed2000

[Actual conditions of occupational health administration of small-scale enterprises in Japan: (II). Occupational health controls for hazardous and musculo-skeletally stressful working factors].

In order to clarify the actual condition of occupational health management for hazardous and musculo-skeletally stressful work factors in small-scale enterprises (SSEs) in Japan, a questionnaire survey was conducted in an area near Osaka city. The hazardous work factors examined were dust, organic solvents, lead, specified chemical substances, anoxia, noise, hand-arm vibration, ionizing radiation, high and low temperatures, and high air pressure. The musculo-skeletally stressful work factors examined were VDT work, prolonged standing, unnatural postures, handling of heavy weights, and stress on neck, shoulders and arms. The number of SSEs that replied to the questionnaire was 765 (recovery rate: 69.3%). Enterprises with noise, dust, hand-arm vibration and organic solvents numbered 14.0%, 10.7%, 6.9% and 6.4%, respectively, and those with other hazardous factors numbered less than 3%. Special medical examinations and working environment measurements for hazardous factors were conducted in 0.0% to 26.7% and 0.0% to 13.3%, respectively, of the enterprises. Working environment controls were conducted in 0.0% to 40.2%. Enterprises with prolonged standing and VDT work, were 42.0% and 35.8%, whereas those with other stressful factors were approximately 30%. Special medical examinations for musculo-skeletally stressful factors were conducted in 3.0% to 5.1% of the enterprises, and work controls were conducted in 20.4% to 25.3%. Non execution of the special medical examinations and working environment measurements were mainly due to "lack of knowledge of the law (19.7% and 30.2%)" and "lack of time to perform (16.0% and 23.3%)". Non execution of the controls for the hazardous work factors was due to "lack of knowledge as to how to control (9.0%)", "high costs (7.4%)", "lack of time to perform (6.4%)" and "absence of a suitable adviser (5.9%)". Non execution of the controls for stressful work factors was due to "lack of knowledge as to how to control (15.6%)" and "lack of time to perform (10.2%)". Consequently, as a result of the survey, it was suggested that it is necessary to enlighten the employers of SEEs as to the importance of occupational health controls. It is also necessary to propose low-cost, feasible control methods.

Computer Terminals↗
PubMed1989

Occupancy of adenosine receptors on human neutrophils inhibits respiratory burst stimulated by ingestion of complement-coated particles and occupancy of chemoattractant but not Fc receptors.

Chemoattractants are generated at inflammatory loci that not only induce neutrophils (PMNs) to leave the vasculature but also stimulate PMNs to release potentially toxic agents (e.g., H2O2, O2- or OH). We have recently demonstrated that endothelium releases adenosine which, when bound to a specific receptor on the PMN surface, inhibits release of toxic oxygen metabolites from stimulated PMN. To determine whether occupancy of adenosine receptors modulates generation and release of oxygen metabolites, we have studied the effect of 2-chloroadenosine on O2- generation and O2 consumption in response to opsonized zymosan particles (STZ) and immune complexes (IC). 2-Chloroadenosine inhibits, in a dose-dependent fashion, O2- generation by neutrophils that have been exposed to C3b-coated particles (STZ). Inhibition of O2- generation is similar in the presence or absence of cytochalasin B (IC50 = 53 +/- 19 and 16 +/- 5 nM, respectively, P = NS). Since occupancy of adenosine receptors might inhibit only externalization but not generation of oxygen metabolites, we studied the effect of 2-chloroadenosine on oxygen consumption by activated neutrophils. 2-Chloroadenosine inhibited O2 consumption stimulated by STZ and the surrogate bacterial chemoattractant FMLP; however, inhibition of O2 consumption varied with the presence or absence of cytochalasin B. In contrast, when neutrophils were stimulated by immune complexes, 2-chloroadenosine only minimally inhibited O2- release and O2 consumption (10 +/- 5 and 5 +/- 4% inhibition, respectively). Thus, occupancy of adenosine receptors inhibits O2 consumption in parallel with inhibition of O2- release.(ABSTRACT TRUNCATED AT 250 WORDS)

2-Chloroadenosine↗
PubMed1985

Intensity and kinetics of the respiratory burst of human neutrophils in relation to receptor occupancy and rate of occupation by formylmethionylleucylphenylalanine.

Studies on the relationship between the binding of fMet-Leu-Phe and the respiratory response in human neutrophils have been carried out under two different conditions of stimulus presentation, i.e., instantaneously and over a period of time. The main findings are as follows (1) Under the first condition the activation of the respiratory response reaches the maximum value very quickly, when the receptor occupancy is less than 20% that at equilibrium. After reaching this maximal value, the activated respiration progressively decreases, while the specific binding of the stimulant continues until equilibrium. (2) Under the second condition, i.e., when the stimulus to neutrophils is presented over a time of 1, 2 or 4 min, the respiratory response (and also the secretory one) is depressed or absent, and the initial rate of the binding (initial Vass) is lower, but the maximal values of the receptor occupancy at equilibrium and of the rate of receptor occupation (maximal Vass) are similar and only slightly lower than those reached under the condition of instantaneous presentation of the stimulus. (3) This form of desensitization is specific for fMet-Leu-Phe and does not consist of the inactivation of the target (NADPH oxidase), since neutrophils desensitized by the slow presentation of the peptide are able to respond to a second challenge with other stimulants. These results indicate that: (1) the efficacy of the stimulus-receptor complexes is short-lived; (2) the intensity of the respiratory response is dependent on the rate of reaching a threshold of binding; (3) when this initial rate is slow, owing to the slow presentation of the stimulus, a specific desensitization takes place, indicating the existence of a molecular mechanism, linked in some way to the initial rate of binding, that modulates the capacity of the stimulus-receptor complexes to transduce signals for cell responses. The physiological role of this type of desensitization is discussed.

Adult↗
PubMed2001

Differential occupancy of somatodendritic and postsynaptic 5HT(1A) receptors by pindolol: a dose-occupancy study with [11C]WAY 100635 and positron emission tomography in humans.

Augmentation of selective serotonin reuptake inhibitors (SSRIs) therapy by the 5-HT(1A) receptor agent pindolol may reduce the delay between initiation of antidepressant treatment and clinical response. This hypothesis is based on the ability of pindolol to block 5-HT(1A) autoreceptors in the dorsal raphe nuclei (DRN) and to potentiate the increase in 5-HT transmission induced by SSRIs. However, placebo-controlled clinical studies of pindolol augmentation of antidepressant therapy have reported inconsistent results. Here, we evaluated the occupancy of 5-HT(1A) receptors during treatment with pindolol controlled release (CR) in nine healthy volunteers with Positron Emission Tomography and [11C]WAY 100635. Subjects were studied four times: at baseline, following one week of pindolol CR 7.5 mg/day (4 and 10 hrs post dose), and following one dose of pindolol CR 30 mg(4 hrs post dose). Occupancy of the DRN was 40 +/- 29% on scan 2, 38 +/- 26% on scan 3, and 64 +/- 15% on scan 4. The average occupancy in all other regions was significantly lower at each doses (18 +/- 5% on scan 2, 12 +/- 3% on scan 3, and 42 +/- 4% on scan 4). These results suggest that the blockade in the DRN reached in clinical studies (7.5 mg/day) might be too low and variable to consistently augment the therapeutic effect of SSRIs. However, these data indicate that pindolol exhibits in vivo selectivity for the DRN 5-HT(1A) autoreceptors. As DRN selectivity is desirable for potentiation of 5-HT function, this observation represents an important proof of concept for the development of 5-HT(1A) agents in this application.

Adult↗
PubMed2005

Occupational safety and health in china, part I: u.s.-China symposium on "integrating occupational and environmental health".

A joint China-U.S. symposium entitled "Integrating Occupational and Environmental Health" was organized by the Department of Science and Technology of Hebei Province, PRC, and the Department of Work Environment at the University of Massachusetts Lowell, U.S.A. A framework called "Sustainable Production" was proposed by U.S. participants to link environmental and worker protection. Sustainable production focuses on systems of production that integrate concerns for the long-term viability of the environment, worker health and safety, the community, and the economic performance of firms and other enterprises. The disciplines of environmental and occupational health and safety were brought together by Chinese participants under the unifying theme of the development, implementation, and impact of new technologies. As production processes are increasingly concentrated in China, collaboration among U.S. and Chinese environmental and occupational health and safety professionals is ever more essential.

Journal Article↗
PubMed1989

[Preparation for an occupational-social new beginning--preparation for occupational rehabilitation].

Rehabilitation preparation is needed to the extent that occupational reorientation may give rise to a multitude of personal insecurities. Increased requirements demand augmented efforts to motivate for independent and competent functioning in the occupational career ahead. Given this aim, the Bad Krozingen rehabilitation center's preparatory programmes, in their entry phase, are focussed on assessment of deficits in competence and on enhancing basic skills--social, educational as well as vocational. The subsequent main phase is aimed at demonstrating the practical applicability of learning contents in future occupational situations, and a reality-based vocational setting is sought to be attained by implementation of a holistic, project-oriented approach in this context in particular. The transition phase, finally, is intended to achieve the individual prerequisites for subsequent rehabilitation activities, in particular training programmes. Initial experience has shown that the approach outlined is promising in particular in respect of independence, social behaviour and motivation for the learning and vocational tasks ahead.

Adaptation, Psychological↗
PubMed1983

[The pneumonologist and the occupational physician in relation to immuno-allergologic risks in the occupational environment].

The author reviews recent ideas on allergic occupational respiratory disorders which clearly define the severity and the possibility of a cure, thanks to early diagnosis. The diversity of specific and non-specific causes of occupational asthma and the need for research into new causes of pulmonary granulomas are emphasized. The basis for industrial compensation and medico-social prevention are recalled. The author finally looks to the future for a detailed epidemiological study in matters relating to allergic occupational respiratory diseases.

Alveolitis, Extrinsic Allergic↗
PubMed1999

[Polyneuropathy and encephalopathy caused by organic solvents and mixed solvent solutions. Occupational medicine and neurologic aspects of a new occupational disease].

Solvent induced polyneuropathy and encephalopathy have been acknowledged quite recently as occupational diseases in Germany. For compensation first of all the diagnosis has to be proven. For differential diagnosis other known causes as well as non-organic mental diseases must be taken into consideration. The causality between proven exposures and diagnosed disease has at least to be probable. To evaluate causation extensive experience of the experts is needed. In this context scientific criteria regarding neurotoxicity of the solvent, duration of exposure, individual aspects of non-occupational influences, time course of the disease are important within a through synoptic evaluation. Possibilities and limitations of sensitive diagnostic measures such as neurographic, neuropsychologic and neuroimaging examinations are discussed. The prognosis of toxic polyneuropathy and encephalopathy is in general favorable if exposure has stopped. Additionally, adequate therapy and rehabilitation measures are supportive for a good prognosis.

Brain Damage, Chronic↗
PubMed2000

Association between 8-hydroxy-2'-deoxyguanosine levels in DNA of workers highly exposed to asbestos and their clinical data, occupational and non-occupational confounding factors, and cancer.

In the preceding paper [B. Marczynski, P. Rozynek, T. Kraus, St. Schlösser, H.J. Raithel, X. Baur, Levels of 8-hydroxy-2'-deoxyguanosine in DNA of white blood cells from workers highly exposed to asbestos in Germany, Mutat. Res. (2000) submitted] we described significant increases (p<0.001) in the levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) adducts in the DNA of white blood cells (WBC) of workers highly exposed to asbestos fibers at the workplace relative to those found in the control group in all three study years (period between 1994 and 1997). The results show that the oxidative DNA damage in exposed individuals is between 1.7 times and twice that found in control samples for all 3 years of the study (p<0.001). The aim of this study was to examine the association between the 8-OHdG levels in WBC DNA of workers highly exposed to asbestos fibers at the workplace and clinical data, occupational and non-occupational confounding factors, and cancer. There is no obvious correlation between the steady-state levels of 8-OHdG in the circulating WBC DNA of asbestos workers and possible confounding factors, such as the presence of benign asbestos-associated diseases, the duration of asbestos exposure, the latency period, the fixed cumulative fibrous dust dose ("fiber years"), age, smoking status, acute febrile infections, medicines, aspirin, calcium (Ca(2+)), magnesium (Mg(2+)), and the hormone and vitamin intake. This indicates that previous inhalation of asbestos fibers is the major factor responsible for the difference observed in oxidative DNA damage between asbestos workers and controls. For patients suffering from respiratory cancer, cancer of the gastrointestinal tract, mouth/pharynx/larynx, and urogenital tract the mean DNA-adduct level was significantly higher (p<0.01) than that found in controls, but not significantly higher (p>0.05) than that for asbestos-exposed patients without tumours. The formation of 8-OHdG adduct levels in WBC DNA of patients with hematopoietic cancer, chondrosarcomas and multiform glioblastomas was not significantly higher than that found in the control group (p>0.05). Our results support the hypothesis that oxidative DNA damage in man caused by asbestos fibers plays a role in the formation of malignant tumours.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed1998

Comparison of AIHA ISO 9001-based occupational health and safety management system guidance document with a manufacturer's occupational health and safety assessment instrument.

Numerous manufacturing and service organizations have integrated or are considering integration of their respective occupational health and safety management and audit systems into the International Organization for Standardization-based (ISO) audit-driven Quality Management Systems (ISO 9000) or Environmental Management Systems (ISO 14000) models. Companies considering one of these options will likely need to identify and evaluate several key factors before embarking on such efforts. The purpose of this article is to identify and address the key factors through a case study approach. Qualitative and quantitative comparisons of the key features of the American Industrial Hygiene Association ISO-9001 harmonized Occupational Health and Safety Management System with The Goodyear Tire & Rubber Co. management and audit system were conducted. The comparisons showed that the two management systems and their respective audit protocols, although structured differently, were not substantially statistically dissimilar in content. The authors recommend that future studies continue to evaluate the advantages and disadvantages of various audit protocols. Ideally, these studies would identify those audit outcome measures that can be reliably correlated with health and safety performance.

Environmental Monitoring↗
PubMed1996

Quality improvement by means of "differential' occupational health care: an experiment in a regional occupational health centre.

From a general policy of quality improvement, the regional Occupational Health Centre Eastern Gelderland has developed a method of company health care based on the particular demands and needs of companies. A procedure of care "made to measure' based on company and work characteristics was designed. For one year, an experiment was carried out in seven companies, to investigate if this "differential care' is feasible, and if its quality is better than the traditional "standard' form. After the experiment, the companies' satisfaction proved to have increased. The influence of the Occupational Health Centre on working conditions was estimated more important than before. The increased satisfaction is considered to be an indication of better quality of care, compared with the traditional "standard' care. The differential approach appeared to be feasible. The method requires skills of professionals in the field of planning, cooperation, estimating costs and negotiating.

Netherlands↗
PubMed2004

Physician assistants in occupational medicine: how do they compare to occupational physicians?

BACKGROUND: Physician assistants (PAs) have been present in occupational and environmental medicine (OEM) in the USA since 1971, yet remarkably little is known about their activity. METHODS: An administrative study of PA activities was undertaken and compared with the activities of physicians in the same occupational medicine setting. Patients were not triaged to either provider and all resources of care were recorded for the visit. An episode of care approach was used for the analysis. RESULTS: The characteristics of patients seen by each provider were similar in age, gender ratio and severity of injury. Physicians saw a mean of 2.9 patients/h and PAs 2.5, but PAs worked more hours and saw more patients per year than physicians. The average charge per patient visit and total charge for an episode of care were similar. Differences between PAs and physicians were seen in the areas of 'limited duty' duration given to patients and on average PAs prescribed 15 days and physicians 17 days. PAs referred a patient 19.7% of the time, while physicians referred 17.4%. Most of the referrals were to physical therapy. The salary of a physician, based on an hourly rate, was approximately twice as much as a PA. CONCLUSION: The use of PAs in OEM may represent a cost-effective advantage from an administrative standpoint. Clearly, more research is necessary in determining the role and utilization of PAs in OEM and how they may improve the delivery of physician services.

Costs and Cost Analysis↗