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PubMed2004

Risk of injury for occupants of motor vehicle collisions from unbelted occupants.

OBJECTIVE: Unbelted occupants may increase the risk of injury for other occupants in a motor vehicle collision (MVC). This study evaluated the association between occupant restraint use and the risk of injury (including death) to other vehicle occupants. DESIGN: A population based cohort study. SETTING: United States. SUBJECTS: MVC occupants (n = 152 191 unweighted, n = 18 426 684 weighted) seated between a belted or unbelted occupant and the line of the principal direction of force in frontal, lateral, and rear MVCs were sampled from the 1991-2002 National Automotive Sampling System General Estimates System. Offset MVCs were not included in the study. MAIN OUTCOME MEASURE: Risk ratios and 95% confidence intervals for injury (including death) for occupants seated contiguous to unbelted occupants compared to occupants seated contiguous to belted occupants. Risk ratios were adjusted for at risk occupant's sex, age, seating position, vehicle type, collision type, travel speed, crash severity, and at risk occupants' own seat belt use. RESULTS: Exposure to unbelted occupants was associated with a 40% increased risk of any injury. Belted at risk occupants were at a 90% increased risk of injury but unbelted occupants were not at increased risk. Risks were similar for non-incapacitating and capacitating injuries. There was a 4.8-fold increased risk of death for exposed belted occupants but no increased risk of death for unbelted occupants. CONCLUSIONS: Belted occupants are at an increased risk of injury and death in the event of a MVC from unbelted occupants.

Accidents, Traffic↗
PubMed2004

Car occupant death according to the restraint use of other occupants: a matched cohort study.

CONTEXT: A car occupant could be killed if struck by another occupant who was catapulted forward, backward, or sideways in a crash. OBJECTIVE: To estimate the association between death of a car occupant (the target) and restraint use by other occupants. DESIGN: Matched-pair cohort study comparing the outcomes of 2 target occupants in the same passenger car that crashed. SETTING: United States traffic crashes in 1988-2000, using data from the Fatality Analysis Reporting System. SUBJECTS: Target pairs, at least 1 of whom died: 61 834 front-seat pairs, 5278 rear-seat pairs, and 21 127 pairs on the left or right side. MAIN OUTCOME MEASURES: Adjusted risk ratio (RR) for death within 30 days of a crash. RESULTS: The risk of death was greater for a restrained front target occupant in front of an unrestrained occupant compared with a restrained front target in front of a restrained occupant (adjusted RR, 1.20; 95% confidence interval [CI], 1.10-1.31). For a restrained rear target occupant behind an unrestrained occupant compared with a restrained rear target occupant behind a restrained occupant, the adjusted RR was 1.22 (95% CI, 1.10-1.36). For a restrained side target occupant sitting next to an unrestrained occupant compared with a restrained side target occupant sitting next to a restrained occupant, the adjusted RR was 1.15 (95% CI, 1.08-1.22). Among unrestrained target occupants, the adjusted RRs were, for front targets, 1.04 (95% CI, 0.97-1.12), rear targets, 1.22 (95% CI, 1.10-1.36), and side targets, 0.85 (95% CI, 0.80-0.92). CONCLUSION: Persons who wish to reduce their risk of death in a crash should wear their own restraint and should ask others in the same car to use their restraints.

Accidents, Traffic↗
PubMed1995

A comparison of some of the characteristics of patients with occupational and non-occupational asthma.

Occupational asthma is the most frequently diagnosed occupational lung disease reported to the SWORD (Surveillance of Work-related and Occupational Respiratory Disease) scheme. However, diagnosing occupational asthma is not straightforward, and establishing a link with work may be difficult. This study was undertaken to determine the differences between patients with occupational asthma and those with non-occupational asthma which might help in their diagnosis. Information was collected using a self-completed questionnaire. Questionnaires were distributed to 30 subjects aged 18-65 years at each of two clinics--one for patients with occupational asthma and one for those with cryptogenic and environmental asthma. Replies were received from 26 patients with occupational asthma (87%) and 29 patients with non-occupational asthma (97%). The age of onset was significantly higher for those with occupational asthma (42.6 vs 20.7 years). Significantly more subjects with occupational asthma reported improvement on holiday, whereas no significant difference was found in the numbers reporting worsening of symptoms on work days. Those with occupational asthma were less likely to report seasonal variation in symptoms, exacerbation by allergies, pets and stress, or a family history of asthma. Subjects with occupational asthma were more likely to become unemployed (50% vs 3%). Recognition of some of these features in a patient's history may help in the difficult task of differentiating occupational from non-occupational asthma, potentially avoiding the need for exhaustive investigations in some patients. The high prevalence of holiday improvement among subjects with non-occupational asthma suggested that domestic or environmental allergies arising outside the workplace may have been making an important contribution to ongoing symptoms in these subjects.

Adolescent↗
PubMed2001

Occupational asthma as identified by the Surveillance of Work-related and Occupational Respiratory Diseases programme in South Africa.

BACKGROUND: The nationwide Surveillance of Work-related and Occupational Respiratory Diseases in South Africa, SORDSA, was established in 1996 to provide systematic information on occupational respiratory diseases. OBJECTIVE: SORDSA's objectives are to monitor the nature, extent and distribution of occupational respiratory diseases, and to increase awareness of their diagnosis and prevention. This paper describes the programme and results obtained for occupational asthma in the first 2 years, ending in October 1998. METHODS: SORDSA identifies newly diagnosed cases of occupational respiratory disease through voluntary reporting by pulmonologists, occupational medicine doctors and occupational health nurses. Initially, recruitment of the above health care providers was done through the membership infrastructure of their respective professional societies. Booklets with prescribed monthly reporting forms were distributed annually to all reporting members and a core of reporting providers was established through a proactive method of data collection. Information dissemination and reporting feedback takes place through quarterly newsletters and issue-specific brochures on certain hazardous agents. RESULTS: Over the initial 2-year period, 3285 cases of occupational respiratory disease were reported to SORDSA by 203 doctors and 97 occupational health nurses. After pneumoconiosis and associated respiratory conditions, occupational asthma was the second most commonly reported disease with 225 cases (6.9%). The average annual incidence for occupational asthma in South Africa was 13.1 per million employed people, with the highest incidence reported from the Western Cape province (37.6 per million). Latex was the most frequently reported agent for occupational asthma, followed by isocyanates and platinum salts. Low molecular weight agents accounted for 59.6% of the cases of occupational asthma. CONCLUSION: The results from this initial phase show that despite some limitations, SORDSA has the potential to obtain useful data on the industries, agents and occupations causing occupational asthma in South Africa.

Asthma↗
PubMed2001

Occurrence and causes of occupational asthma in South Africa--results from SORDSA's Occupational Asthma Registry, 1997-1999.

OBJECTIVE: To present results for the first 3 years of the occupational asthma registry of the Surveillance of Work-related and Occupational Respiratory Diseases in South Africa (SORDSA) programme, ending December 1999. DESIGN: Surveillance was accomplished by collecting voluntary reports of occupational asthma cases from pulmonologists, occupational medicine practitioners and occupational health nurses. SETTING: Medical and occupational health referral centres in the nine provinces of South Africa. SUBJECTS: Patients diagnosed with new-onset occupational asthma with latency or irritant-induced asthma, reported to SORDSA during 1997-1999. OUTCOME MEASURES: Frequencies of cases, causative agents, industries causing exposure and diagnostic methods. Average annual incidence rates by province and by occupation. RESULTS: During this period 324 cases of occupational asthma were reported. The average annual incidence rate of occupational asthma was estimated in the three best-reporting provinces, namely Gauteng, KwaZulu-Natal and the Western Cape, as 17.5 per million employed people annually. This rate was highest in the Western Cape (25.1 per million). Semi-skilled operators had the highest incidence rate of 68.7 per million annually in the three provinces. Isocyanates and latex were the most common agents. Low molecular weight causative agents predominated (68.8%) over high molecular weight agents. Health care was the most frequently reported workplace for occupational asthma (OA) development. Serial peak flow testing was the method most often used for diagnosis. One-fifth of the cases were still occupationally exposed to the causative agent at time of diagnosis. CONCLUSION: Despite underreporting, SORDSA's estimate of the occupational asthma incidence rate was similar to that of the UK. SORDSA has also demonstrated that surveillance programmes in a developing country can provide useful information on which to base prevention activities.

Asthma↗
PubMed2006

Living in a restricted occupational world: the occupational experiences of stroke survivors who are wheelchair users and their caregivers.

BACKGROUND: In order to meet the responsibilities of understanding and enabling occupation, occupational scientists and therapists must conduct research that is framed within an occupational perspective. PURPOSE: This paper reports the results of a qualitative investigation of the occupational experiences of stroke survivors (n = 16) who use wheelchairs and their primary caregivers (n = 15). RESULTS: Inductive analysis of data collected via in-depth interviews resulted in two major themes related to occupation, specifically: living in a restricted occupational world and challenges to participation in occupation. These results highlight the overall experience labeled occupation by default, and the intricate interconnections or spill-over effect between the occupations of stroke survivors and caregivers. PRACTICE IMPLICATIONS: In addition to providing empirical support for the importance of having a sense of control over occupation and the connection between occupation and identity, the results have implications for practice aimed at enabling occupation and directions for future research. As well, the results illustrate that occupational therapy services need to extend beyond wheelchair prescription in order to enable occupation with clients.

Activities of Daily Living↗
PubMed2005

[Analysis of the situation of occupational health surveillance and the morbidity of occupational diseases in Guangzhou].

OBJECTIVE: To analyze the situation of occupational health surveillance and the characteristics of occupational diseases in Guangzhou. METHODS: The situation of occupational health surveillance and the morbidity of occupational diseases were studied retrospectively by use of the physical examination data collected from the labour hygienic reports of the city from 1993 to 2002. The data were divided into two groups: the first group from 1993 to 1997, and the second from 1998 to 2002. RESULTS: Annual average of occupational health examination in the past 10 years was over 75%. The data in the second group (1998 - 2002) showed that the number of hearing loss observed subjects, noise surveilled personnels, dust and chemicals contraindicated personnels were significantly higher than those in the 1st group (P < 0.01). The morbidity of chronic occupational disease newly occurred was 91 cases in lst group, and 181 cases in 2nd group (P < 0.05), in which the incidence of chemical poisoning and noise induced hearing loss increased significantly but that of pneumoconiosis between two groups was not significantly different (P > 0.05). In the past 10 years, 581 cases of occupational diseases were diagnosed, of which, 309 cases (53.18%) were acute poisonings, while 272 cases (46.82%) were chronic occupational diseases. Pneumoconiosis, lead and benzene poisoning were common in chronic occupational diseases (16.70%, 16.87% respectively). With the passage of time, the incidence ages of pneumoconiosis, chemical poisoning and total occupational diseases tended towards younger. The difference was statistically significant (P < 0.01) CONCLUSION: A normal system for occupational health surveillance has been developed in Guangzhou. Detectable rates in focused surveillance and contraindication have been obviously increasing. The incidence of occupational disease (mainly including acute occupational poisoning, pneumoconiosis, lead and benzene poisonings) is also going up. The incidence age of chronic occupational diseases tends to be younger accompanied with a shorter work history.

China↗
PubMed2004

Occupational balance: exploring the relationships among daily occupations and their influence on well-being.

In this lecture, I have reviewed theoretical discussions and definitions of occupational balance, findings from selected studies, and highlighted some methods for measuring aspects of occupational balance. Are any of these ideas directly applicable to occupational therapy practice, education and research? Consider the hassles of everyday life, and add the complicating factors of illness, injury, disability, and limited income. Life, and the pursuit of necessary, desirable and obligatory occupations, can become overwhelming. Given that occupational therapists aim to enable individuals, regardless of ability, to successfully engage in a range of occupations, the answer to the question is yes. Furthering our understanding of occupational balance can improve our ability to serve individual clients and society. In 2001, Fearing stated in her Muriel Driver Memorial Lecture: We will not only recognize and value the skill of maintaining balance, our own and that of our clients, but we will live it. Balance will not be viewed as a set of scales that has equal parts such as work on one side and play on the other but rather the kind of balance that comes from being centred so that we act from a stable base. From that stable base, we will gain a keen sensitivity to rhythm--knowing when to move and when to let go. (Fearing, 2001 pp. 214-215) Perhaps these reflections have added a little coherence to the study of occupational balance. Occupational balance is a relative state, recognizable by a happy or pleasant integration of life activities and demands. There are indicators of imbalance, more so than tangible ways to measure it, and once recognized occupational therapists have the strategies to help restore a sense of occupational balance. Given our collective history and skill in client-centred practice, occupational therapists are capable of both advancing this line of inquiry and attaining occupational balance for ourselves and our clients.

Family Relations↗
PubMed1989

An epidemiological comparison between occupational and non-occupational hand eczema.

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.

Adult↗
PubMed1989

Non-occupational factors in occupational morbidity and mortality.

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.

Female↗
PubMed2001

Multidisciplinary model of occupational health services. Medical and non-medical aspects of occupational health.

Since 1950, the International Labour Organization (ILO) and the World Health Organization (WHO) have had a common definition of occupational health. The definition was adopted by the Joint ILO/WHO Committee on Occupational Health at its First Session (1950) and revised at its 12th Session (Geneva, November 1995). Occupational health should aim to promote and maintain the highest degree of physical, mental and social well-being of workers in all occupations; to prevent amongst workers the departure from health caused by their working conditions; to protect workers in their employment from risk resulting from factors adverse to health; to place and maintain workers in an occupational environment adapted to their physiological and psychological capabilities; in summary, to adapt work to the workers and each worker to his or her job. According to the ILO Convention No. 161/1985 (1) and the 1996 WHO Global Strategy on Occupational Health for All, to protect the worker against sickness, disease and injury arising out of his or her employment, the establishing of occupational health services for all workers is recommended. The Convention as well as the Strategy emphasize the importance of multidisciplinary approach and multisectoral collaboration. It is evident that during the last decades of the 20th century, the concept of occupational medicine and occupational health has been changed. Occupational health services mean services entrusted with essentially preventive functions. Is there still a room for medical services provided by occupational physicians? The dominance of medical professionals seems to disappear in the modern multidisciplinary model of Occupational Health Services.

Europe↗
PubMed2000

Occupational diseases in the Czech Republic in the year 1998. The need for unifying European standards/criteria for all occupational diseases.

In the Czech Republic, the Clinics and Departments for Occupational Medicine according to the legislation have the right to recognise occupational diseases. The diagnosis must correspond to the Czech list of occupational diseases, which is similar to the European list of occupational diseases. The exposure, sufficient enough to cause certain occupational disease, must be confirmed by regional industrial hygienists, responsible for hygienic control of the workplace. It is evident that the number of diseases is very much dependent upon the standards/criteria used to recognise occupational diseases. In the Czech Republic, the patients suffering from occupational diseases are given considerable financial compensations, which creates a great motivation for them to apply for occupational diseases. The article presents the overview of occupational diseases in the Czech Republic in the year 1998. The total number of diseases was 2111, the incidence per 100,000 employees was 45.8. It is necessary to present and discuss unifying criteria for occupational diseases in European countries, as well as the minimum level of the damage, that could be called an occupational disease. The criteria should be co-ordinated, because in a unified Europe, there will be many more possibilities for change in the workplace.

Czech Republic↗