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PubMed1998

Relation between occupational asthma case history, bronchial methacholine challenge, and specific challenge test in patients with suspected occupational asthma.

Inhalative methacholine challenge (MC) was performed in 229 subjects presumed to suffer from occupational asthma due to exposure to airborne latex allergens (n = 62), flour (n = 28), isocyanates (n = 114), or irritants in hairdressers' salons (n = 25). They were also subjected to specific challenges with the occupational agents they were exposed to, completed a questionnaire using an abbreviated version of the ATS-DLD, and were interviewed by an experienced physician. Bronchial hyperresponsiveness in MC was defined by the results obtained in a previous study with 81 healthy volunteers. The threshold in these controls was set at a cumulative MC dose of 0.3 mg, corresponding to a sensitivity of 95%. The main purpose of the study was to investigate whether the MC and/or the occupational asthma case history are reliable predictors of the specific challenge test outcomes. In 40-72% of examined subjects, workplace-related asthma complaints occurred, with bronchial hyperreactivity in the MC ranging from 48% to 61%. However, only 12-25% demonstrated a significant bronchoconstructive reaction in the specific challenge test. MC results are only moderately associated with workplace-related asthma case histories. Positive outcomes of challenges with occupational agents are well correlated with positive MC results plus occupational asthma case histories. The combination of MC and occupational asthma case history shows a relatively high specificity (62%, 86%, 80%), but the sensitivity was moderately low (83%, 71%, 52%). MC sensitivities were 92%, 71%, and 62% (case histories of hairdressers were not available). We conclude that in most cases, occupational asthma (as defined by a specific challenge test response) is combined with bronchial hyperresponsiveness and workplace-related asthmatic symptoms. However, subjects of each exposure group demonstrated bronchial hyperresponsiveness and complained of workplace-related asthmatic symptoms, but occupational asthma could not be proved in the specific challenge test. In subjects with a positive occupational asthma case history, a negative MC test result can almost rule out a positive specific challenges test result. Hence, the MC test can reduce performance of the laborious specific challenge test.

Adult↗
PubMed1988

Comparison of death certificate occupation and industry data with lifetime occupational histories obtained by interview: variations in the accuracy of death certificate entries.

This study compares usual and recent occupation and industry data from lifetime work histories obtained by interview with death certificate entries for occupation and industry for 2,435 persons diagnosed with cancer. Match rates are calculated as the percent of death certificate occupation and industry entries that were confirmed by interview data and are compared for exact 3-digit 1980 U.S. Census Bureau occupation and industry codes and for groups of these codes. The overall match rate for individual usual occupation codes was 47.9% and for exact usual industry codes it was 61.8%. Significant differences between the interview data for usual occupation or industry and the death certificate entry were observed by race and gender, marital status, number of years worked, and occupation and industry groups and by age for industry. Misclassification or overreporting of occupation and industry data on the death certificate ranged from 30 to 50% in this study. Our results suggest that the utility of death certificate data for investigations into the occupational risk factors for cancer may be quite limited.

Adult↗
PubMed2005

An overview of occupational benzene exposures and occupational exposure limits in Europe and North America.

Benzene has become one of the most intensely regulated substances in the world. Its ubiquitous use as a solvent has led to many working populations being exposed; in the early days often in uncontrolled conditions, leading to high exposures. Current occupational exposures are tightly controlled and are largely confined to workers in the petrochemical industry, vehicle mechanics, firefighters, workers exposed to automobile emissions, and some other occupational groups. Typically, occupational exposure levels are currently at or below 3.25 mg/m3 (1 ppm), and environmental exposures are typically below 50 microg/m3 (15 ppb). Smoking remains a significant source of exposure in both occupationally and non-occupationally exposed individuals. The early experiences of high occupational exposures led to the identification of haematopoietic effects of benzene and the need for improved control and regulation. As with most occupational standards, there has been a reduction in exposure limits as effects have been identified at ever-lower levels, accompanied by a societal concern for improved standards of occupational health. In 1946, the United States occupational exposure limit for benzene, promulgated by the American Conference of Governmental Industrial Hygienists, was 325 mg/m3 (100 ppm), but nowadays most European and North American countries have harmonised at 1.63-3.25mg/m3 (0.5-1 ppm). This latter figure was agreed within the European Union in 1997 and was adopted within national legislation by all Member States. The data on which this limit is set are essentially the same as those used by other standard-setting committees; this is an excellent example of how standards are set using science, pragmatism and societal values in the absence of complete information.

Air Pollutants, Occupational↗
PubMed1999

Occupational hygiene science and its application in occupational health policy, at home and abroad.

This paper examines the role of occupational hygiene in the overall framework of occupational health. It draws attention to the unique combination of required individual science subjects, and to the way in which occupational hygiene science contributes to the practice of occupational hygiene in the real world. It focuses in particular on occupational exposure standards. The paper provides, as an example, the specific case of occupational aerosol exposures. It is here that scientific research has made a notable impact on standards and led to a considerable degree of international harmonization. Finally, some broader insights into occupational exposure standards are given, based on experience gained during visits to a number of contrasting countries. The similarities and differences between the various national approaches help indicate what is generic in how standards are set. Such insights provide a basis for further international harmonization in the future. It is concluded that occupational exposure standards appear to be most effectively applied in countries where there are strong occupational hygiene cultures.

Aerosols↗
PubMed2000

[A study on coordination of occupational and community health--a survey of occupational health nurses].

The survey was conducted on occupational health nurses to find out their awareness of the issue, levels of coordination practiced at work and contributing factors. Based on the results, measures to facilitate the coordination of the two areas were examined. The major findings are as follows: 1. Cooperation between occupational and community health nurses: More than 40% of the occupational health nurses surveyed were aware of the necessity for cooperation with community health nurses. However, less than 7% of those surveyed actually practiced it at work. The deciding factors included the use of a support system in the community, previous training in community health, and work experience in health centers in the community. To facilitate the cooperation between the two sectors, it is suggested that occupational health nurses acquire more knowledge of community health issues. 2. Coordination through focusing on the employee's life in the community: More than 85% of those surveyed were aware of the necessity of coordinating occupational and community health issues through focusing on the lives of the employees in the community. However, less than 30% practiced it at work. Awareness and practice of occupational health planning scored the lowest. The deciding factors included completion of a public health nursing course and the number of employees assigned to each nurse, the use of a support system in the community, and previous training in community health. To facilitate coordination of occupational and community health issues, it is suggested that occupational health nurses acquire more knowledge of community health issues, the number of employees assigned be carefully considered, and that activities focusing on community health be incorporated into occupational health planning.

Community Health Nursing↗
PubMed2006

Occupational asthma after withdrawal from the occupational allergen exposure.

Occupational asthma is characterised by airway inflammation, variable airflow limitation and airway hyperresponsiveness related causally to work. The aim of the study was to ascertain whether in patients with occupational asthma findings persist after withdrawal from occupational allergen exposure. A group of 37 patients with occupational asthma and a control group of 19 persons were examined. Results in asthmatics obtained during the first visit when occupational asthma was acknowledged, were compared with recent results about 6.5 yr on average after elimination of occupational allergen exposure. Recent findings in occupational asthma patients were compared with the control group. In patients with occupational asthma, no significant differences were found between results obtained at the first and recent visit. Symptoms of asthma persisted in as much as 86.5% of patients. During recent examination there were more positive results in asthmatic patients comparing with the control group in histamine challenge (61.3 vs. 5.3%, p<0.01), eosinophile cationic protein (41.7 vs. 5.3%, p<0.05), prick tests (45.9 vs. 10.5%, p<0.05). Positive results of the present histamine challenge test and elevated eosinophils in sputum were more frequent (p<0.05) in patients with occupational asthma due to high molecular weight allergens than to low molecular weight allergens.

Adult↗
PubMed2002

Communication between Dutch rheumatologists and occupational physicians in the occupational rehabilitation of patients with rheumatic diseases.

BACKGROUND: Rheumatic diseases are a major cause of permanent work disability. In the process of occupational rehabilitation several health professionals may have a role. OBJECTIVE: To assess the quality and quantity of communication and cooperation between Dutch rheumatologists and occupational physicians. METHODS: A postal survey among 187 Dutch rheumatologists. RESULTS: 153/187 rheumatologists (82%) returned the questionnaire. They considered reducing pain and fatigue to be their major responsibility in the process of occupational rehabilitation, followed by improving work participation (68/153 (44%)) and quality of work (55/153 (36%)). Although 112/153 (73%) of the rheumatologists judged the communication and cooperation with occupational physicians as reasonable to good, 119/153 (78%) of them were willing to improve the collaboration. Perceived bottlenecks mentioned were a lack of clarity about the occupational physician's position and activities, and the absence of practice guidelines. The most important prerequisites for improvement were found to be guarantees about the occupational physician's professional independence and more clarity about the competence of the occupational physicians and how they used the information provided. CONCLUSION: Dutch rheumatologists are willing to improve cooperation and communication with occupational physicians. The perceived lack of clarity about their mutual tasks appears to be a major obstacle. Thus the development of a joint education programme and a guideline for occupational rehabilitation in rheumatic diseases may be appropriate first steps towards improvement.

Adult↗
PubMed1995

Occupationally embedded exercise versus rote exercise: a choice between occupational forms by elderly nursing home residents.

OBJECTIVES: The provision of options in the occupational form that encourages meaningful choices and subsequent purposeful occupational performances is a basic premise of occupational therapy. This study examines the preferences of elderly nursing home residents when presented with an occupationally embedded exercise versus a rote exercise and addresses the methodological problems identified in similar past research. METHODS: Fifty-two elderly nursing home residents were presented with a choice between an occupationally embedded exercise that involved unilateral dunking of a small, spongy ball into a basketball hoop and a rote exercise that involved moving the arm above the head in a simulation of the dunking exercise. Both exercises required flexion of the shoulder joint. Random assignment of the 52 subjects into one of four groups controlled for the order of the presentation of the exercises and the order of the choice statements. RESULTS: Sixty-nine percent of the subjects chose the occupationally embedded exercise. Analysis with the significance of a proportion statistic revealed a statistically significant difference (z = 2.77; p (one-tailed) = .003). CONCLUSION: Results were consistent with the hypothesis that elderly nursing home residents would tend to choose the occupationally embedded exercise. To further confirm this basic premise of occupational therapy, future studies that investigate therapeutic patterns of movement embedded in common occupations are recommended.

Aged↗
PubMed1997

Occupational asthma and other nonasbestos occupational respiratory diseases notified between 1993 and 1996.

AIM: To review notifications to the Occupational Safety and Health Service of the Department of Labour Notifiable Occupational Disease System since its inception until June 1996. METHODS: All notifications received for non asbestos related occupational respiratory disease were reviewed to evaluate the outcome of the notification and to identify the causative agent where possible. RESULTS: There were 277 cases notified and investigated including worksite investigations. Of these 73 cases were confirmed as having occupational asthma, 35 by the asthma validation panel. Nineteen cases of other occupational respiratory disease were notified of which 11 were reviewed by the panel. Extrinsic allergic alveolitis secondary to organic dusts was the most common such notification. CONCLUSIONS: Isocyanates are well recognised as a cause of occupational asthma in New Zealand. It is suspected that occupational asthma and other occupational respiratory diseases are poorly notified to this system. Better mechanisms are needed to identify occupational causes of respiratory (and other) disease.

Asthma↗
PubMed2002

Occupational relevance of positive standard patch-test results in employed persons with an initial report of an occupational skin disease.

OBJECTIVES: It is commonly accepted that the standard screening tray is an essential diagnostic test in patch testing supporting the diagnosis of contact dermatitis, the most common type of occupational skin disease (OSD). In this study standard patch-test results of employed persons with an initial report of an OSD were analyzed within 24 occupational groups. METHODS: An evaluation was made of employed persons recorded in the Register of Occupational Skin Diseases in Northern Bavaria (Berufskrankheitenregister Haut-Nordbayern; BKH-N) between 1990 and 1999, catering for those standard screening tray allergens tested over the 10-year period. RESULTS: Nickel sulfate was the most common sensitizer (29.5%), showing occupational relevance in only 11% of the cases sensitized. Other common sensitizers were cobalt chloride (13.5%), p-phenylenediamine free base (10.7%), potassium dichromate (9.8%), fragrance mix (5.4%), thiuram mix (4.2%), balsam of Peru (4.0%), chloromethylisothiazolinone/methylisothiazolinone (4.0%), and formaldehyde (4.0%). The most occupationally relevant sensitizers were thiuram mix (71%), epoxy resin (67%), p-phenylenediamine free base (59%), p-phenylenediamine-black-rubber mix/ N-isopropyl- N'-phenyl- p-phenylenediamine (53%), potassium dichromate (48%), formaldehyde (38%), chloromethylisothiazolinone/methylisothiazolinone (37%), and mercapto-mix/mercaptobenzothiazole (35%). Occupational groups at risk of acquiring delayed-type sensitization were, in particular, electroplaters, tile setters and terrazzo workers, construction and cement workers, solderers, wood processors, and leather and fur processors. CONCLUSIONS: The standard series contributes valuable information and asserts its position in clarifying the causes of OSDs. Based on the study results, the rate of occupationally relevant sensitization to each single allergen is demonstrated, and the difficulties in verifying the occupational relevance are discussed.

Adult↗