Occupational mental health: a brief history

This paper describes the development of occupational mental health in the United Kingdom. It looks at the increasing involvement of occupational health staff in this aspect of the workplace and the role played by organizational psychologists in exploring the relationship between work and mental well-being. It provides a background for the reviews of current knowledge described in the other papers in this issue of Occupational Medicine.     

Occupational contact dermatitis in the UK: a surveillance report from EPIDERM and OPRA

Since February 1993 the EPIDERM surveillance scheme has collected data on occupational skin disease from consultant dermatologists in the UK. Reporting by occupational physicians to the scheme began in May 1994 and was superseded in January 1996 by the Occupational Physicians Reporting Activity (OPRA). The schemes currently receive reports on incident cases from 244 dermatologists and 790 occupational physicians. An estimated total of 9937 cases of contact dermatitis reported by dermatologists was calculated from surveillance data; 8129 contact dermatitis cases were estimated from reports by occupational physicians. The annual incidence of occupational contact dermatitis from dermatologist reports was 6.4 cases per 100,000 workers and 6.5 per 100,000 from reports by occupational physicians, an overall rate of 12.9 cases per 100,000 workers. Manufacturing industries account for the greatest number of cases seen by both sets of reporting physicians, with health care employment second. Reports from dermatologists also indicate high rates of dermatitis in the personal service industries (mainly hairdressers and barbers) and in agriculture. With the exception of an increase in cases seen in nurses in both schemes, the numbers and proportions of cases of contact dermatitis within occupations have remained fairly constant over the 6-year reporting period. Agents accounting for the highest number of allergic contact dermatitis cases were rubber (23.4% of allergic cases reported by dermatologists), nickel (18.2), epoxies and other resins (15.6), aromatic amines (8.6), chromium and chromates (8.1), fragrances and cosmetics (8.0), and preservatives (7.3). Soaps (22.0% of cases), wet work (19.8), petroleum products (8.7), solvents (8.0), and cutting oils and coolants (7.8) were the most frequently cited agents in cases of irritant dermatitis. The national scope of the data, together with the parallel structure by which both dermatologists and occupational physicians report incident cases, is useful in determining the extent of skin hazards in UK industry and may help in better targeting efforts to reduce the burden of skin disease at work.     

Occupational groups at risk of voice disorders: a review of the literature

BACKGROUND: Occupational voice health is becoming more important as more people rely on their voices for their work. A number of studies have identified certain occupational groups at increased risk of developing occupational voice disorders, namely teachers, singers and aerobics instructors. Aim The paper aims to review the literature on occupational groups at risk of voice disorders and identify areas for future research. METHOD: A literature review of key databases using key words such as 'occupational', 'voice health', 'voice loss', 'dysphonia' and 'work related' was undertaken. RESULTS: The review identified case reports, studies of attendees at hospital voice clinics and a few cross-sectional studies of occupational groups in the workplace. There were no longitudinal studies found or intervention studies looking at reduction of risk. CONCLUSION: Further research on occupational voice disorders needs to be based in the workplace, and to look at the risk factors for the development of voice problems and for the efficacy of controls.     

Occupational toxicology and the control of exposure to pharmaceutical agents at work

BACKGROUND: The pharmaceutical industry employs >350 000 people worldwide in operations including research and development (R&D), manufacturing, sales and marketing. Workers employed in R&D and manufacturing sectors are potentially exposed to drug substances in the workplace that are designed to modify physiology and also to chemical precursors that are potentially hazardous to health. Pharmaceutical workers are at risk from adverse health effects, including occupational asthma, pharmacological effects, adverse reproductive outcomes and dermatitis. AIM: This study aimed to describe the approaches taken by pharmaceutical companies for identifying and communicating potential adverse health effects that may result from workplace exposures and in setting 'in-house' exposure control limits and to highlight the challenges in controlling workplace exposures to increasingly potent compounds. METHOD: The literature was reviewed by searching the Medline and HSELine databases. RESULTS: The findings are presented in five sections, covering: test methods and approaches to occupational toxicology; hazard communication; approaches to setting health-based occupational exposure limits for pharmaceutically active agents; recent approaches to risk control; and occupational hygiene and exposure controls. CONCLUSION: Significant efforts have been directed at predicting and evaluating potential occupational health hazards in the pharmaceutical industry. The pharmaceutical industry has provided leadership in controlling exposure to hazardous substances. Much of this work has been driven by a real need to control occupational exposures to substances that can have profound adverse health effects in exposed employees and that are becoming increasingly more potent.     

Occupational asthma: a community based study.

The incidence and prevalence of occupational asthma has been extensively studied in industry settings and specialist clinics. However, it has been much less studied in the community. This study looked at the general practice notes of asthmatics in an attempt to assess the overall load of occupational asthma in the community. Eighty-six per cent of the patients with adult onset asthma in the practice population studied had at least one occupation recorded in their notes. Nearly a third of these (32%) were in jobs known to be significant causes of occupational asthma, yet a potential link between their occupation and symptoms had only been recorded in 18% of patients in these jobs. Overall 4% of the patients with adult onset asthma had been given a diagnosis of occupational asthma although in nearly half these cases the diagnosis had been made by a general practitioner and not a specialist.     

Occupational eye injuries: a continuing problem

Background Ocular trauma is a worldwide cause of visual morbidity,a significant proportion of which occurs in the workplace. Thisis largely preventable with the use of protective eyewear andstrict compliance. Aim To analyse the type of occupational eye injuries that occurand to document the use of eye protection in patients presentingto a UK district general hospital. Methods A pilot retrospective case note analysis of all ocularinjuries seen in one calendar month was performed. A prospectivesurvey of consecutive occupational ocular injuries presentingto this district general accident and emergency (A&E) departmentover a 2-month period was then carried out. Demographics, aetiology,eye protection usage and clinical details were recorded andanalysed. Results Of all eye patients attending this A&E, 31% (87/283)were due to occupational eye injuries. Of 55 prospectively reviewedpatients with occupational eye injuries, the majority had minorinjuries. Of the cases where eye protection was recorded, 56%(18/32) were not wearing any protection and 44% (14/32) woreeye protection at the time of injury. Conclusions Occupational eye injuries are a commonly seen ocularcomplaint in the A&E department. Provision of appropriateeyewear protection and worker education is required to minimizethe incidence of ocular injury in the workplace.     

Occupational dermatitis and allergic respiratory diseases in Finnish metalworking machinists

AIM: To investigate the incidences and trends of occupational skin diseases (OSDs) and allergic respiratory diseases (ARDs) in machinists working in the fabrication of metal products. METHODS: Data from the Finnish Register of Occupational Diseases during 1992-2001 were analysed. Incidence rates for skin and respiratory diseases of machinists were calculated and compared to the total working population. The patients investigated at the Finnish Institute of Occupational Health in the same period were described in detail. RESULTS: A total of 279 dermatoses and 34 ARDs were reported. Skin diseases accounted for 27% of all occupational diseases. The incidences of the skin and respiratory diseases were 1.6 and 0.2 cases per 1000 person-years, respectively. This represents a 3-fold risk for getting an OSD compared to the total working population. The number of allergic contact dermatitis (ACD) increased 3-fold during the study period. The most common causes of ACD were metalworking fluids (MWFs) and their ingredients such as formaldehyde, ethanolamines and colophony. Eighty-five per cent of ARDs were asthmas. The commonest causes of asthma were metal dusts and fumes, epoxy resins and hardeners and MWFs and their components. CONCLUSIONS: Contact dermatitis is a common occupational health problem in metalworking machinists, whereas occupational respiratory disease is rare. Only a few specific chemicals in the metalworking have thus far been identified as respiratory allergens. Specific skin tests and inhalation challenge tests with MWFs and their ingredients are recommended if an OSD or a respiratory disease is suspected.     

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 OccupationalHealth Centre Eastern Gelderland has developed a method of companyhealth care based on the particular demands and needs of companies.A procedure of care ‘made to measure’ based on companyand work characteristics was designed. For one year, an experimentwas carried out in seven companies, to investigate if this ‘differentialcare’ is feasible, and if its quality is better than thetraditional ‘standard’ form. After the experiment,the companies' satisfaction proved to have increased. The influenceof the Occupational Health Centre on working conditions wasestimated more important than before. The increased satisfactionis considered to be an indication of better quality of care,compared with the traditional ‘standard’ care. Thedifferential approach appeared to be feasible. The method requiresskills of professionals in the field of planning, cooperation,estimating costs and negotiating.     

Occupational asthma in New South Wales (NSW): a population-based study

BACKGROUND: The proportion of asthma in adults that is due to occupational exposures is not known. AIM: To examine the contribution of workplace exposures to the development of asthma in adults in New South Wales (NSW) in a cross sectional, population-based study. METHODS: A randomly selected population of 5,331 18- to 49-year olds completed and returned a mailed questionnaire (response rate 37%). In adult-onset asthmatics we examined the association of asthma with reported exposure, within 1 year of asthma onset, to a list of occupations and exposures known to be at risk for occupational asthma (high-risk jobs and exposures). RESULTS: Among 910 subjects (18%) with asthma, 383 (7%) subjects reported adult-onset disease. After adjusting for sex, age and smoking, working in any high-risk job or exposure at the time of asthma onset was significantly associated with adult-onset asthma (OR 1.51, 95% CI 1.19-1.92). The population attributable risk (PAR) of adult-onset asthma for either a high-risk job or an exposure was 9.5%. Sudden onset, irritant or reactive airways dysfunction syndrome type exposures were associated with adult-onset asthma (OR 4.65, 95% CI 1.64-13.2). The PAR of adult-onset asthma for these exposures was 0.2%. CONCLUSION: Reported adult onset of asthma is common and occupational exposures may be associated with 9.5% of prevalent cases of adult-onset asthma in NSW.     

Occupational epidemiology

The epidemiological literature for assessing risk in many, if not most, modern occupations has now become sufficiently obsolete that it can no longer be depended upon to guide either prevention or adjudication of compensation. This obsolescence must be dealt with by developing new sources of information pertinent to occupational hazards and the risks associated with most occupations. Ideally, a comprehensive surveillance mechanism that would be automatically updated for the changing risk in a changing economy would be ideal and may be attainable with further developments in health information technology. The characteristics of such a system are described. However, there are many obstacles to such a system which appear insurmountable in the short term. A more eclectic plan for cooperation and data-sharing would help in the short term and would establish a pattern of collaboration that could both place adjudication on a more solid foundation and avoid allegations of collusion in business. The general outline for a practical programme of collaboration along these lines is presented.     

SWORD '95: Surveillance of Work-related and Occupational Respiratory Disease in the UK

An estimated 2,741 new cases of occupational respiratory diseaseswere reported by chest and occupational physicians in 1995.Total cases reported by ‘core’ chest physiciansand occupational physicians have risen but cases reported by‘sample’ physicians have fallen by 32%, reducingthe estimated total overall by approximately 16% from 1994.Steps are being taken to reverse this downward trend. Occupationalasthma remains the single most frequently reported disease ofwhich more than two thirds of cases were attributed to sensitization.Non-malignant pleural disease was the next most frequently reported,with pleural plaques predominating in 71% of cases. In a studyof a selected sample of 158 cases of non-malignant pleural disease,81 (51%) were seen for medico-legal reasons; of the remainder13% had signs or symptoms ascribed to the disease.     

Occupational molybdenum exposure and a gouty electrician

BACKGROUND: Molybdenum is an essential trace element and a component of xanthine oxidase, which catalyses the formation of urate. The toxicity of molybdenum in humans is considered to be low, but hyperuricaemia and gout-like symptoms have been observed sporadically. METHODS: A case of hyperuricaemia and gouty arthritis in a young man with occupational exposure to molybdenum is described. Improvement during an exposure-free period was followed by a relapse after a reconstruction designed to quantify his molybdenum exposure. CONCLUSION: This case seems to represent the first observation of gout associated with occupational molybdenum exposure, but the association might also be entirely circumstantial.     

Occupational stress management programmes: a practical overview of published effect studies

There are many occupational stress management programmes availablewhich are designed to prevent and cure the negative aspectsof job-stress. The focus of the programmes can be directed towardsthe individual worker, the working group, the organization ofthe work or the organization as a whole. Moreover, programmesshow a considerable variation with respect to the type of interventionsthey promote and their underlying assumptions, as well as theirduration and costs. In this paper, effect studies of occupationalstress programmes published between 1987 and 1994 are reviewed.The aim is to give a practical overview of the variety in occupationalstress programmes, their scope, applicability and the evidenceof their effectiveness. The paper updates the review by DeFrankand Cooper published in 1989.     

Occupational health in the Andalusian Fisheries Sector

BACKGROUND: The conditions of work in the fisheries sector are arduous with high rates of occupational accidents. Numerous factors are known that can directly influence the health of the sailor or fisherman both in fishing and merchant fleets. AIM: To evaluate the health status, safety and working conditions in the Andalusian fishing sector. METHODS: Cross-sectional questionnaire study with proportional sampling of the health and lifestyles of fishery workers in 19 of the 23 Andalusian ports. RESULTS: A total of 247 workers employed on 202 craft fishing boats responded. In all 87% of workers reported a current medical condition. The main problems reported were musculoskeletal disorders, respiratory diseases, diseases of the digestive system, eye problems and skin problems. A total of 72% reported taking some self-prescribed medication, and 60% of fishery workers smoked. Nine per cent of fishery workers admitted taking illicit drugs and 3% reported using illicit drugs on board. Diets on board were poorly balanced. While on board, 62% of crews reported a subjective significant worsening of previous health. The lifetime prevalence of accidents was 76%. CONCLUSIONS: Fishery workers had a high prevalence of self-reported medical problems, a high prevalence of self-medication, poor diets and frequently smoked. Self-medication and some medical conditions (diabetes, angina and depression) may reflect a potential failing of health checks and pre-employment checks. National health services and insurance companies dealing with occupational health should focus more on appropriate health checks, illness prevention and health promotion activities for this population.     

Occupational skin infections

A number of skin infections may complicate different occupations depending on the working environment and level of exposure to a particular agent. These in turn may affect the productivity of an individual worker and ultimately the company as a whole. This review aims to highlight some common and important skin infections that may be acquired at work. Epidemiology, clinical features, diagnosis, treatment and prevention will be covered.     

Occupational health management: an audit tool

BACKGROUND: Organizations must manage occupational health risks in the workplace and the UK Health & Safety Executive (HSE) has published guidance on successful health and safety management. AIMS: This paper describes a method of using the published guidance to audit the management of occupational health and safety, first at an organizational level and, secondly, to audit an occupational health service provider's role in the management of health risks. The paper outlines the legal framework in the UK for health risk management and describes the development and use of a tool for qualitative auditing of the efficiency, effectiveness and reliability of occupational health service provision within an organization. The audit tool is presented as a question set and the paper concludes with discussion of the strengths and weaknesses of using this tool, and recommendations on its use.     

Occupational respiratory disease in mining

This review is based on research-based literature on occupational lung disease in the mining and related industries, focusing on conditions of public health importance arising from asbestos, coal and silica exposure. Both 'traditional' and 'new' concerns about occupational respiratory disease in miners are addressed, with the inclusion of practical evidence-based findings relevant to practitioners working in developed and developing countries. Mining is not a homogeneous industry since current miners work in formal and informal operations with numerous, and often multiple, air-borne exposures. A further occupational health challenge facing primary care practitioners are ex-miners presenting with disease only after long latency. The sequelae of silica exposure remain an occupational health priority, particularly for practitioners who serve populations with concomitant HIV and tuberculosis infection and even when exposure is apparently below the statutory occupational exposure level. Coal workers' pneumoconiosis, asbestos related diseases, lung cancer and other occupational respiratory diseases remain of considerable importance even after mining operations cease. While mining exposures contribute significantly to lung disease, smoking is a major factor in the development of lung cancer and chronic obstructive airways disease necessitating a comprehensive approach for prevention and control of mining-related occupational lung disease.     

Occupational asthma prevention and management in industry--an example of a global programme

Isocyanates are widely used in the manufacture of polyurethane foams, plastics, coatings and adhesives, and are known to cause occupational asthma in a proportion of exposed workers. Substitution as a prevention strategy is not currently a feasible option. For this reason, health and safety professionals working together in an automotive coatings business created a proactive global programme to address the known potential effects of isocyanates on its workers. The goals of the programme are prevention, early detection and mitigation of effect of key endpoints, especially asthma and to a lesser degree dermatitis, in people who are occupationally exposed, or potentially exposed, to isocyanates and products containing isocyanates. The surveillance programme for isocyanates has several important components, which include assessment of exposure, pre-placement questionnaire and spirometry, training and education of employees, regularly administered periodic questionnaires, medical assessment for abnormal questionnaire responses, process for early reporting and investigation of symptomatic employees and incidents, group data review and management reporting. Although regional differences exist regarding availability of specialized services, we have successfully implemented this programme in parts of North America, Europe and Latin America, and are currently implementing elsewhere. These simple control measures are relatively inexpensive and can be applied in even small business settings. It is recommended that all employers who manufacture, handle or use isocyanate-containing products consider such a strategy.