Periodic Health Surveillance Research Articles

Current and new challenges in occupational lung diseases.

Occupational lung diseases are an important public health issue and are avoidable through preventive interventions in the workplace. Up-to-date knowledge about changes in exposure to occupational hazards as a result of technological and industrial developments is essential to the design and implementation of efficient and effective workplace preventive measures. New occupational agents with unknown respiratory health effects are constantly introduced to the market and require periodic health surveillance among exposed workers to detect early signs of adverse respiratory effects. In addition, the ageing workforce, many of whom have pre-existing respiratory conditions, poses new challenges in terms of the diagnosis and management of occupational lung diseases. Primary preventive interventions aimed to reduce exposure levels in the workplace remain pivotal for elimination of the occupational lung disease burden. To achieve this goal there is still a clear need for setting standard occupational exposure limits based on transparent evidence-based methodology, in particular for carcinogens and sensitising agents that expose large working populations to risk. The present overview, focused on the occupational lung disease burden in Europe, proposes directions for all parties involved in the prevention of occupational lung disease, from researchers and occupational and respiratory health professionals to workers and employers.

Hypersensitivity to Latex Gloves among Dental Students: Is the Pre-Matriculation Evaluation and Periodic Health Surveillance Necessary?

Hypersensitivity to Latex Gloves among Dental Students: Is the Pre-Matriculation Evaluation and Periodic Health Surveillance Necessary?

Attitude of Health Care Workers (HCWs) toward Patients Affected by HIV/AIDS and Drug Users: A Cross-Sectional Study.

Caring for HIV/AIDS patients and/or drug users requires health care workers (HCWs) to have good knowledge of the issues. Cultural differences in HCWs, combined with professional ethics and personal beliefs, could also result in conflicting attitudes, leading to difficulties related to looking after people affected by HIV/AIDS or drug users. A cross-sectional study was carried out to assess the attitude towards HIV/AIDS patients and/or drug users in a sample of workers operating in a large university hospital in southern Italy. A total of 736 workers were surveyed from May to November 2016. During the periodic occupational health surveillance, a questionnaire was administered about attitudes of discrimination, acceptance and fear towards these patients. Respondents showed average levels of acceptance to HIV/AIDS and drug user patients. As years of experience and professional training increased, scores for discrimination, acceptance of HIV/AIDS, acceptance of drug users and fear decreased. Factors positively influencing levels of attitudes were being female and younger. Supplementary education is needed to strengthen the awareness of HCWs.

Hypersensitivity to Natural Rubber Latex Gloves among Albanian Dental Students: The Role of Exposure Duration

Latex allergy is a common occupational disease among healthcare workers who use latex gloves. The aim of the present study was to determine the prevalence of allergy to latex gloves among dental students and the role of exposure duration in latex allergy. In this prospective study, a total of 240 students completed a self-administered questionnaire aiming at providing information about glove, working habits, signs and symptoms related to glove use, precautions taken to minimize it, etc. The challenge and patch tests were performed through latex gloves, and skin prick test with commercial extracts. The questionnaire items and diagnostic tests revealed that one-fourth of subjects were suspicious for latex gloves hypersensitivity. Their mean value for skin reactions like contact urticaria, irritant or allergic dermatitis was between 10% and 14%, while for non-cutaneous symptoms the mean value was under 5%. The average latex exposure (in hours) is estimated to be about 214±71 (SE), with a maximum of 11500 hours. The correlation between studied variables and the time exposure to latex gloves revealed weak to moderate relations with respect to reported latex allergy, eczematous reactions, hand erythema after glove wearing, irritant reactions during wash/washout procedures, concentration oscillations during usage of latex gloves, or dyspnea attack during latex exposure. Due to the relationship between allergic reactions to latex gloves and some medical histories during school practice, it seems to be necessary to undergo pre-matriculation evaluation and periodic health surveillance of dental students.

Assessing the effects of biomechanical overload on dairy parlor workers' wrist: Definition of a study approach and preliminary results.

Dairy milking is a demanding work task that has been associated with hand and wrist musculoskeletal disorders. Clinical approaches to identify the early effects of musculoskeletal disorders among dairy parlor workers' wrist have not been well defined. The purpose of this pilot study was to develop a study protocol that would assist in the identification and quantification of hand and wrist disorders among dairy workers that perform tasks in the dairy parlor. Additionally, such a study protocol was needed to perform relatively rapid assessments of the wrist/hand on large samples of dairy workers. Fourteen dairy parlor workers were assessed for i) upper limb symptoms and work history through questionnaire, ii) a physical examination of the upper limb and in particular wrists and iii) wrist ultrasonography. An additional 21 unexposed paired participants (the control group) also participated in the data collection. The study results identified two ultrasound acoustic windows characterized by the highest predictive value for alteration of the wrist's structure. Study results indicated an impairment of the distal median nerve in structure and mobility and impairment of the distal tendon of the muscle extensor carpi ulnaris that included dislocation and frank damage. This study identified at least two acoustic windows that should be assessed with ultrasound studies on larger groups and in prospective periodical health surveillance of dairy workers. The study confirmed the wrist was at risk for biomechanical stress among workers conducting milking tasks in the dairy parlors.

Prevalence and associated factors of occupational injuries among municipal solid waste collectors in four zones of Amhara region, Northwest Ethiopia.

BackgroundRefuse collectors are at a high risk for fatal and non-fatal occupational accidents. This is more intensified in developing countries, like Ethiopia, due to physically demanding nature of the job. However, information on occupational injuries and related factors are almost non-existent in Ethiopia. Thus, the aim of this study was to assess the prevalence of occupational injuries and its associated factors.MethodsA cross-sectional study was conducted among municipal solid waste collectors in four zones of Amhara region from February to May 2015. Computer generated simple random sampling technique was used to select the samples. Interviewer administrated questionnaires were used for the data collection process. Binary logistic regression was used to assess the association between outcome variables and explanatory variables.ResultsIn this study, the annual prevalence of at least one occupational injury among solid waste workers was 34.3 % (95 % CI: 29.52, 39.10). Of these, 50.7 % of them were visited health facility to receive health care. The independent predictors of at least one occupational injury were shorter service years, low monthly salary, history of job related stress, and sleeping disturbance related to the job. Being illiterate, having lower monthly income, and those who reported sleeping disturbance were significantly and positively associated with severe occupational injuries of solid waste collectors.ConclusionThe magnitude of occupational injuries among municipal solid waste collectors is lower than other similar studies conducted in Ethiopia. Based on the finding of this and other studies, job rotation among work components, improvement of employees’ income, job specific guideline regarding maximum production limits, and replacement of bags and bins with wheeled containers are an interventions expected to cope with the problem. There is also a need of specific periodic health surveillance (PHS) for refuse collectors to detect early signs of work related complaints and to monitor work ability.

Health surveillance for occupational asthma in the UK.

Periodic health surveillance (HS) of workers can identify early cases of occupational asthma. Information about its uptake and its content in the UK is lacking. To identify the overall levels of uptake and quality of HS for occupational asthma within three high-risk industry sectors in the UK. A telephone survey of employers, and their occupational health (OH) professionals, carried out in three sectors with exposures potentially capable of causing occupational asthma (bakeries, wood working and motor vehicle repair). A total of 457 organizations participated (31% response rate). About 77% employed <10 people, 17% between 10 and 50 and 6% >50. Risk assessments were common (67%) and 14% carried out some form of HS for occupational asthma, rising to 19% if only organizations reporting asthma hazards and risks were considered. HS was carried out both by in-house (31%) and external providers (69%). Organizational policies were often used to define HS approaches (80%), but infrequently shared with the OH provider. OH providers described considerable variation in practice. Record keeping was universal, but worker-held records were not reported. HS tools were generally developed in-house. Lung function was commonly measured, but only limited interpretation evident. Referral of workers to local specialist respiratory services was variable. This study provided new insights into the real world of HS for occupational asthma. We consider that future work could and should define simpler, more practical and evidence-based approaches to HS to ensure maximal consistency and use of high-quality approaches.

Small airways involvement in coal mine dust lung disease.

Inhalation of coal mine dust results in a spectrum of symptoms, dysfunction, and pathological changes in the respiratory tract that collectively have been labeled coal mine dust lung disease. Recent reports from periodic health surveillance among underground and surface coal miners in the United States have demonstrated an increasing prevalence and severity of dust diseases, and have also documented that some miners experience rapid disease progression. The coal macule is an inflammatory lesion associated with deposited dust, and occurs in the region of the most distal conducting airways and proximal respiratory bronchioles. Inflammatory changes in the small airways have long been recognized as the signature lung pathology among coal miners. Human and laboratory studies have suggested oxidant injury, and increased recruitment and activity of macrophages play important roles in dust-induced lung injury. However, the functional importance of the small airway changes was debated for many years. We reviewed published literature that documents a pervasive occurrence of both physiologic and structural abnormalities in small airways among coal miners and other workers exposed to airborne particulates. There is increasing evidence supporting an important association of abnormalities in the small peripheral airways with the development of respiratory symptoms, deficits in spirometry values, and accelerated declines in ventilatory lung function. Pathologic changes associated with mineral dust deposition in the small airways may be of particular importance in contemporary miners with rapidly progressive respiratory impairment.

Exploring electronic health records as a population health surveillance tool of cardiovascular disease risk factors.

The objective of this study was to examine the utility of using electronic health record (EHR) data for periodic community health surveillance of cardiovascular disease (CVD) risk factors through 2 research questions. First, how many years of EHR data are needed to produce reliable estimates of key population-level CVD health indicators for a community? Second, how comparable are the EHR estimates relative to those from community screenings? The study takes place in the context of the Heart of New Ulm Project, a 10-year population health initiative designed to reduce myocardial infarctions and CVD risk factor burden in a rural community. The community is served by 1 medical center that includes a clinic and hospital. The project screened adult residents of New Ulm for CVD risk factors in 2009. EHR data for 3 years prior to the heart health screenings were extracted for patients from the community. Single- and multiple-year EHR prevalence estimates were compared for individuals ages 40-79 years (N=5918). EHR estimates also were compared to screening estimates (N=3123). Single-year compared with multiyear EHR data prevalence estimates were sufficiently precise for this rural community. EHR and screening prevalence estimates differed significantly-systolic blood pressure (BP) (124.0 vs. 128.9), diastolic BP (73.3 vs. 79.2), total cholesterol (186.0 vs. 201.0), body mass index (30.2 vs. 29.5), and smoking (16.6% vs. 8.2%)-suggesting some selection bias depending on the method used. Despite differences between data sources, EHR data may be a useful source of population health surveillance to inform and evaluate local population health initiatives.

Tetanus immunity in construction workers in Italy

Tetanus is a serious vaccine-preventable disease that remains a significant health risk in certain occupations. Since 2006, Italy has reported the highest number of cases in Europe. Some professions, such as construction workers, are more exposed to tetanus. To evaluate tetanus immunity status and associated factors in construction workers in Italy. A cross-sectional study of construction workers attending for periodic occupational health surveillance at one site in Italy between September 2011 and January 2013. Serum tetanus antitoxin levels were measured and analysed according to demographic and clinical variables. All 5275 workers attending for health surveillance between September 2011 and January 2013 agreed to participate. Protective tetanus antitoxin levels (>0.1 IU/ml) were found in 4116 workers (78%). Multivariate logistic regression analysis suggested that the following risk factors were significantly associated with inadequate immunization status: older age (age >58 years, odds ratio [OR] 1.78, 95% confidence intervals [CIs] 1.76-1.84), poor education (no formal education: OR 3.74, 95% CI: 3.69-3.78), unskilled work tasks (OR 2.71, 95% CI: 2.67-2.77) and country of origin (Egypt: OR 1.72, 95% CI: 1.67-1.77; Morocco: OR 1.69, 95% CI: 1.62-1.76). In this study, a significant proportion of construction workers in Italy were not adequately immunized against tetanus, as required by Italian law. Occupational health professionals should promote and implement vaccination campaigns, especially among migrant workers, for public health and legal reasons.

Chest health surveillance utility in the early detection of bronchiolitis obliterans syndrome in children after allo-SCT

To prospectively assess whether periodic chest health surveillance is beneficial for the early detection of bronchiolitis obliterans syndrome (BOS) in children after allo-SCT. Children up to 18 years of age receiving allo-SCT from September 2009 to September 2011 were included. Surveillance consisted of the following: a 7-item respiratory system questionnaire of cough, wheeze and shortness of breath; focused physical examination; and pulmonary function test (PFT) conducted before SCT and at 1, 3, 6, 9, 12, 18 and 24 months after SCT. Thirty-nine patients were enrolled. Five children developed BOS at a median time of 192 days (range 94-282). Positive response comparisons between the BOS group vs the non-BOS group were NS for history questionnaire (P=0.2), heart rate (P=0.3), respiratory rate (P=0.3) and oxygen saturation monitoring (P=0.8). Differences between the two groups for chest auscultation and PFT were statistically significant (P=0.03 and P=0.01, respectively). However, chest auscultation in the BOS group was only positive after BOS diagnosis. PFT reduction was evident in the asymptomatic phase (BOS group 33%; non-BOS group 4.5%, P=0.01). Changes in PFT, but not history/physical examination, allow the early detection of BOS in children after SCT. Our study is limited by the small sample size.

Los orígenes de la reglamentación de la prostitución en la España contemporánea : de la propuesta de Cabarrús (1792) al Reglamento de Madrid (1847)

The publication in 1847 of the Reglamento para la represión de los excesos de la prostitución en Madrid (Regulations for the repression of the excesses of prostitution in Madrid) inaugurated an era of regulated prostitution in Spain, which followed upon a period of abolitionism decreed by Philip IV. In view of the spread of prostitution and venereal diseases, police measures, and especially medical measures were both considered in the development of these regulations, which had first been proposed by the Count of Cabarrús in 1792. Allthough completely confidential, the new system of regulations, drawn up in 1847, set the stage for the wide-reaching regulation of prostitution that came into effect in several cities in Spain during and after the mid-nineteenth century, and which included city residence and periodic health surveillance for prostitutes.

Ageing, working hours and work ability

The current paper reports the main results of several studies carried out on Italian workers using the work ability index as a complementary tool for workers' periodical health surveillance. The work ability index shows a general decreasing trend over the years, but it changes differently according to working conditions and personal health status. In jobs with higher mental involvement and autonomy, but lower physical constraint, it remains quite constant and high over the years, while it significantly decreases with a steeper trend the higher the physical work load and the lower the job control are. Sex and working hours appear to act concurrently in influencing work ability, particularly in association with more physically demanding jobs. It is therefore necessary to adopt flexible interventions, able to give ageing shift workers a proper support for maintaining a satisfactory work ability, by means of actions addressed both to work organization and psycho-physical conditions.

Latex Gloves Allergy in Dental Workers, Iran

Dermal-respiratory reactions to latex glove is a common problem and sometimes life threatening. Some of the health related past histories such as hand dermatitis, atopy and food allergy increase the probability of these reaction. The purpose of this study was to evaluate reactions to latex gloves amongst dental workers in military dental health centers. In this cross-sectional descriptive survey, dental workers with minimum three months length of employment and most often use of latex gloves were asked to fill standard questionnaire regarding latex related clinical manifestation and personal medical history and predisposing factors. Those with clinical problems did Skin Prick Test (SPT). In this study 330 personnel were assessed. The mean age and length of employment was 31.6 and 8 years, respectively. The most occupation was dentistry. A total of 232 subjects (70.3%) reported latex gloves-allergic symptoms. 72 (21.8%) of persons have history of atopy and food allergy was seen in 114 (34.5%). 63 (19.1%) of subjects reported history of hand dermatitis. All of these had positive regression with allergic responses. Among 73 (34%) symptom positives, 28 (38%) had positive result of SPT. In this survey, the prevalence of allergic reactions is higher than similar studies, which may be due to type of gloves, lack of preemployment assessments and other factors. Because of relationship between allergic reactions to latex gloves and some medical histories, it seems to be necessary for preemployment evaluation and periodic health surveillance of dental workers.

Work ability in health care workers

Work Ability Index was used as a complementary tool for the periodical health surveillance of health care workers in order to evaluate their functional working capacity and to plan more appropriate preventive and compensatory measures. 867 health care workers of both sexes (337 men, 530 women), aged between 23 and 65 years and with a work experience from 0.5 to 48 years ere examined. They were physicians, registered and assistant nurses, biologists, technicians, and clerks, working in hospital departments, ambulatory health care services, laboratories, and offices. WAI proved to be “excellent” in 27.0%, “good” in 49.7%, “moderate” in 20.1%, and “poor” in 3.2%. Women showed significantly lower mean WAI than men in all age groups, particularly among registered nurses. Both men and women shift workers showed a more pronounced decrease of WAI over the years as compared to their colleagues day workers. By increasing the number of illnesses suffered, WAI similarly decreased in all age groups. Skin and neuropsychic illnesses appear to lower WAI to a greater extent than other health disorders.

A study of the mercury levels in Scottish dentists

Aim A study of 180 dentists in the West of Scotland was conducted to determine their exposure to mercury during the course of their work and the effects on their health and cognitive function. Design Data were obtained from questionnaires distributed to dentists and by visiting their surgeries to take measurements of environmental mercury. Methods Dentists were asked to complete a questionnaire including items on handling of amalgam, symptoms experienced, diet and possible influences on psychomotor function such as levels of stress and alcohol intake. They also completed the 12-item General Health Questionnaire. Dentists were asked to complete a dental chart of their own mouths and to give samples of urine, hair and nails for mercury analysis. The dentists were visited at their surgeries where environmental measurements were made in eight areas of the surgery and they undertook a computerised package of psychomotor tests. One hundred and eighty control subjects underwent a similar procedure, completing a questionnaire, having their amalgam surfaces counted, giving urine, hair and nail samples and undergoing the psychomotor test procedure. Results Dentists were found to have, on average, urinary mercury levels over 4 times that of control subjects although all but one dentist had urinary mercury below the Health and Safety Executive health guidance value of 20 μmol mmol−1 creatinine. Urine was found to be a better biological marker for mercury exposure than hair or nails. Dentists were significantly more likely than control subjects to have suffered from disorders of the kidney but these symptoms were not significantly associated with their level of mercury exposure as measured in urine. One hundred and twenty two (67.8%) of the 180 surgeries visited had environmental mercury measurements in one or more areas above the Occupational Exposure Standard (OES) set by the Health and Safety Executive. In the majority of these surgeries the high levels of mercury were found at the skirting and around the base of the dental chair. In 45 surgeries (25%) the personal dosimetry measurement (ie in the breathing zone of dental staff) was above the OES. Conclusion On the basis of these findings, it is recommended that greater emphasis should be made relating to safe handling of amalgam in the training and continuing professional development of dentists, that further studies are carried out on levels of mercury exposure of dental team members during the course of their working day, and that periodic health surveillance, including urinary mercury monitoring, of dental personnel should be conducted to identify possible effects of practising dentistry.

Mercury vapour levels in dental practices and body mercury levels of dentists and controls

A study of 180 dentists in the West of Scotland was conducted to determine their exposure to mercury during the course of their work and the effects on their health and cognitive function. Data were obtained from questionnaires distributed to dentists and by visiting their surgeries to take measurements of environmental mercury. Dentists were asked to complete a questionnaire including items on handling of amalgam, symptoms experienced, diet and possible influences on psychomotor function such as levels of stress and alcohol intake. They also completed the 12-item General Health Questionnaire. Dentists were asked to complete a dental chart of their own mouths and to give samples of urine, hair and nails for mercury analysis. The dentists were visited at their surgeries where environmental measurements were made in eight areas of the surgery and they undertook a computerised package of psychomotor tests. One hundred and eighty control subjects underwent a similar procedure, completing a questionnaire, having their amalgam surfaces counted, giving urine, hair and nail samples and undergoing the psychomotor test procedure. Dentists were found to have, on average, urinary mercury levels over 4 times that of control subjects although all but one dentist had urinary mercury below the Health and Safety Executive health guidance value of 20 mumol mmol(-1) creatinine. Urine was found to be a better biological marker for mercury exposure than hair or nails.Dentists were significantly more likely than control subjects to have suffered from disorders of the kidney but these symptoms were not significantly associated with their level of mercury exposure as measured in urine. One hundred and twenty two (67.8%) of the 180 surgeries visited had environmental mercury measurements in one or more areas above the Occupational Exposure Standard (OES) set by the Health and Safety Executive. In the majority of these surgeries the high levels of mercury were found at the skirting and around the base of the dental chair. In 45 surgeries (25%) the personal dosimetry measurement (ie in the breathing zone of dental staff) was above the OES. On the basis of these findings, it is recommended that greater emphasis should be made relating to safe handling of amalgam in the training and continuing professional development of dentists, that further studies are carried out on levels of mercury exposure of dental team members during the course of their working day, and that periodic health surveillance, including urinary mercury monitoring, of dental personnel should be conducted to identify possible effects of practising dentistry.

Superoxide anion release by peripheral polymorphonuclear leukocytes in welders.

To investigate peripheral blood neutrophil [polymorphonuclear leukocyte (PMN)] function in a group of 23 welders compared with that in an age- and smoking habit-matched non-exposed control group. Stimulated release of superoxide anions from PMN isolated from peripheral blood of welders and of a matched group was carried out. The stimulated release of superoxide anions in PMNs from welders was significantly lower (P = 0.021) than that of a control group. Smokers and older workers had a lower function of PMNs than non-smokers and younger workers. PMN function of welders is lower than that of controls. This effect might indicate reduced immunological defences in oxidant-exposed individuals. It is possible that PMN function might serve as a biological marker of exposure in the periodic health surveillance of welders.

Evaluation research in occupational health services: general principles and a systematic review of empirical studies.

OBJECTIVES: To study the nature and extent of evaluation research in occupational health services (OHSs). METHODS: Literature review of evaluation research in OHSs. On the basis of a conceptual model...