EAACI position paper: prevention of work-related respiratory allergies among pre-apprentices or apprentices and young workers.

Apprenticeship is a period of increased risk of developing work-related respiratory allergic diseases. There is a need for documents to provide appropriate professional advice to young adults aiming to reduce unsuitable job choices and prevent impairment from their careers. The present document is the result of a consensus reached by a panel of experts from European and non-European countries addressed to allergologists, pneumologists, occupational physicians, primary care physicians, and other specialists interested in this field, which aims to reduce work-related respiratory allergies (rhinoconjunctivitis and asthma) among allergic or nonallergic apprentices and other young adults entering the workforce. The main objective of the document is to issue consensus suggestions for good clinical practice based on existing scientific evidence and the expertise of a panel of physicians.

[Health problems related to occupational activities]. / Problèmes de santé liés à l'activité professionnelle.

Statistical data obtained from insurance companies give certainly a good picture of work effects on health in the field of accidents. This is different for occupational diseases, which are more difficult to diagnose and which are recognized on the basis of medicolegal criteria. Statistics do not involve other aspects than diseases, such as discomfort, ergonomical questions, psychophysiological consequences and situations where there is a limited role of occupation. Prevention of work related health problems has to consider these characteristics and needs to be based on risk analysis, a prospective procedure. The advantage of such an approach is the possibility of adjustment to a changing work environment and to new technologies.

[The iodine-azide test in low exposure to carbon disulfide]. / La réation iode-azide en cas de faible exposition au sulfure de carbone.

The iodine-azide test was performed on urine specimens of 28 workers exposed to CS2 (mean concentration 5-10 ppm) and of 17 control subjects. No significant difference between the two groups could be ascertained.

[Preventive examinations in the rotogravure printing industry]. / Examens préventifs dans l'héliogravure.

One hundred and sixty rotogravure printing workers exposed mainly to toluene are compared (clinical examination, liver and kidney tests) to 38 unexposed workers. The exposure to toluene is assessed by personal air sampling at the workplace (mean: 54 ppm) and by analysis of hippuric acid in urine (mean: 1.86 g/g creatinine). Fatigue, alcohol intolerance, mouth dryness appear more frequently among the exposed subjects. Differences observed in liver tests are difficult to relate to toluene exposure. The additional eight-year health surveillance of 18 workers shows no significant changes in liver and kidney functions.

[Monitoring of persons exposed to perchloroethylene or styrene]. / Surveillance de personnes exposées au perchloréthylène ou au styrène.

Forty-nine employees exposed to perchloroethylene (dry cleaning) and 41 employees exposed to styrene (fiber reinforced polyester) are compared to a control group of 68 persons. Symptoms such as dizziness, mouth dryness, fatigue, mucous membranes and skin irritation appear more frequently among the exposed groups, while liver and kidney functions remain unchanged. This study demonstrates that medical examination, industrial hygiene survey and biological monitoring can complement each other in the evaluation of work conditions.

Musculoskeletal and skin disorders in a population of floor-layers.

In the frame of a study on hydrocarbon-induced toxic effects, the knee morbidity and the prevalence of work-related arthralgias, gonalgias, myalgias and skin anomalies were investigated in a group a floor-layers. The results show that a previous history of knee morbidity is distinctly higher in floor-layers and that these workers have a higher prevalence of musculoskeletal and cutaneous disturbances than the comparison group. Owing to the fairly high prevalence of these troubles, it seems that this pathology deserves more attention and that more efficient preventive measures are indicated.

[Hydrocarbons and non-neoplastic kidney diseases]. / Kohlenwasserstoffe und nichtneoplastische Nierenkrankheiten.

Substituted and nonsubstituted hydrocarbons are suspected of causing nonneoplastic kidney diseases. Although the problem was already known about 100 years ago, epidemiological studies have only been conducted since 1975. This paper attempts to give an overview on the present situation, first of all on the cross-sectional and case-control studies. Practical recommendations for the prevention of such damage are done, but should be considered as preliminary until our knowledge has been completed by better designed epidemiological studies.

[Physical examination preceding entry into apprenticeship: preventive measure or administrative burden?]. / L'examen médical précédant l'entrée en apprentissage: instrument de prévention ou tracasserie administrative?

The new Swiss federal legislation on vocational and trade training requires that all cantons organize a system of medical screening for young people entering an apprenticeship. This paper focuses on the principles and implementation of such an examination. It outlines the most frequent health problems young people may face upon leaving school and entering apprenticeship. It underlines the difficulties of this kind of examination, since absolute contra-indications to distinct professions are very rare. Indeed, the medical examination should not be a selection procedure but much more an occasion to facilitate the transition from school to workplace. With this objective, the canton of Vaud health authority has created an examination sheet that will be supplied each year to the physicians (private pediatricians, general practitioners and internists) examining about 5000 candidates. This instrument introduces a uniform history taking procedure oriented towards occupational medicine and focuses on a few important screening items. No laboratory tests are mandatory. The process does not use a contra-indication list, which most of the time appears fallacious. It insists on the importance of an assessment of each individual situation.

Occupational risk assessment of aspergillosis after renal transplantation.

Returning to work after transplantation is a much-discussed topic today, especially as a measure to avoid permanent work disability. Many transplant patients regain their ability to work 2-6 months after transplantation. However, returning to work should not endanger their health. This means that occupational risks such as occupational exposure to Aspergillus spores must be evaluated. We evaluated the community-acquired aspergillosis risk and in particularly the occupational aspergillosis risk, using the example of a 39-year-old construction worker immunosuppressed after renal transplantation. On one hand the risk is linked to the exposure to microorganisms that the individual is likely to be subjected to, and on the other hand to the factors that modify his state of susceptibility or resistance to these infectious agents. The necessity of immunosuppressive therapy after transplantation elevates the aspergillosis risk, especially 1-6 months after transplantation. There are many professions in which exposure to Aspergillus spores can occur. The risk of acquiring aspergillosis at work exists, but is not quantifiable today. Nevertheless, the risk should be minimized during the period of vulnerability by preventive measures such as restriction of certain activities, changing work methods and reorganizing the work day to adapt to the risk, and wearing personal protective equipment, as well as attention to information about aspergillosis risk and about the likelihood of exposure in the patient's professional and leisure activities.

[Synthetic mineral fibers]. / Fibres minérales artificielles.

The group of man-made mineral fibres includes slagwool, glasswool, rockwool, glass filaments and microfibres, as well as refractory ceramic fibres. The toxicity of mineral fibres is determined by several factors such as the diameter (< or = 3-3.5 microns) and the length of the fibres (< 100 microns), their biopersistence, which is much shorter for man-made mineral fibres than for asbestos fibres, their physicochemical structure and surface properties, and the exposure level. The chemical composition of the various types of man-made mineral fibres depends directly on the raw material used to manufacture them. While naturally occurring fibres are crystalline in structure, most man-made mineral fibres are amorphous silicates combined with various metal oxides and additives. Observations using intracavitary administration have provided evidence that some types of man-made mineral fibres are bioactive in cellular and animal experiments and may induce lung tumours and mesothelioma. It is difficult to extrapolate these results to humans since they bypass inhalation, deposition, clearance and translocation mechanisms. Inhalation studies show more realistic results but differences are observed between animal species regarding their sensibility to tumours. There is no firm evidence that exposure to various wools is associated with lung fibrosis, pleural lesions or nonspecific respiratory disease in humans. A possible exception may be mentioned for refractory ceramic fibres. A slightly elevated standard mortality ratio for lung cancer has been documented in large cohorts of workers (USA, Europe and Canada) exposed to man-made mineral fibres, especially in the early technological phase. It is not possible to determine from these data whether the risk of lung cancer is due to the man-made mineral fibres themselves, in particular due to the lack of data on smoking habits. No increased risk of mesothelioma has been demonstrated in these cohorts. Epidemiological data are insufficient at this time concerning neoplastic diseases in refractory ceramic fibres.

[Reasons for consultation in occupational medicine]. / Motifs de consultation en médecine du travail.

The inability to characterize more precisely the extent of occupational diseases limits the implementation of an effective preventive policy. Furthermore, not all work-related conditions are reported by the Swiss workers' compensation system. A seven-year (1986 to 1992) retrospective study of medical visits in an Institute of Occupational Health Sciences is presented. The objective of this study is to expand data on occupational diseases for clinical and public health intervention. 298 patients have been examined for a possible work-related condition. In 140 cases (47%), an occupational disease according to the Swiss Law was found. Respiratory tract was the main target of industrial pollutants. Respiratory irritations, solvent intoxications, contact dermatitis and asthma were the most frequent conditions seen. 97 workplace visits (32% of all medical visits) were necessary for diagnostic purposes. Painters (construction, cars) and other solvent exposed workers were at particular risk. Rare alpha-1-antitrypsin phenotypes were found several times in workers with respiratory diseases confirming the value of this test in occupational medicine. Despite many referral biases, direct clinical and public health applications of the data are possible. This study confirms the hypothesis that occupational respiratory diseases and intoxications are probably underreported in the workers' compensation statistics. Activities with an increased risk of work-related diseases have been identified so workplace intervention could be highly targeted. This study shows also that a more intense collaboration between primary care physicians, hospital services and occupational medical specialists is necessary to improve clinical and epidemiological surveillance of work-related health conditions.

Carpal tunnel syndrome: role of occupation.

A total of 21 consecutive patients who underwent surgery for carpal tunnel syndrome in a regional hospital were analysed for their trade and serum alpha 1-antitrypsin phenotypes. The majority of these cases were women and mostly manual trades and professions were involved. Furthermore, heterozygous antitrypsin phenotypes were more frequent among the surgical cases than among the general Swiss population. In a second stage, the incidence of carpal tunnel syndrome in Switzerland was studied for 1 year from June 1988 through May 1989 using the sentinel system developed by the Federal Office of Public Health Administration. In all, 188 cases were found, most of whom were women, which was compatible with the frequency in other countries. A complementary questionnaire that was filled out by 65 cases and their matched controls showed that housewives and shop clerks were overrepresented among the patients. Likewise, exposure to vibrating tools and frequent extensions and/or flexions of the wrist were mentioned more often by the cases than by the controls. The present study confirms previous findings that women are at greater risk of developing carpal tunnel syndrome especially in jobs requiring repetitive movements or operation of vibrating tools. A constitutional element in pathogenesis was suggested by observations that the mothers of the cases had often also been afflicted with carpal tunnel syndrome and that the frequency of distribution of antitrypsin phenotypes in patients differed from that in the general population.

Health and health-related problems in a cohort of apprentices in Switzerland.

Out of a cohort of 1200 apprentices in Switzerland, 781 boys and 417 girls completed a questionnaire on their perceived health and health problems in their selected apprenticeship. Each participant was interviewed afterwards by the school nurses in three state-owned professional schools where the apprentices attended their classes. Ninety-five per cent of the respondents enjoyed excellent health, 28 cases had nervous system or psychological problems, 17 cases had problems of a locomotor nature, 12 subjects had gastrointestinal or endocrinological symptoms, and there was one with a past history of a malignant disease. Twelve cases also had respiratory symptoms or diagnoses. One hundred and nineteen apprentices reported that they had been troubled by the workplace. Exposure to solvents, chemicals in general, dust, smoke and noise were often mentioned as causes. Thirty-eight of them had contacted their family physician in connection with these problems. The cohort had experienced, mostly during their first year, 191 cases of accident necessitating medical care. Cuts, shocks and falls were the most common occurrences. Meat cutters and butchers had the highest frequency of accidents. Near-accidents had been experienced so far by 46 per cent of the respondents. At the interviews, school nurses provided counsel and intervened in flagrant cases of occupational risks. It seems that an ordinary medical certificate does not predict accident-proneness or possible medical problems, while in-school health programmes could provide rapid intervention and support.