Intensive education combined with low tech ergonomic intervention does not prevent low back pain in nurses.

AIMS: To evaluate the effectiveness of an intensive educational and low-tech ergonomic intervention programme aimed at reducing low back pain (LBP) among home care nurses and nurses' aids. METHODS: In 1999, 345 home care nurses and nurses' aids in four Danish municipalities were studied. Participants in two municipalities constituted the intervention group and participants in the other two served as the control group. In the intervention group, participants were divided into small groups, each of which was assigned one specially trained instructor. During weekly meetings participants were educated in body mechanics, patient transfer, and lifting techniques, and use of low-tech ergonomic aids. In the control group, participants attended a one time only three hour instructional meeting. Information on LBP was collected using the Standardised Nordic Questionnaire supplemented with information on number of episodes of LBP and care seeking due to LBP during the past year. RESULTS: A total of 309 nurses and nurses' aids returned the questionnaire at baseline and 255 at follow up in August 2001. At follow up, no significant differences were found between the two groups for any of the LBP variables, and both groups thought that education in patient transfer techniques had been helpful. Within group changes in LBP status was not related to the intervention or to satisfaction with participating in the project. CONCLUSIONS: Intensive weekly education in body mechanics, patient transfer techniques, and use of low-tech ergonomic equipment was not superior to a one time only three hour instructional meeting for home care nurses and nurses' aids.

Increased driving accident frequency in Danish patients with epilepsy.

OBJECTIVE: To determine driving accident frequency in a cohort of patients with epilepsy. METHODS: A 10-year historical cohort register study of 159 subjects with epilepsy and 559 controls individually matched for age, gender, place of residence, and exposure period was carried out. All had nonprofessional driver's licenses without restrictions. Persons with recorded diagnoses of other neurologic diseases, diabetes, psychoses, seizures, abuse, or poisoning of any kind were not included. The outcome measure was treatment at the casualty department after an accident as a car driver. RESULTS: Ten patients with epilepsy and five controls had been treated at the casualty department, the rate per 1,000 person-years with exposure being seven times higher (CI 2.18 to 26.13) in those with epilepsy than in the control cohort. CONCLUSIONS: Drivers with epilepsy are more likely than healthy controls to be treated at a casualty department after having a motor vehicle accident.

Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies.

Relevant studies of low back pain (LBP) published between 1990 and 2002 were systematically retrieved via electronic databases and checking of reference lists. Forty papers fulfilled the inclusion criteria; 10 were of high quality. A wide variety of instruments had been used for collection of data on work related psychosocial factors, many of which had not undergone any form of validation. Moderate evidence was found for no association between LBP and perception of work, organisational aspects of work, and social support at work. There was insufficient evidence for a positive association between stress at work and LBP. No conclusions could be drawn regarding perception of work and consequences of LBP. There was strong evidence for no association between organisational aspects of work and moderate evidence for no association between social support at work and stress at work and consequences of LBP.

Nitrosamine formation via non-prescription drugs?

Both carcinogenic and non-carcinogenic nitrosamines can be formed under physiological conditions in the human body by a reaction between nitrite and secondary or tertiary amines. A large number of people are exposed daily through drinking water to high levels of nitrate, which can be reduced to nitrite. Moreover, nitrate and nitrite are present in vegetables and nitrite is used in food preservation. Dietary exposure to amines is normally below 100 mg per day, whereas paracetamol and antazolin, both secondary amines, are used therapeutically at much higher doses. Knowledge about the possible interactions between these widely used drugs and the background exposure to nitrite is presently not available. Therefore, an evaluation of the carcinogenic hazard related to this combination is needed.

Assessing driving capability: a method for individual testing: the significance of paraparesis inferior studied in a controlled experiment.

The part played in traffic safety by driver illness or disability is uncertain or unknown. So also are the specific identity and degree of the disorders which necessitate the use of driving aids or which completely incapacitate a person from driving. Despite the gravity of the problems, the question of fitness to hold a driving licence is decided throughout the world mainly on the basis of subjective assessment. Controlled experiments exploring the significance of disorders have only been carried out on a restricted scale. In this paper a description is given of a mock car, which is used both for research and individual assessment. It enables the measurement of strength application, steering wheel turn speed, simple reaction times when operating pedals and steering wheel, erroneous reactions, and choice reaction times. Experiments involving 109 able-bodied and healthy persons showed, as expected, that the muscular strength of men was greater than of women, and that men were significantly quicker at carrying out functions which primarily depend upon speed of movement and of strength. Apart from this, however, there were no significant sex-related differences. Almost all variables showed age dependence, this being most pronounced in the case of men. Thirty-two percent of the test candidates committed errors like braking instead of turning the wheel or turning to the wrong side. Neither the incidence nor the seriousness of errors bore any relation to sex or age. Fifty-two persons suffering from paraparesis inferior were compared with the 109 able-bodied subjects. The degree of paresis co-varied with reaction times, but the degree of spasticity only to a minor extent. The results indicate that at a speed of 80 km/h, 'slight paresis' increases reaction distance by around 2-3 m (15%), and 'moderate paresis' by the region of 50 m.

[Milker's hand]. / Malkehånd.

The predominant skin problems in cattle-breeders are toxic and allergic eczemas, with cleansers, water, rubber, disinfectants and fodder being the most frequent provoking factors. The Danish register of occupational diseases yields information based on notifications during the years 1984-1992. Detailed data especially concerning dairy farms are not obtainable, but during the whole period 101 hand-skin diseases in farmers and farming assistants were notified, 12-23 annually in recent years. This number is not alarming, but there is general agreement that underreporting is significant. The main elements of prevention are 1) reduction of harmful actions and 2) optimization of skin resistance. Among the steps that ought to be taken immediately are reduction of contact with cleansing and disinfective agents through change of working methods and behaviour. Alteration of tools, for instance substitution of rubber with less sensibilizing materials, is desirable.

[Nitrosamine formation via non-prescription drugs?]. / Nitrosamindannende håndkøbspraeparater?

Both carcinogenic and non-carcinogenic nitrosamines can be formed under physiological conditions in the human body as a reaction between nitrite and a secondary or tertiary amine. A major part of the population is exposed daily through drinking water to high levels of nitrate, which can be reduced to nitrite. Moreover, nitrate and nitrite are both present in vegetables and nitrite is used in food preservation. Dietary exposure to amines is normally well below 100 mg per day, whereas paracetamol and antazoline, both secondary amines, are used therapeutically at much higher doses. Knowledge about the possible interactions between these widely used drugs and the background exposure to nitrite is presently not available. Therefore, an evaluation of the carcinogenic hazard related to this combination is needed.

[Occupational accidents in road traffic]. / Arbejdsulykker i trafikken.

An emergency room material covering 13 years (1980-92) was analyzed to see whether occupational accidents in road traffic had been following special patterns revealing possibilities for prevention. Of 41,332 traffic accident victims, every year 2.3-4.2% had sustained their injuries during working hours. Males were overrepresented, the male to female sex ratio was 2.9 for occupational accidents, 1.6 for non-occupational accidents. The age group 15-19 years accounted for a relatively large share of both occupational and non-occupational accidents. There were no differences according to body distribution of injuries, severity or need for treatment between occupational and non-occupational accidents. In occupational accidents more automobiles but fewer bicycles and motorbikes were involved. No type of accident showed increasing tendency throughout the period. It is concluded, that occupational road traffic accidents do not seem to follow special patterns, and the proportion is not increasing. Although the younger age groups were overrepresented, the limited material does not give grounds for elevating the age limit for occupational car driving, as for extent of exposure in the single age groups is not known.

[Occupational environment in veterinary clinics]. / Arbejdsmiljøet i dyreklinikker.

In veterinary clinics many drugs and materials are handled, for instance antibiotics, disinfectants and anaesthetic gases. The staff is in close contact with various animal species and performs surgical and obstetrical operations as well as post mortem examinations. X-ray is used widely. Some investigations have indicated, that the working environment has incurred little attention. For example, X-ray equipment has been found defective and air-extraction insufficient in connection with anaesthesias. Consequently the potential for work-related health problems is obvious. The few epidemiologic investigations done indicate an increased frequency of toxic and allergic skin diseases, asthma and certain infections such as ornithosis. As general prophylaxis, better arrangement of the clinics, alterations of drug administration forms and use of gloves and other protective devices are recommended. It is concluded, that the existing knowledge about the working environment in Danish veterinary clinics is scarce, that it may imply health risks, and that further investigation of the question is needed.

[Carbon monoxide poisoning from a natural gas burner]. / Kulilteforgiftning fra naturgasfyr.

The use of natural gas as a heating source in private homes in Denmark is increasing. Previous case reports describe carbon monoxide poisoning as a result of poor maintenance. Another case is reported here. The family experienced episodes of carbon monoxide intoxication. The woman was six weeks pregnant. Inspection of the gas burner revealed an air inlet blocked by rust debris. Following counselling, the woman elected to have an abortion. Review of the current literature indicates that severe, short-term exposure to carbon monoxide during pregnancy may result in foetal death or serious toxic effects. The current Danish legislation does not specify regular maintenance checks, which are needed to safeguard against future accidents.

[Working environment in Danish veterinary clinics]. / Arbejdsmiljøet i danske dyreklinikker.

Occupational health risks to veterinary personnel have been recognized in other countries. We have investigated the situation in Denmark by use of a questionnaire sent to 654 veterinarians identified through telephone books. Seventy-one percent responded. Two-thirds used inhalational anaesthesia; one-half had noticed the smell of gas, mostly one to four times per week, others even more frequently. Room ventilation existed in 85% of the clinics, local exhaust in 68% of those using anaesthetic gases. Eighty-one percent worked with X-rays, almost all using lead aprons, 83% lead gloves; two-thirds always carried film badges, the rest only occasionally; 4.4% had shown exposure within the last five years. One half applied insecticides two-thirds frequently other powders, creams or ointments. Almost everybody applied antibiotics, one-fourth local analgesics. Eighty-eight percent wore gloves in various contexts, though only 5% wore gloves consistently on animal contact. In conclusion, occupational hazards are identified, with obvious possibilities for improvements at reasonable costs.

[Whole body vibrations and low back pain]. / Helkropsvibrationer og laenderygsmerter.

Whether exposure to whole body vibration (WBV) in transport vehicles and moving machinery constitutes a health risk is unclear. The literature on this subject is vast, but most is of limited scientific value. A recent review covering the literature up to 1992 has been used as a basis for a further search concerning the period 1992-1996. Fifty-three articles were found: 14 epidemiological studies, 15 human laboratory experiments, four animal experiments, seven field studies and 13 reviews. Almost all epidemiological studies yielded insufficient information and had methodological shortcomings. Of the reviews, only three were critical. Experimental data support the hypothesis that WBV can have a negative effect on the spine. Epidemiological studies have shown drivers to have an increased prevalence of low back pain, probably in a dose-related fashion. Hence, it is likely that long-term exposure to WBV can contribute to back disorders. Present studies do not allow for a quantitative specification of the association between exposure and effect.

[Treatment of chronic occupational lead poisoning with dimercaptosuccinic acid (DMSA)]. / Behandling af erhvervsbetinget kronisk blyforgiftning med dimerkaptoravsyre (DMSA).

2,3-dimercaptosuccinic acid (DMSA) mobilizes lead from superficial depots. In comparison with other chelating agents, DMSA has a high therapeutic index and has the additional advantage that it can be administered orally. We have used DMSA for treatment of chronic occupational lead poisoning in a 54-year old male with signs of neurotoxic effects. The treatment resulted in a rapid decrease in the blood-lead concentration, followed by a slow increase after the treatment and subsequent stabilization at a blood-lead level lower than prior to treatment. During the first course of treatment, almost 100 mumols lead was excreted in the urine. As a result of successive courses of treatments, the patient's condition was improved. However, during the third course of treatment, he developed a mucocutaneous rash which faded again after withdrawal of DMSA; this reaction was subsequently provoked by sub-therapeutic doses, and continued treatment was therefore cancelled. Only minor, reversible side effects of DMSA have hitherto been reported, and DMSA must therefore be regarded a promising agent for long-term, out-patient chelation treatment of chronic lead poisoning.