Early changes in respiratory health in trades' apprentices and physician visits for respiratory illnesses later in life.

OBJECTIVES: An inception cohort of trades' apprentices had rapid declines in lung function (forced expiratory volume in 1 s (FEV(1))) and rapid increases in bronchial responsiveness ( upward arrowBR) over the first 2 years of employment. We used physician visit data to assess respiratory health over the following 13 years. METHODS: Construction painter, electrician, insulator and machinist apprentices beginning at a British Columbia trade school in 1988 were invited to participate and were followed up 2 years later. Subjects were linked to provincial medical databases to examine physician visits for asthma and other respiratory illnesses for the 13 years following. Multivariable models with rapid decline in FEV(1) and rapid increase in BR from years 1 to 3 were constructed. Respiratory symptoms were also examined as predictors of visit rates and meeting a case definition (for asthma or other respiratory illness). RESULTS: The cohort included 281 apprentices (97% are men). Sixteen subjects met the asthma case definition (>or=2 visits coded as asthma in 1 year) and 20 met the other respiratory illness case definition (>or=3 visits for bronchitis, emphysema, respiratory symptoms in 1 year). In models controlling for demographic factors and smoking, subjects with bronchitis symptoms at baseline were more likely to develop other respiratory illness during follow-up (RR 4.4, 95% CI 1.6 to 11.9). Apprentices who developed asthma symptoms over the first 2 years were approximately six times more likely to become asthma cases (95% CI 1.9 to 18.8). Those with a rapid increase in BR were at increased risk of becoming asthma cases (RR 5.5, 95% CI 1.9 to 16.1), as well as having higher asthma visit rates (RR 6.5). Subjects with rapid decline in FEV(1) were 3.2 times more likely to become asthma cases (95% CI 0.8 to 12.1). CONCLUSIONS: Changes in respiratory health early in adulthood, especially increased BR, are associated with respiratory physician visits. These findings are important for workplace screening and prevention and also suggest that physician visit databases are promising research tools in respiratory epidemiology.

Pre-employment and Return to Work Examinations.

The occupational health examination can be a challenging and interesting part of family practice. The pre-employment examination is conducted to ensure that the prospective employee has the physical and mental capacity for the job's demands. It is important to know both the state of the employee's health and the actual work environment, best assessed by visiting the work site. Most difficult decisions can be resolved by good communication with the employee and, with the employee's permission, with the employer.

Rear-end accident victims. Importance of understanding the accident.

Family physicians regularly treat victims of rear-end vehicle accidents. This article describes how taking a detailed history of the accident and understanding the significance of the physical events is helpful in understanding and anticipating patients' morbidity and clinical course. Eight questions to ask patients are suggested to help physicians understand the severity of injury.

Are automobile head restraints used effectively?

Observation of 992 motor vehicles and their drivers revealed that most drivers do not have their head restraints effectively positioned. Improper positioning was more common with adjustable restraints, in commercial vehicles, and among male drivers. Some head restraints could not be adjusted properly. Improvements in headrest adjustment might help decrease morbidity in motor vehicle accidents.