TeAM YYePG Digitally signed by TeAM YYePG DN: cn=TeAM YYePG, c=US, o=TeAM YYePG, ou=TeAM YYePG, email=yyepg@msn.com Reason: I attest to the accuracy and integrity of this document Date: 2005.01.06 02:58:29 +08'00' This page intentionally left blank Occupational Health Practice Occupational Health Practice Fourth edition H.A. Waldron PHD MD MRCP FFOM MAE Consultant Occupational Physician Occupational Health Department, St Mary's Hospital, London, UK C. Edling PHD MD Professor Department of Occupational and Environmental Medicine, Uppsala University Hospital, Sweden A member of the Hodder Headline Group LONDON Distributed in the United States of America by Oxford University Press Inc., New York Fourth edition published in Great Britain in 1997 by Butterworth Heinemann. This impression published in 2004 by Arnold, a member of the Hodder Headline Group, 338 Euston Road, London NW1 3BH http://www.arnoldpublishers.com Distributed in the USA by Oxford University Press Inc., 198 Madison Avenue, New York, NY10016 Oxford is a registered trademark of Oxford University Press ©2001 Arnold All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronically or mechanically, including photocopying, recording or any information storage or retrieval system, without either prior permission in writing from the publisher or a licence permitting restricted copying. In the United Kingdom such licences are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London WIT 4LP. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however, it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies' printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN 0 7506 2720 4 3456789 10 Printed and bound in India by Replika Press Pvt. Ltd. What do you think about this book? Or any other Arnold title? Please send your comments to feedback.arnold@hodder.co.uk Contents Contributors Preface to the fourth edition Preface to the third edition Richard Schilling 1911-1997 Preface to the first edition 1 The medical role in occupational health C Edling and HA Waldron 3 Basic toxicology B Hellman 4 Principles of occupational epidemiology O Axelson 5 Risk assessment VT Covello 6 Risk communication VT Covello 1 Survey design KM Venables 8 Sickness absence SJ Searle 9 Biological monitoring: general principles P Hoet, V Haufroid A Bernard and R Lauwerys 10 Biological monitoring and genotoxicity B Hellman 11 Current occupational health problems C Edling vn ix xi xiii xv 12 Cancer in the workplace H Vainio 161 10 18 35 57 82 101 112 126 143 152 13 Male reproductive effects 171 M-L Lindbohm, M Sallmen and A Anttila 14 Pregnancy and work 183 H Taskinen and M-L Lindbohm 15 The management of occupational asthma and hyperreactive airways disease in the workplace 200 P Sherwood Burge 16 Occupational skin diseases 215 P-J Coenraads and C Timmer 17 Musculoskeletal disorders 231 E-P Takala 18 Noise 241 A Kjellberg 19 Psychosocial factors in the work environment - an occupational medicine perspective 257 T Theorell 20 Substance abuse 278 Ch Mellner 21 Preventing occupational injury 283 N Carter and E Menckel 22 Rehabilitation and prevention of work-related musculoskeletal disorders 294 K Ekberg Appendix: Occupational medicine resources on the Internet 303 Index 305 2 Preplacement screning and fitness to work Contributors A Anttila PhD Epidemiologist, Finnish Institute of Occupational Health, Department of Epidemiology and Biostatistics, Helsinki, Finland O Axelson MD Professor of Occupational and Environmental Medicine, University Hospital, Department of Occupational and Environmental Medicine, Faculty of Health Sciences, Linkoping, Sweden A Bernard PhD Industrial Toxicology and Occupational Medicine Unit, Catholic University of Louvain, Brussels, Belgium P Sherwood Burge DIH MFOM FRCP FFOM Consultant Physician; Director of Occupational Lung Disease Unit; Lecturer of Occupational Health, Department of Respiratory Medicine, Birmginham Heartlands Hospital, Birmingham, UK N Carter Department of Occupational and Environmental Medicine, Uppsala University Hospital, Sweden P-J Coenraads MD MPH Professor of Occupational and Environmental Dermatology, Groningen University Hospital, The Netherlands VT Covello PhD Center for Risk Communication, New York, USA C Edling PhD MD Professor, Department of Occupational and Environmental Medicine, Uppsala University Hospital, Sweden K Ekberg PhD Department of Occupational and Environmental Medicine, Centre for Public Health Sciences, Linkoping, Sweden V Haufroid Pharm. Pharmacist, Industrial Toxicology and Occupational Medicine Unit, Catholic University of Louvain, Brussels, Belgium B Hellman PhD Toxicologist, Department of Occupational and Environmental Medicine, Uppsala University Hospital, Sweden P Hoet MD MIH MSc Industrial Toxicology and Occupational Medicine Unit, Catholic University of Louvain, Brussels, Belgium A Kjellberg PhD Professor, National Institute for Working Life, Solna, Sweden R Lauwerys MD DSc Professor of Occupational Medicine and Industrial Toxicology, Catholic University of Louvain, Brussels, Belgium This page intentionally left blank viii Occupational Health Practice M-L Lindbohm DrPH Epidemiologist, Finnish Institute of Occupational Health, Department of Epidemiology and Biostatistics, Helsinki, Finland Ch Mellner MD Medical Adviser, Pripps Brewery AB, Stockholm, Sweden £ Menckel PhD Associates Professor; Specialist in Occupational Health Psychology, National Institute for Working Life, Solna, Sweden M Sallmen MSc Epidemiologist, Finnish Institute of Occupational Health, Department of Epidemiology and Biostatistics, Helsinki, Finland SJ Searle MD MSc MBA FFOM The Post Office, Occupational Health Service, Birmingham, UK E-P Takala MD Specialist in Physiatrics, Finnish Institute of Occupational Health, Musculoskeletal Research Unit, Helsinki, Finland H Taskinen MD Professor of Occupational Health, Department of Occupational Medicine, Finnish Institute of Occupational Health and Tampere University Public School of Health, Helsinki, Finland T Theorell MD PhD Professor and Director, National Institute for Psychosocial Factors and Health, Stockholm, Sweden C Timmer MD Dermatologist, Occupational and Environmental Dermatology Unit, University Hospital, Groningen, The Netherlands H Vainio MD Chief, Unit of Chemoprevention, International Agency for Research on Cancer, Lyon, France KM Venables MD FRCP FFOM MFPHM Senior Lecturer, Department of Occupational and Environmental Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London, UK HA Waldron PhD MD FRCP FFOM MAE Consultant Occupational Physician, Department of Occupational Health, St Mary's Hospital, London, UK TTTTTTTT Occupational medicine is changing, especially in the countries of the western world where exposure to toxic substances has generally been greatly reduced over the years and this has had a consid- erable effect on the types of occupational diseases which are now seen. These days occupational phy- sicians need to know a great deal about stress- related illnesses; they will need a good knowledge and understanding of epidemiology and the man- ifestation of disease in populations; they will be required to know about the causes of museuloske- letal disorders; their knowledge of toxicology will have to encompass the effects of low levels of potentially toxic materials on the central nervous system, on reproduction and on genetic material. They will also need to be informed about the effects of industry on the general environment and on the health of the general population. In this context we, the editors, note that many departments of occupational health are now in the process of renaming themselves as depart- ments of occupational and environmental health. This is a trend which we feel is bound to continue. We have tried to reflect the changes which have taken place in occupational medicine by concen- trating the text on those areas which we consider to be of most relevance to practitioners now and for a few years to come. Thus, there are no chap- ters on what are sometimes referred to as the 'classic' occupational diseases which few occupa- tional physicians are likely to see; we leave this to some other textbooks which seem more concerned to preserve the history of occupational medicine rather than deal with its actuality. Since the objectives of this present edition are completely different from its predecessors, the contents have been thoroughly reviewed and not many of the chapters from the previous edition survive; we have recruited many new authors and, indeed, a second editor. Many of the chapters in the previous edition have been omitted, not because we felt that the information which they contained was of no value, but simply for reasons of space and because there was little to add to what was said then. Readers are, therefore, advised, not to discard the old edition (if they have it), but to use it in conjunction with this one, the two together forming a useful whole. We have directed the book towards the occupa- tional physician rather than towards any of the other professionals who practise occupational health, as they now have textbooks aplenty for their own consumption; we hope, however, that occupational nurses, hygienists and ergonomists may find something of interest in the book, per- haps something of value, and frequently areas for discussion and disagreement. There is not one pure way to practise occupational medicine, and what we present here is one of the many possible ways, one which we consider to be a good reflec- tion of how health and work interact in contem- porary occupations and of how occupational physicians can best preserve the health of those for whom they are responsible. Richard Schilling, the first editor of this book, tells how he was once asked by one of his employ- ers, 'Whose side are you on, doc?' The whole of his life as an occupational physician provided the very [...]... difference between occupational health and occupational medicine is likely to become more distinct The term 'occupational health' will describe the team work carried out at the occupational health unit in a plant, where the tasks on an individual level will be directed towards health screening, * A list of useful addresses on the World Wide Web can be found in the Appendix 8 Occupational Health Practice biological... to those actively engaged in occupational health practice Its aim is to be of direct use to those actively engaged in occupational health practice wherever they may be, and as far as possible, to the problems which may arise from the complex interaction between work and health Suggestions as to how the occupational health professional should deal with perturbations in the health of the worker and workplace... workers' health Over the years there has been a tendency to divide this area of preventive medicine into two separate disciplines: occupational medicine and occupational health Occupational health carries with it the implication of a multidisciplinary health service and team work performed at the plant by, for example, ergonomists, nurses, doctors, hygienists and safety officers By contrast, occupational. .. certainly decrease their access to an occupational health service The solution then may be to increase the training of general practitioners and have a more flexible system of occupational health services in which only the large companies will have an 'old-fashioned' occupational health unit with specialists in occupational medicine The ultimate goal of the occupational health service should be to cover... commitment to achieve these goals The goals of occupational medicine and occupational health remain as they have always been, that is: The medical role in occupational health 9 • to study the health effects of the work environment • to prevent the negative effects of work on health • to promote the positive health effects by which an adequate number of competent occupational physicians are trained To achieve... and nurse actually do to protect and improve the health of people at work has become increasingly obvious to the staff of this Institute Although many books have been written on occupational health, there are none in English which deal comprehensively with its practice We teach the principles of occupational health practice to postgraduate students in occupational medicine, nursing and hygiene, and... at work, the occupational health service should facilitate preventive activities at the workplace It is, therefore, important to increase the access of workers to occupational health services In Sweden, for example, about 80% of the labour force has access to an occupational health service, whereas in the UK the figure is only about 30% The association between workers and the occupational health service... refers solely to the training and work of the occupational physician The doctor is frequently, but not invariably, the manager of the team, but whether this is so or not, it must be clear that only the doctor has the required knowledge and training to pronounce 2 Occupational Health Practice on matters of health - by which is usually meant disease The health effects of exposures, of whatever sort,... where occupational health services have been in situ for many years, very little is known or documented about their impact on the health of the workforce Therefore, the audit of occupational health services must become a priority in the future In a world of shrinking economic resources it is very important to show, in economical terms, the advantages of preventive medicine at the occupational health. .. exposures and health effects In most cases, no other human data on the effect of a certain environmental factor are available other than those obtained from the study of a working population In practice, environmental issues and occupational health The medical role in occupational health issues are often difficult to separate Preventive strategies used in environmental and occupational health are clearly . of this document Date: 2005.01.06 02:58:29 +08'00' This page intentionally left blank Occupational Health Practice Occupational Health Practice Fourth . medical role in occupational health 2 Occupational Health Practice on matters of health - by which is usually meant disease. The health effects