D Fishwick

Self-reported work-related symptoms in hairdressers

BACKGROUND Detailed studies of current symptoms reported by hairdressers and of the training received to reduce the health risks associated with this work are uncommon. AIMS To document current levels of self-reported health problems in hairdressers, compared to non-hairdressing controls. METHODS An interviewer-led questionnaire recording demographic information, work history, health training levels and the presence of self-reported respiratory, skin, musculoskeletal and non-specific symptoms was administered. RESULTS In total, 147 hairdressers, 86% of whom were female (median age 27 years) and 67 non-hairdressing controls, all female (median age 38 years) were recruited. Following adjustment for age, smoking and years worked, hairdressers reported significantly higher levels of musculoskeletal problems, including work-related shoulder pain (OR 11.6, 95% CI 2.4-55.4), work-related wrist and hand pain (2.8, 1.1-7.6), work-related upper back pain (3.8, 1.0-14.9), work-related lower back pain (4.9, 1.5-15.9) and work-related leg/foot pain (31.0, 3.8-267.4). The frequency of self-reported asthma was similar in both groups (hairdressers 16%, controls 17%) as was chest tightness and wheeze. Work-related cough was significantly more frequently reported in hairdressers than in controls (13.2, 1.3-131.5). While hairdresser training was commonplace, such training did not always appear to have resulted in awareness of potential workplace health risks. CONCLUSIONS This study identified frequently reported musculoskeletal, skin and respiratory symptoms in hairdressers. This points to a need to develop training that not only deals with risk assessment but also informs hairdressers about the health risks of their work.

Work-related symptoms in nail salon technicians

BACKGROUND Nail salons are a rapidly expanding small business sector. Environmental health practitioners have raised concerns about potential health and safety issues. AIMS To establish the extent of work-related health issues reported by nail salon technicians, their knowledge of health and safety regulations and of the products used. METHODS Nail technicians completed a researcher-administered questionnaire, and responses were compared to those of non-exposed office-based control subjects. RESULTS In all, 39 of 588 nail salons approached agreed to participate (7%), with all 71 (100%) of the available nail technicians within these salons completing study questionnaires. The majority of the nail technicians (99%) had received training that had included aspects of health and safety and most reported being aware of the Control of Substances Hazardous to Health regulations (59/70, 84%) and risk assessments (65/70, 93%). Compared to the control group, the nail technicians reported statistically significant increased levels of work-related neck (OR 5.0, 95% CI 1.6-15.6), shoulder (15.0, 3.1-71.8), wrist/hand (3.6, 1.2-10.7) and lower back problems (3.5, 1.0-12.5). Work-related nasal symptoms were also significantly more common in nail technicians (6.2, 1.3-30.7). CONCLUSIONS This study demonstrated a higher prevalence of a range of musculoskeletal problems and respiratory symptoms reported by nail technicians compared to office-based controls. An ergonomic and exposure assessment of work practices in this industry is warranted to identify the working practices associated with these symptoms, in order to inform best practice, supplement industry and regulatory guidance and develop appropriate practical work-based training.

Occupational chronic obstructive pulmonary disease: a standard of care

BACKGROUND Consistent evidence from population studies report that 10-15% of the total burden of chronic obstructive pulmonary disease (COPD) is associated with workplace exposures. This proportion of COPD could be eliminated if harmful workplace exposures were controlled adequately. AIMS To produce a standard of care for clinicians, occupational health professionals, employers and employees on the identification and management of occupational COPD. METHODS A systematic literature review was used to identify published data on the prevention, identification and management of occupational COPD. Scottish Intercollegiate Guidance Network grading and the Royal College of General Practitioner three star grading system were used to grade the evidence. RESULTS There are a number of specific workplace exposures that are established causes of COPD. Taking an occupational history in patients or workers with possible or established COPD will identify these. Reduction in exposure to vapours, gases, dusts and fumes at work is likely to be the most effective method for reducing occupational COPD. Identification of workers with rapidly declining lung function, irrespective of their specific exposure, is important. Individuals can be identified at work by accurate annual measures of lung function. CONCLUSIONS Early identification of cases with COPD is important so that causality can be considered and action taken to reduce causative exposures thereby preventing further harm to the individual and other workers who may be similarly exposed. This can be achieved using a combination of a respiratory questionnaire, accurate lung function measurements and control of exposures in the workplace.

UK asbestos imports and mortality due to idiopathic pulmonary fibrosis.

BACKGROUND Previous studies have demonstrated that the rising mortality due to mesothelioma and asbestosis can be predicted from historic asbestos usage. Mortality due to idiopathic pulmonary fibrosis (IPF) is also rising, without any apparent explanation. AIMS To compare mortality due to these conditions and examine the relationship between mortality and national asbestos imports. METHODS Mortality data for IPF and asbestosis in England and Wales were available from the Office for National Statistics. Data for mesothelioma deaths in England and Wales and historic UK asbestos import data were available from the Health & Safety Executive. The numbers of annual deaths due to each condition were plotted separately by gender, against UK asbestos imports 48 years earlier. Linear regression models were constructed. RESULTS For mesothelioma and IPF, there was a significant linear relationship between the number of male and female deaths each year and historic UK asbestos imports. For asbestosis mortality, a similar relationship was found for male but not female deaths. The annual numbers of deaths due to asbestosis in both sexes were lower than for IPF and mesothelioma. CONCLUSIONS The strength of the association between IPF mortality and historic asbestos imports was similar to that seen in an established asbestos-related disease, i.e. mesothelioma. This finding could in part be explained by diagnostic difficulties in separating asbestosis from IPF and highlights the need for a more accurate method of assessing lifetime occupational asbestos exposure.

Respiratory symptoms in insect breeders

BACKGROUND A number of specialist food suppliers in the UK breed and distribute insects and insect larvae as food for exotic pets, such as reptiles, amphibians and invertebrates. AIMS To investigate the extent of work-related (WR) symptoms and workplace-specific serum IgE in workers potentially exposed to a variety of biological contaminants, including insect and insect larvae allergens, endotoxin and cereal allergens at a UK specialist insect breeding facility. METHODS We undertook a study of respiratory symptoms and exposures at the facility, with subsequent detailed clinical assessment of one worker. All 32 workers were assessed clinically using a respiratory questionnaire and lung function. Eighteen workers consented to provide serum for determination of specific IgE to workplace allergens. RESULTS Thirty-four per cent (11/32) of insect workers reported WR respiratory symptoms. Sensitization, as judged by specific IgE, was found in 29% (4/14) of currently exposed workers. Total inhalable dust levels ranged from 1.2 to 17.9 mg/m(3) [mean 4.3 mg/m(3) (SD 4.4 mg/m(3)), median 2.0 mg/m(3)] and endotoxin levels of up to 29435 EU/m(3) were recorded. CONCLUSIONS Exposure to organic dusts below the levels for which there are UK workplace exposure limits can result in respiratory symptoms and sensitization. The results should alert those responsible for the health of similarly exposed workers to the potential for respiratory ill-health and the need to provide a suitable health surveillance programme.

Health surveillance for occupational asthma in the UK.

BACKGROUND 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. AIMS To identify the overall levels of uptake and quality of HS for occupational asthma within three high-risk industry sectors in the UK. METHODS 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). RESULTS 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. CONCLUSIONS 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.

Artificial stone-associated silicosis in the UK

We read with interest the recent article by Hoy et al highlighting the risk of accelerated silicosis in workers installing kitchen and bathroom worktops.1 The Australian paper noted that artificial stone had been available in Australia since the early 2000s, and identified seven cases of silicosis diagnosed between 2011 and 2016. We were particularly interested by this, as the same type of artificial stone worktops have also been commercially available in the UK for approximately the same time period, yet there have been no published cases of accelerated silicosis from our country. To investigate further, we interrogated the Surveillance of Work-related Occupational Respiratory Disease (SWORD) national reporting scheme database and reviewed the 161 reported cases of silicosis between 2000 and 2017. …

Job satisfaction is more than a fruit basket, health checks and free exercise: Cross-sectional study among 10,000 wage earners:

Aim: Workers who are satisfied with their job are the cornerstones of healthy and productive companies. This study investigated factors associated with job satisfaction in the general working population. Methods: From the 2010 round of the Danish Work Environment Cohort Study, currently employed wage earners (N=10,427) replied to questions about work, lifestyle and health. Multinomial logistic regression controlled for sex, age, job group, smoking, body mass index, chronic disease and general health assessed the association between work factors and job satisfaction (very satisfied and satisfied, respectively, with unsatisfied as reference). Results: Psychosocial work factors – social support from superiors, social support from colleagues and influence at work – had the strongest association with job satisfaction. For example, for high social support from superiors, the odds ratio (OR) for being very satisfied with the job was 12.35 (95% confidence interval [CI] 8.71–17.51). With sedentary work as reference, the OR for being very satisfied with the job for ‘standing and walking work that is not strenuous’ was 1.57 (95% CI 1.06–2.33), while the opposite was seen for ‘heavy and strenuous work’ with an OR of 0.34 (95% CI 0.18–0.62). Only two out of five types of workplace health-promotion offers (physical exercise and healthy diet) were associated with job satisfaction. For example, for offers of physical exercise the OR for being very satisfied with the job was 1.84 (95% CI 1.33–2.55). Conclusions: While psychosocial work factors and to some extent physical work demands are important for job satisfaction, workplace health-promotion offers appear to play a minor role.

Underestimation of spirometry if recommended testing guidance is not followed

Background Lung function measured at work is used to make important employment decisions. Improving its quality will reduce misclassification and allow more accurate longitudinal interpretation over time. Aims To assess the amount by which lung function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]) values will be underestimated if recommended spirometry testing guidance is not followed. Methods Lung function was measured in a population of workers. Knowledge of the final reproducible FEV1 and FVC for each worker allowed estimation of the underestimates that would have occurred if less forced manoeuvres than recommended had been performed. Results A total of 667 workers (661 males, mean age 43 years, range 18-66) participated. Among them, 560 (84%) achieved reproducible results for both FEV1 and FVC; 470 (84%) of these did so after three technically acceptable forced expiratory manoeuvres, a cumulative total of 533 after four, 548 after five, 557 after six, 559 after seven and 560 after eight blows. If only one (or first two) technically acceptable blow(s) had been performed, mean underestimates were calculated for FEV1 of 115.1 ml (35.4 ml) and for FVC of 143.4 ml (42.3 ml). Conclusions In this study, reproducible spirometry was achievable in most workers. Not adhering to standards underestimates lung function by clinically significant amounts.

0024 The occupations at increased risk of copd in the uk biobank cohort

Background Occupational hazards are important, preventable causes of COPD but the high-risk occupations are uncertain. In an analysis of current occupation in the UK Biobank cohort we reported 14 jobs of increased risk (De Matteis, S. et al. OEM 2016). Aims and objectives Our aim was to develop these findings using lifetime job-histories to identify occupations at increased COPD risk, taking into account potential confounders. Methods We used OSCAR, an online tool that automatically codes full job-histories using the UK Standard Occupational Classification (SOC) v.2000 (De Matteis, S. et al. SJWEH 2016). In 2016 we administered OSCAR to all UK Biobank participants with an email address (n=324,653). All paid jobs of >6 months duration, were collated and coded. COPD was spirometry-defined as FEV1/FVC< LLN. Prevalence ratios (PRs) for ever-exposure to each job vs. lifetime office work were estimated using Poisson regression adjusted for age, sex, centre and lifetime smoking. Results Among 116,375 OSCAR-responders, we analysed the 94 551 with acceptable spirometry data and smoking information. Six occupations showed an increased risk of COPD confirmed by positive exposure-response trends, and in analyses restricted to never-smokers and never-asthmatics. In comparison with our findings for current occupation, some associations were confirmed (e.g. food/drink/tobacco processors: PR 1.70;95% CI:1.17–2.48) while others emerged (e.g. plastics processors: PR 1.86;95% CI:1.09–3.17; agriculture/fishing: PR 1.76;95% CI:1.22–2.55). Conclusions In order to focus workplace preventive strategies, we are in the process of applying a job-exposure matrix to identify the underlying occupational respiratory hazards.