John Hobson

The Montreal Cognitive Assessment (MoCA)

O Montreal Cognitive Assessment (MoCA) foi concebido como um instrumento de rastreio breve da disfunção cognitiva ligeira. Este instrumento avalia diferentes domínios cognitivos: função executiva; capacidade visuo-espacial; memória; atenção, concentração e memória de trabalho; linguagem; e orientação temporal e espacial. O tempo de administração é de aproximadamente 10 a 15 minutos. A pontuação máxima é de 30 (pontos).

To die for? The health and safety of fast fashion

Cost-effectiveness of a workplace-based incentivized weight loss program. Association between wellness score from a health risk appraisal and prospective medical claims costs. last accessed). 29. Kouvonen A, Kivimäki m, Virtanen m et al. Effort-reward imbalance at work and the co-occurrence of lifestyle risk factors: cross-sectional survey in a sample of 36,127 public sector employees. If the world wants an image that sums up the true cost of supplying big-name retailers with cheap, fast fashion, it only has to look at the horrifying images that emerged from Dhaka in April 2013. This is now the deadliest garment-factory accident in history [1]. The death toll from the building collapse at the Rana Plaza complex in the Savar district of Greater Dhaka, Bangladesh stands at more than 1100 making it the worlds worst industrial accident since the Bhopal disaster in India in 1984 and worse than the Triangle Shirtwaist Factory fire of 1911 that prompted American legislation requiring improved factory safety standards. Since 2005, at least 1800 garment workers have been killed in factory fires and building collapses in Bangladesh alone according to research by the advocacy group International labor Rights Forum [2] and the problem affects many other countries where cheap clothes are manufactured. Prior to the collapse in Bangladesh the factory owners had been repeatedly asked to close the factory because of concerns about the structural safety of the building after cracks appeared and a bank on the second floor of the same building sent its workers home the day before. The building was built three floors higher than it had been designed or licensed for and there were concerns about how building permits were obtained. The Bangladeshi government has publicly acknowledged that as many as 90% of Dhakas high rise buildings do not meet local construction standards, let alone international rules. In the aftermath of the disaster, thousands of workers demonstrated against poor safety standards. The factory supplied clothing companies Primark and matalan amongst others. There have been repeated building collapses in Bangladesh but fire is the greater hazard in clothing factories. In September 2012 two fires on the same day in separate garment factories in Pakistan killed more than 300 workers [3]. Between 300 and 400 workers were inside the first factory when a boiler exploded and the flames ignited stored chemicals. Officials said that all the exit doors in the factory were locked and many of the windows …

Annals of Occupational Hygiene archive online.

The Annals of Occupational Hygiene has put its entire archive from 1958 online and now its past issues can be freely accessed. The Occupational Medicine archive from 1948 onwards is similarly available. Oxford University Press, the publisher of both journals, is gradually digitizing back issues of its catalogue and placing them online. Currently, this includes 169 journals (.50 medical) and encompasses 4 million article pages covering 147 years of publishing. When announcing completion of the Annals archive, a number of significant papers were highlighted. The paper which caught my attention was that on dust control in the asbestos textile industry published in 1959 [1]. Bamblin of Turner Brothers Asbestos, Rochdale, England, examined the advances that had been made in asbestos dust control over the 30 years following publication of the 1930 Merewether and Price report. This report was initiated by the Factory Department of the Home Office and was the first work to scientifically demonstrate a problem. Dr Merewether examined 363 asbestos workers and found a 34% incidence of fibrosis in those who had worked in the more dusty processes for 5 years rising to 85% after 20 years employment. The second part of the report by Price made engineering recommendations to reduce dust exposure through enclosure, extraction and mechanization to avoid manual handling of dust. As a result in 1931, the Regulations for the Asbestos Industry were introduced under the Factories Act and the rest of the Bamblin paper details the changes Turners implemented as a result. Prior to the changes, the paper notes that when carding engines were cleaned or stripped by hand workers reported that it was not possible to recognize a workmate 6 or 8 feet away. They remembered the gradual improvements as ‘the day when we found we could see across the width of the room’ or finally ‘the day when we could see the clock at the far end of the room’. The paper is illustrated by some fascinating photographs of the processes and machinery to demonstrate the improvements that were introduced. The paper ends with a table showing the incidence of fibrosis in a group of 398 workers employed after 1933 which had fallen to 0.8% overall and 3% in those employed for.20 years. Three men had been suspended for asbestosis by the Pneumoconiosis Medical Panel but were still employed by the factory on other work. The most poignant thing about this paper is that we know what happened next. Regardless of the improvements made by Turners, the industry founder, thousands of people were fatally exposed to asbestos. Turners became part of the infamous Turner and Newall whose successor finally collapsed in 2001 as a result of huge compensation payments. While asbestos was subsequently banned in this country, as recently as 2007 Turnall Fibre Cement products containing asbestos were still being produced in Zimbabwe. John Hobson

Born to Run

Objective realism and compassion merge in this powerful story, an indictment of greyhound racing. Patrick rescues a litter of greyhound puppies from a cruel and deliberate drowning. He instantly falls in love with one of them, which he keeps and names Best Mate. Both boy and dog flourish until the day that Best Mate is kidnapped. The dog is removed to a racing kennels where he is trained to be a champion. Life here is merciless, and the trainer, Craig, treats him as an object of profit, nothing more. Best Mate makes friends with fellow greyhound Alfie, a supreme champion who makes the days more bearable, and Suzie, the trainer?s stepdaughter. She loathes Craig for his brutality, and suspects him of killing the dogs when their racing days are over. When her suspicions are confirmed, she runs away, taking Best Mate, renamed Brighteyes, with her. Though harrowing at times, the story is skilfully resolved through happy outcomes regarding the fate of the characters while ensuring a deep emotional response from the reader. There are parallels to be drawn here with Black Beauty, but the book also explores the animal/human relationship and the healing power that an animal can have on the human psyche. There is nothing sentimental in this story, and the greyhound, vulnerable and innocent, is described with dignity and restraint. The book is finely crafted, the writing almost detached, thus reinforcing the reality and cruelty of the dog-racing industry. The interjection of a first-person narrative as the greyhound brings his own perspective and feelings to the story makes it all the more poignant. Beautifully written, at all times measured, this is a story that will endure.

Swimming with sharks: delivering the occupational health message

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In this issue of Occupational Medicine

This issue of Occupational Medicine has an education theme. Allender and Venables have already published research resulting from their questionnaire survey of occupational health provision in UK universities. This is a significant employment sector with 340 000 employees and .2 million students, many of whom will have occupational health needs similar to those already employed for instance in health care. In the first of two papers [1], they present the characteristics of the occupational health services among the 117 universities included in the study over a 3-year period. Not surprisingly, they found significant variation in service nature and provision. The average service was small, typically one nurse and a doctor half-day per week or a third of the staffing level for the equivalent employed population in the National Health Service. Only half of universities had in-house provision and one in five universities either had no formal provision or relied on campus medical services which are unlikely to offer specialist expertise. Worryingly, a number of universities did not have a mechanism for core services such as management or selfreferral. In a second paper [2], they examine the reasons for the wide variation in staffing levels and found, not surprisingly, that a third of the variation was explained by university size. However, after adjustment for other factors neither research activity nor high-need disciplines such as health care studies appeared to explain the amount of investment made by universities in their occupational health provision. While the authors welcome updated governmental guidance published by the Health and Safety Commission in 2006, they feel that more focused guidance is required on specific topics such as staffing and core functions. They suggest that this could be developed by relevant bodies and point to the important role of HEOPs, the recently formed special interest group on higher education. This model has worked very well in local authority for instance (ALAMA), but it doesbegthe question as towhymanyemploymentsectors effectively rely on voluntary initiatives to enable development of important services such as occupational health. The occupational health of those who educate us is examined further in two papers looking at the occupational health of teachers [3,4]. In a study of almost 500 non-university teachers in Spain, Moreno-Abril and colleagues found workload, poor job satisfaction and female sex to be associated with psychiatric morbidity. However, personality characteristics and a negative perception of the workplace were strong influencing factors in determining cases. And if the strain in Spain is mainly on the brain, O’Connell finds the same in Ireland where the commonest reason for ill-health retirement in Irish schoolteachers is mental ill-health. His finding that 46% retired for these reasons is similar to Bavarian head teachers (45%) and Scottish teachers (37%). Elsewhere in this issue, we have papers reviewing occupational causes of dental erosion [5] and the relationship between smoking and injury in newly recruited marines [6]. Finally we take a look at the Epworth Sleepiness Scale but hope that this issue would not contribute to your score!