Pulmonary fibrosis and exposure to steel welding fume.

BACKGROUND: Arc welders who have been exposed to high concentrations of steel welding fume for prolonged periods of time may develop pulmonary fibrosis but the nature of the fibrotic changes has been debated over the last 80 years without any clear international consensus. AIMS: To characterize the nature of the pulmonary fibrosis that develops in response to steel welding fume exposure and to provide a working hypothesis that would explain the findings of the existing research, to provide a platform for future research and to inform future occupational and clinical management of welders with pulmonary effects from welding fume. METHODS: Review of the world literature on pulmonary fibrosis and welding of steel in all languages using PubMed, with further secondary search of references in the articles found in the primary search. Google and Reference Manager were used as further confirmatory search tools. RESULTS: Only case series and case reports were found but these provided consistent evidence that the consequence of exposure to steel welding fume at high levels for a prolonged period of time is a type of pulmonary fibrosis similar to, and possibly the same as, respiratory bronchiolitis which eventually develops into desquamative interstitial pneumonia with ongoing exposure. CONCLUSIONS: Steel welding fume may cause an occupational respiratory bronchiolitis which may develop into de squamative interstitial pneumonia with ongoing exposure. This concept may explain the difficulties in interpreting the wider literature on welding fume and lung function at lower exposures and may also explain the increased risk of lung cancer in welders.

Vaccinating welders against pneumonia.

BACKGROUND: In 2011, the Department of Health in England recommended that welders should each receive a single dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23). AIMS: To assess the evidence behind the advice and its practical implications. METHODS: The review was informed by a systematic search in Medline, which related pneumonia to welding and/or exposure to metal fume, and was supplemented using the personal libraries of the authors. RESULTS: There is consistent evidence that welders die more often of pneumonia, especially lobar pneumonia, are hospitalized more often for lobar and pneumococcal pneumonia, and more often develop invasive pneumococcal disease (IPD). It is estimated that one case of IPD may be prevented over a 10-year period by vaccinating 588 welders against pneumococcal infection. CONCLUSIONS: A good case exists that employers should offer PPV23 vaccination to welders and other employees exposed to metal fume. Additionally, reasonable measures must be taken to minimize exposure to welding fume, and welders should be encouraged not to smoke.

Work-related stress and Type 2 diabetes: systematic review and meta-analysis.

BACKGROUND: Work-related psychosocial stress has been hypothesized to increase the individual risk of Type 2 diabetes; however, observational epidemiological studies investigating the association between work-related psychosocial stress and Type 2 diabetes have provided an inconsistent picture. AIMS: To evaluate whether work-related psychosocial stress (defined by a work-related stress model or by long work hours) is associated with the risk of Type 2 diabetes. METHODS: A systematic review of the literature was conducted until March 2010. Studies eligible for inclusion were published observational epidemiological studies of adult participants in community or occupational settings if they had a measure of work-related stress on a validated scale or a measure of work hours or overtime assessed prior to, or at the same time as, assessment of Type 2 diabetes status. Where possible, meta-analysis was conducted to obtain summary odds ratios of the association. RESULTS: We located nine studies (four prospective, one case-control and four cross-sectional). The meta-analyses did not show any statistically significant associations between any individual aspect of work-related psychosocial stress or job strain and risk of Type 2 diabetes. CONCLUSIONS: The specific hypothesis that a working environment characterized by high psychosocial stress is directly associated with increased risk of Type 2 diabetes could not be supported from the meta-analysis.

Aircrew wives and the intermittent husband syndrome.

A survey of commercial airline wives compared aircrew with groundcrew families, using a simple self-rating questionnaire. Aircrew wives were found to have slept significantly less well the night before completion of the questionnaire than groundcrew wives (poorer vs. better: 16/41 aircrew, 5/59 groundcrew, p = 0.02), although aircrew wives showed no difference in sleep during the preceding week. Aircrew wives had a lower sense of well-being than groundcrew wives (poorer vs. better: 12/45 wives, 6/58 groundcrew, p = 0.06), and those less than 40 years of age had a poorer mood (poorer vs. better: 7/21 aircrew, 2/28 groundcrew p = 0.05). The similarities with the intermittent husband syndrome described in oil workers (being like a one-parent family, difficulty in involving the husband in things he has missed whilst away, isolation, and feeling upset and rejected when the husband returns and is tired,) are discussed. The effect on aviator stress, flight safety, and the implications for the general practitioner and airline industry are described. General practitioners need to be aware of the possibility that an aviator's spouse is presenting in the office due to the stresses of her husband's occupation on her life. Airlines need to consider how to minimize the effect of frequent separations on their aircrews' wives and families: in particular using forward planning, not changing rosters at the last moment and encouraging a closer relationship with the airline through involvement in the aviators' work.

Defaulters in general practice: reasons for default and patterns of attendance.

A series of 40 patients in general practice who failed to attend for their appointments were studied to look at their patterns of attendance over the previous five years, together with their reasons for default. The group not only defaulted more often than a group of age and sex matched controls but made significantly more visits to the surgery. Seventeen of the patients increased their default rate as their attendance rate increased over the five year period. The main reasons patients gave for defaulting on the occasion studied were: feeling too ill to attend (eight patients), resolution of symptoms (six) or forgotten/confused appointment time (seven). Four patients were thought by the general practitioner to need a home visit, two of whom were suffering from depression. Further research is needed to define those who would be expected to need a visit.