Implementing ergonomic strategies in the workplace--an occupational health nursing perspective.

1. Failure to recognize the work relatedness of cumulative trauma disorders has contributed to an insufficient emphasis on appropriate ergonomic strategies in many industries. 2. Occupational health nurses have a responsibility to make clear their roles, skills, and contributions as integral members of the ergonomic team. 3. When implementing a comprehensive ergonomic program, the "wins" are most often seen in the gradual steps of continuous improvement. 4. To meet the challenges of the year 2000 and beyond, education is a critical element. This means education of management and employees, community health care providers, nurses in other specialty areas, allied health professionals, regulatory agencies, and others about the broad and diversified roles and contributions of occupational health nurses in ergonomics and other occupational health arenas as well.

Quality assurance through use of a self evaluation tool. Methods of a pilot study.

Quality assurance data from a valid, reliable tool can provide the occupational health nurse with evidence of contributions made to worker health and corporate goals. A committee of occupational health nurses devised a tool for quality assurance measurement. This tool represents a significant beginning. A pilot study was undertaken to test the tool. The tool itself presented barriers to completion. Use of a convenient sample, lack of tool completion, and a low response rate precluded inference or generalization. Creation of an overall design and approach using the research process can facilitate tool development and analysis. The authors encourage the refinement of this tool or the development of others.

Occupational exposure to human immunodeficiency virus (HIV) and hepatitis B virus (HBV) among embalmers: a pilot seroprevalence study.

We performed a serosurvey of 133 embalmers in an urban area where human immunodeficiency virus (HIV) infection is prevalent. Although we found histories of needlesticks to be common, and the seropositivity rate of hepatitis B virus (HBV) (13%) was approximately twice that of a blood donor comparison group, HIV antibody was uniformly absent in 129 embalmers who denied HIV risk factors, and present in one of four with self-described risk behaviors. The risk of HBV infection was higher among embalmers who have worked more than 10 years, relative risk (RR) 16.2 (95% confidence interval 2.1, 126.5), did not routinely wear gloves, RR 9.8 (CI 3.4, 28.5), or are employed in the city of Boston, RR 4.7 (CI 1.8, 12.0).

Soft tissue disorders of the upper extremities.

The incidence of occupationally induced cumulative trauma disorders of the upper extremities appears to be in the rise in the United States. Such disorders account for a significant amount of human suffering, loss of productivity and economic burden. The author defines the problem and its etiology, reviews appropriate screening procedures and the diagnosis, summarizes treatment approaches, and concludes with a discussion of preventative measures that should be considered.

Risk assessment in electronic assembly workers: carpal tunnel syndrome.

Symptoms that develop in workers after repeated mechanical injury may be overlooked until the disability affects their productivity and safety. Modifications in the design of hand-operated tools or adaptations in production ergonomics may prevent further damage and permit affected workers to recover while avoiding the development of repetitive cumulative trauma in workers who are new to the job task. This article describes the results of an on-site survey, a biomechanical analysis, and a special neurologic assessment in an electronic assembly plant and provides a structured approach to worker surveillance and intervention to reduce the risk of carpal tunnel syndrome caused by repetitive motions.

Occupational lead neurotoxicity: improvement in behavioural effects after reduction of exposure.

To evaluate critical exposure levels and the reversibility of lead neurotoxicity a group of lead exposed foundry workers and an unexposed reference population were followed up for three years. During this period, tests designed to monitor neurobehavioural function and lead dose were administered. Evaluations of 160 workers during the first year showed dose dependent decrements in mood, visual/motor performance, memory, and verbal concept formation. Subsequently, an improvement in the hygienic conditions at the plant resulted in striking reductions in blood lead concentrations over the following two years. Attendant improvement in indices of tension (20% reduction), anger (18%), depression (26%), fatigue (27%), and confusion (13%) was observed. Performance on neurobehavioural testing generally correlated best with integrated dose estimates derived from blood lead concentrations measured periodically over the study period; zinc protoporphyrin levels were less well correlated with function. This investigation confirms the importance of compliance with workplace standards designed to lower exposures to ensure that individual blood lead concentrations remain below 50 micrograms/dl.

Long-term follow-up after single toxic exposure to trichloroethylene.

In an earlier report [Feldman and Lessell, 1967], neurologic findings following acute intoxication to trichloroethylene were presented. Facial anesthesia, asymmetric pupillary responses, and electrical evidence of sensorimotor neuropathy accompanied neuropsychological deficits, manifested by difficulty in solving sequential problems and poor memory affecting the acquisition of new information. Twelve years after the initial exposure, patches of hypalgesia over the malar eminences persisted and corneal reflexes remained absent, although sensation in the snout region was totally normal. Neuropsychological test results continued to demonstrate impaired attention and short-term memory as well as diminished visuospatial organization and sequencing, 16 years after exposure. In addition, MMPI profile and interview suggested continued depressive symptomatology. Eighteen years after exposure, findings included paresthesia and hypalgesia in the malar area of the face as well as myokymia of the facial muscles. Facial nerve latency studies were normal as were pattern shift visual evoked responses. The patient continued to have large pupils that reacted asymmetrically to light. In the right eye, contraction was synchronous in all segments of the sphincter. In the left eye, there was segmental contraction, suggestive of a tonic pupil. This report offers evidence of long-term residual oculomotor and ciliary reflex dysfunction as well as impaired neuropsychological performance as a result of acute TCE intoxication.