Building healthy construction workers: Their views on health, wellbeing and better workplace design.

Construction is a heavy manual industry where working into later life can be a challenge. An interview study was conducted to explore workers' understanding of their health at work and ways of making their jobs easier, safer or more comfortable. Using purposive sampling, 80 trades' workers were selected from construction sites in the UK. The Nordic Musculoskeletal Questionnaire and Work Ability Index were used to explore aches and pains and reducing strain on the body. A high prevalence of symptoms was reported and ratings of work ability were high. Workers were aware of the physical demands of their work and had over 250 ideas around health and wellbeing e.g. rucksacks for tools, bespoke benches, adapting PPE, and higher cost solutions e.g. mechanical lifting aids. Engagement of the workforce should be encouraged and feed into change processes in the industry to enable all workers stay fit for work for longer.

Contributing factors in construction accidents.

This overview paper draws together findings from previous focus group research and studies of 100 individual construction accidents. Pursuing issues raised by the focus groups, the accident studies collected qualitative information on the circumstances of each incident and the causal influences involved. Site based data collection entailed interviews with accident-involved personnel and their supervisor or manager, inspection of the accident location, and review of appropriate documentation. Relevant issues from the site investigations were then followed up with off-site stakeholders, including designers, manufacturers and suppliers. Levels of involvement of key factors in the accidents were: problems arising from workers or the work team (70% of accidents), workplace issues (49%), shortcomings with equipment (including PPE) (56%), problems with suitability and condition of materials (27%), and deficiencies with risk management (84%). Employing an ergonomics systems approach, a model is proposed, indicating the manner in which originating managerial, design and cultural factors shape the circumstances found in the work place, giving rise to the acts and conditions which, in turn, lead to accidents. It is argued that attention to the originating influences will be necessary for sustained improvement in construction safety to be achieved.

Manual handling of highway kerbs--focus group findings.

The manual handling of concrete highway kerbs remains commonplace in the construction industry despite obvious risks to operatives. This study was undertaken to find out why kerb installation still includes manual handling, to identify the alternatives that exist and to consider how the organisation of the work affects exposure to risk. Focus groups were held with industry professionals to discuss kerb design, installation and the training of operatives, with site visits and interviews undertaken to place the focus group findings in context. The focus group discussions highlighted manufacturer's "myopia", a lack of installation knowledge of designers and shortfalls in training for installation work. It was concluded that risks to the health of construction workers remain as they are not considered in the design of the product, design of the work or ameliorated by adequate risk assessment. Recommendations from the research are that a pro-active approach to health needs to be adopted by the manufacturers of heavy construction products. Designers of work requiring the use of heavy products need to have more experience of site operations, and education and training in manual handling is desirable at all levels in construction organisations.

The role of radiation in delayed hearing loss in nasopharyngeal carcinoma.

Although radiation damage to the inner ear can be induced experimentally in animals, its incidence in humans as a complication of therapy for nasopharyngeal carcinoma (NPC) remains a matter of conjecture due to inadequate histological validation. A case of advanced NPC with a mixed conductive and neurosensory hearing loss is presented that at necropsy showed tumour invasion of the VIIIth cranial nerve in the internal auditory meatus with associated infection. The architecture of the organ of Corti was well-preserved despite heavy doses of radiation but degeneration, the cause of which could not be substantiated, was present in the auditory nerve pathway. A diagnosis of radiation damage to the end-organ of hearing in the absence of supporting histological evidence should be made with caution.

Case studies of occupational health management in the engineering construction industry.

Construction workers are exposed to considerable hazards carrying a health risk, e.g., dusts, fumes, noise and manual handling, yet there is often poor occupational health service provision particularly for subcontracted labourers. This paper presents seven case studies from large, engineering construction organizations, concerning current practice in occupational health management. The results supported the fact that data and records regarding health-related absence were limited and inconsistent, and that little existed in terms of medicals and health surveillance, particularly in the case of subcontracted workers. The main difficulties envisaged were reported to be the sizeable costs involved; the temporary and mobile work force; demonstrating cost-benefits to top management and a lack of interest amongst workers, perhaps exacerbated by the threat of lost livelihood. Managers also admitted limited health expertise and knowledge of the wider role health professionals could play in health management. Training and further research in this area are indicated.

Vancomycin administration in continuous ambulatory peritoneal dialysis: the risk of ototoxicity.

A prospective study was undertaken in 16 patients with chronic renal failure on continuous ambulatory peritoneal dialysis, with 22 episodes of peritonitis treated with vancomycin, a known ototoxic agent. Twelve patients had one episode each, and four had recurrent peritonitis. Each treatment course consisted of two infusions of vancomycin (30 mg/kg body weight) in 2 L of peritoneal dialysate administered at 6-day intervals. Serum vancomycin analyzed by enzyme immunoassay showed a mean trough level of 11.00 microg/ml on day 6 and mean serum levels of 33.8 and 38.6 microg/ml about 12 hours after administration on days 1 and 7, respectively. Similar levels, well within the therapeutic range, were encountered with repeated vancomycin therapy for recurrent episodes of peritonitis, suggesting that no changes occurred in the pharmacokinetic profile of the drug. Pure-tone audiometry, electronystagmography, and clinical assessment performed during each course of treatment showed no evidence of ototoxicity even on repeated courses of vancomycin therapy. The results suggest that vancomycin therapy when given in appropriate concentrations as a single therapeutic agent is both effective and safe. We believe, however, that vancomycin administered in combination with an aminoglycoside may produce ototoxic effects that may be greatly aggravated, possibly because of synergism.

The Singapore swing.

The use of a rotation pedicled flap, entitled the 'Singapore Swing', comprising temporalis fascia and mastoid periosteum, is presented as a new method of promoting healing in 'open' mastoid surgery for chronic ear discharge. Cadaver studies show that the main blood supply of the flap is derived from a branch of the postauricular artery which enters the pedicle near the mastoid tip. A review of the first 14 operations showed complete healing with dry ears and intact tympanic membranes in all instances, three cases requiring secondary grafting of residual perforations. We consider the results sufficiently encouraging to merit an extended trial of the technique.

How I do it: an improved temporal bone holder.

Although some form of temporal bone holder is in use in virtually all ENT postgraduate teaching departments, a paucity of information in the literature may cause problems in selecting the most appropriate model to those responsible for equipping temporal bone laboratories. The bone holder which we describe is based on existing designs but incorporates a built-in irrigation system which offers considerable advantages to the unassisted operator.

Surgical treatment of tympanosclerosis.

Tympanosclerosis as a cause of conductive hearing loss may require corrective surgery in carefully selected cases, although results of treatment have been controversial and must be viewed with caution. Currently available surgical techniques are reviewed and outcomes discussed.

Current considerations in the etiology and diagnosis of tympanosclerosis.

Current concepts of formation of tympanosclerosis in the middle ear are reviewed, as are various clinical considerations. Ultrastructural changes are discussed. A differential diagnosis includes disorders affecting middle ear sound conduction, with the most prevalent involving otosclerosis and cholesteatoma.

Gentamicin ototoxicity in continuous ambulatory peritoneal dialysis.

A prospective study was undertaken of 10 chronic renal failure patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) complicated by repeated bouts of peritonitis treated with gentamicin. Each 10-day treatment course consisted of a 120 mg loading dose, followed by 16 mg in 21 of peritoneal dialysate, given four times a day. Serum gentamicin analysed by enzyme immunoassay showed a mean level of 5.2 micrograms/ml, (range 3.7 to 6.6 mg/ml) four hours after the loading dose. Similar levels, well within the therapeutic range, were maintained on the 3rd, 5th, 7th and 9th days of intraperitoneal gentamicin therapy, suggesting no accumulation of gentamicin in the serum. Pure tone audiometry, electronystagmography and clinical assessment were performed during each course of treatment. Although no evidence of ototoxicity was found during the first two courses of gentamicin, but disequilibrium and bobbing oscillopsia were present during the third and fourth courses of gentamicin. These findings could be explained by cumulative injury to the vestibular apparatus caused by repeated therapeutic insults.

Plasma catecholamine levels following topical application versus infiltration of adrenaline for nasal surgery.

Plasma catecholamine concentrations were measured after vasoconstrictor solutions were administered either by instillation (Moffett's method) or by submucosal infiltration in twenty patients undergoing elective nasal surgery. Following infiltration with 4.4 ml of 1:80,000 adrenaline and 2% lignocaine, plasma adrenaline concentrations increased by 44.3 times to a peak of 9.9 nmol.l-1 (1813 pg.ml-1) within one minute. In contrast the peak level of adrenaline in the patients receiving Moffett's solution containing 1 ml of 1:1,000 adrenaline was 1.27 nmol.l-1 (232 pg.ml-1) occurring 10 minutes after instillation of the solution. The difference in the adrenaline concentrations between the groups was statistically significant (P less than 0.01). The lack of sympathoneuronal response was confirmed by simultaneous measurements of plasma noradrenaline concentrations, which did not change significantly. The operative field was subjectively assessed to be better in the infiltrated patients and the mean operating time and measured blood loss were less in this same group of patients.

Gentamicin administration via peritoneal dialysis fluid: the risk of ototoxicity.

In a prospective study on 47 patients, 16 mg of gentamicin per two litres dialysate was administered intraperitoneally at every cycle of intermittent peritoneal dialysis, carried out over the course of several days. Serum gentamicin sampling, pure tone audiometry and caloric tests were performed before and during the treatment. The gentamicin levels reached at the end of the thirtieth cycle were observed to be low. In view of this, the risk of acute ototoxicity was considered to be minimal. This was confirmed by the absence of clinical audiometric or vestibulometric evidence of toxicity.

An unusual foreign body presenting in the nasopharynx.

A 24-year-old male, who sustained gross facial injuries as a result of a motor accident, presented six months later on account of unilateral nasal obstruction and foul discharge. A diagnosis of right maxillary sinusitis was made and a right Caldwell-Luc operation was performed. At operation, a piece of wood was discovered in the nasopharynx, partly impacted in the choana, and it was removed. The post-operative course was uneventful. The rarity of nasopharyngeal foreign bodies and the mode of entry was discussed. The maxillary sinusitis was considered to be secondary to the presence of the foreign body.

Mucoepidermoid carcinoma of the trachea (a case report).

A case of mucoepidermoid carcinoma of the trachea in a 26-year-old female is presented. Diagnosis was confirmed by histopathology. On the basis of the clinical and histological picture, the tumour is classified as a low grade mucoepidermoid carcinoma. Conservative surgical treatment was the primary mode of treatment. The patient showed no clinical evidence of recurrence twelve months after local resection of the tumour.

Linear measurements in middle ear surgery.

Present methods of linear measurement in micro-surgical procedures in the middle ear are crude when judged in relation to the delicate structure and functioning of the normal ear. Alternative methods of measurement employing the operating microscope are described. These depend on recording the travel of the microscope between two selected focal points and can be employed in both vertical and horizontal planes. Oblique distances can readily be calculated from the information provided. Minor alterations to existing microscopes would be required to ensure precise recording by electronic or linear methods.

Long-term tympanic ventilation by Per-Lee tube.

The fate of 32 Per-Lee ventilation tubes inserted by a single surgeon for secretory otitis media in children and adults is analysed over a 15-year period. There were no extrusions and 25 tubes were still functional at the time of the survey. The total ventilation time achieved by the 32 tubes was over 157 years. Seven tubes were removed on account of either obstruction or infection. Spontaneous healing of the tympanic membrane was uncertain following removal of the tube and a considerable degree of scarring was inevitable. Hearing improvement occurred while the tube was functioning and there were no cases of hearing deterioration. It is concluded that the Per-Lee tube is a suitable prosthesis for long-term middle-ear ventilation.

The extrusion rate of grommets.

A prospective study was performed to determine the factors influencing the extrusion rate of tympanostomy tubes. Nine hundred thirty-nine tubes were inserted in 589 patients and the extrusion of these tubes was reviewed up to a period of 27 months. The eight tubes used in the survey were the Shepard, Exmoor, Bobbin, Armstrong, Paparella, Shah, Arrow, and collar button. These tubes were inserted in strict rotation, the operator using the designated tube. The position, type of incision, presence of fluid, quality of tympanic membrane, and degree of difficulty of insertion were all recorded at operation. The sex, age, side of operation, and any simultaneous operative procedures were also recorded. The patients were reviewed the day after operation and then every 3 months thereafter until the tube was extruded. A definite pattern was identified for the extrusion of each type of tube. At one end of the spectrum, Exmoor and Shepard tubes were, for the most part, extruded between 6 and 9 months after insertion, while at the other end, most of the collar button tubes were still functioning at 18 months. The design of the tube was the only factor found to be a significant determinant of the extrusion of the tube, although the experience of the surgeon affected the extrusion rate of the Arrow tube. The different dimensions of the Exmoor and collar button tubes are examined and compared.

Myringoplasty (A review of 365 operations).

A series of 365 cases of tympanic membrane repair by the same surgeon is analysed, comparing the results of different techniques and grafting materials. A detailed study of 206 of these cases employing the underlay technique with temporal fascia is reported. In this group a graft take rate of 91.4 per cent in dry ears, and of 89.3 per cent in all cases, was achieved. Various factors liable to influence the success rate are analysed and discussed. No cases of conductive or sensori-neural hearing loss resulting from the operation were encountered.