Non-cancer occupational health risks in firefighters.

BACKGROUND: Firefighters are exposed to a number of different workplace hazards. As a result of this and the perception of increased ill-health symptoms, a systematic review was carried out to identify significant associations. AIMS: To carry out a systematic review of evidence relating to non-cancer occupational health risks in firefighters. METHODS: Systematic literature searches were conducted using a predetermined search strategy that encompassed terms describing the population of interest and health outcomes. Titles and abstracts identified were subjected to an initial screening process using specified guidelines. Included papers were reviewed and data extracted. Additional material, in the form of papers cited by those selected for review, was also obtained and, where relevant, added to the review. Extracted data were then collated into evidence tables to support the narrative review. RESULTS: Relatively few papers were identified that addressed forms of ill-health in firefighters other than cancer. Nine papers were considered covering each of coronary heart disease and respiratory health. Other ill-health outcomes studied were hearing loss (five studies); hip osteoarthritis (two studies); and sarcoidosis (two studies). None of these sets of papers provided conclusive evidence of a consistent relationship between the specified disease outcomes and the occupation as a firefighter; although, in some instances (hearing loss, respiratory health, and hip and knee osteoarthritis), there were limited indications of some effect. CONCLUSIONS: None of the sets of papers reviewed showed any consistent association between the occupation of firefighter and any of a number of non-cancer disease and ill-health outcomes.

Workplace management of upper limb disorders: a systematic review.

BACKGROUND: Upper limb pain is common among working-aged adults and a frequent cause of absenteeism. AIMS: To systematically review the evidence for workplace interventions in four common upper limb disorders. METHODS: Systematic review of English articles using Medline, Embase, Cinahl, AMED, Physiotherapy Evidence Database PEDro (carpal tunnel syndrome and non-specific arm pain only) and Cochrane Library. Study inclusion criteria were randomized controlled trials, cohort studies or systematic reviews employing any workplace intervention for workers with carpal tunnel syndrome, non-specific arm pain, extensor tenosynovitis or lateral epicondylitis. Papers were selected by a single reviewer and appraised by two reviewers independently using methods based on Scottish Intercollegiate Guidelines Network (SIGN) methodology. RESULTS: 1532 abstracts were identified, 28 papers critically appraised and four papers met the minimum quality standard (SIGN grading + or ++) for inclusion. There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms. There was limited, but high quality, evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks. In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms. There was a lack of high quality evidence to inform workplace management of lateral epicondylitis. CONCLUSIONS: Further research is needed focusing on occupational management of upper limb disorders. Where evidence exists, workplace outcomes (e.g. successful return to pre-morbid employment; lost working days) are rarely addressed.

The health safety and health promotion needs of older workers.

AIMS: To evaluate current research on the health, safety and health promotion needs of older workers by identifying age-related change, whether older workers need support and evidence of successful intervention in the workplace. METHODS: Using a systematic review methodology, databases were searched identifying 180 publications. Each publication was reviewed and data were extracted. Evidence was assessed for quality using the three-star system. RESULTS: The review identified that there are a number of age-related physical and psychological changes. However, these changes can be moderated by increased physical activity, intellectual activity and other lifestyle factors. Sensory abilities are also subject to change but some of these can be accommodated via equipment or workplace adjustments. In reviewing accident data, although older workers are at a reduced risk of accidents, they are more at risk of fatal accidents. Ill-health data identify that many chronic diseases can be controlled and adjustments put in place in the work environment. A number of intervention studies were identified but few were of high quality. The research suggests that occupational health intervention can reduce the risk of early retirement from the workplace; health promotion interventions are seen as positive by older workers but it is important to ensure equal access to all workers in such promotions. CONCLUSIONS: The review identified that there are still a large number of research gaps including the lack of longitudinal research; no further analysis on fatal accidents or understanding of the high prevalence of musculoskeletal disorders and stress and anxiety in older workers.

A review of multiple chemical sensitivity.

OBJECTIVE: To review critically the scientific literature on multiple chemical sensitivity (MCS). Definitions of MCS vary but, for this review, a broad definition of MCS was adopted as symptoms in more than one organ system elicited by various unrelated chemicals at very low levels of exposure. METHODS: A systematic literature search identified several hundred references from which key papers were selected. Two questions are considered, does MCS exist and what causes MCS. RESULTS AND CONCLUSIONS: Despite extensive literature on the existence of MCS, there is no unequivocal epidemiological evidence; quantitative exposure data are singularly lacking; and qualitative exposure data are, at best, patchy. There is also some evidence to suggest that MCS is sometimes used as an indiscriminate diagnosis for undiagnosed disorders. Despite this, the collated evidence suggests that MCS does exist although its prevalence generally seems to be exaggerated. Many causal mechanisms have been proposed, some suggesting a physical origin--such as MCS reflecting an immunological overload (total body load)--others favouring a psychological basis--such as MCS symptoms being evoked as part of a conditioned response to previous trauma. The available evidence seems most strongly to support a physical mechanism involving sensitisation of part of the midbrain known as the limbic system. However, it is increasingly being recognised that the psychological milieu of a person can considerably influence physical illness, either through generating a predisposition to disease or in the subsequent prognosis. Work is needed to establish the prevalence of MCS and to confirm or refute selected causal mechanisms.

Influence of intermittency and static components of work on heat stress.

This paper summarizes the results of a series of experiments established to examine the effects of the composition and pattern of physical workload on human heat tolerance and to compare the predictive abilities of a selection of prominent heat stress indices. The experiments were carried out in a climatically controlled chamber and involved mixtures of dynamic (treadmill walking) and static (weight holding) activities as appropriate. The average physiological responses to intermittent dynamic workloads did not significantly differ from those to continuous dynamic work of the same average intensity. However, the average values masked periods of peak physiological loading. The inclusion of a static load component had a negligible effect on the average level of physiological thermal strain. As a consequence, the presence or absence of a static work component did not influence the predictive abilities of the five heat stress indices examined. It was concluded that, where peak loading was unlikely to be a problem, time weighted averaging of workload was a reasonable approach in assessing industrial thermal strain and that heat stress criteria, derived originally for continuous dynamic workloads, were likely to be equally appropriate for intermittent combined workloads. However, care should be taken to ensure that peak loading did not present a health risk to industrial populations carrying out intermittent work in hot environments.

The prevention of back pain from manual handling.

About a quarter of 3-day plus accidents are associated with the manual handling of loads and about a half of these result in low back pain. In response to this major cause of injury, sickness absence and pain, legislation is currently being prepared which will require employers to assess manual handling tasks and to reduce the amount of such handling required. Where it is not possible to remove the need for such handling altogether, then steps must be taken to reduce the risk of injury. This paper briefly describes three approaches which have been promulgated: selection or screening, training and ergonomics. It outlines each approach, concluding that a realistic solution to a specific problem may embody elements of all three.

Manual handling of supplies in free and restricted headroom.

The handling of mining supplies still involves manual lifting and carrying, some of which is, of necessity, carried out in restricted headroom conditions. Laboratory studies previously reported in the literature have shown that a reduction in ceiling height led to a progressive increase in truncal stress as measured by intra-abdominal pressure (IAP). However, such studies involved standard stylised lifting procedures. Whether such effects of restricted headroom occurred when free-style lifting, or if the operator compensated by change in lifting style for the restriction, was not known. The effect of reduced headroom was examined on two handling tasks carried out in a simulated underground roadway using eight mining instructors as subjects. Both handling tasks involved the loading, unloading and carrying of stonedust bags (25-30 kg) into different vehicle types. The expected increase in IAP did not occur in the reduced headroom condition for one handling task and only a slight increase (average 3 mm Hg), corresponding to a 7% reduction in lifting capacity, was found for the second handling task. It appears that the subjects, who were free to adopt any posture and handling method, were able to compensate in some way for the effects of the restricted headroom. The vehicle type had a highly significant effect, both in free and restricted headroom conditions, which highlights the importance of design for manual handling tasks.

Intra-abdominal pressure responses of mineworkers to standard loads.

Intra-abdominal pressure (IAP) has been used as the basis for a series of force limits for manual handling based on a limiting pressure criterion of 12 kPa (90 mm Hg). Measurements of the IAP responses to a series of standard loads were carried out on a group of eight instructors from the British coal mining industry. The results showed that there was a very low probability (.0016 or less) of obtaining an IAP value of 12 kPa or greater from the population represented by our sample. Average responses were 33% lower than would have been expected from previous reports on force limits based on IAP measurements. While more data are necessary in order to confirm the applicability of these findings to the general mining population, the results clearly suggest that greater loads could safely be lifted by mineworkers than can be lifted by the industrial population represented by the guidelines.

Background illumination and its effects on peripheral visual awareness for miners using cap lamps.

The effects on the detection of objects moving in the peripheral field of adding ambient illumination (giving an illuminance of 5 lux) to that provided by a miner's cap lamp were examined in simulated underground conditions. The results indicated that an object moving into the visual field was detected at a significantly wider angle with the 5 lux ambient illuminance than without it and that greater target reflectance also increased the range of peripheral vision.

Hormonal and cardiac response of autistic children to changes in environmental stimulation.

A study was made of physiological responses of autistic children to variations in environmental load in order to examine the under- versus over-arousal dichotomy. More specifically, measures of urinary mucoprotein excretion and mean heart rate and three measures of heart rate variability were compared with matched controls in conditions of normal, high, and low total environmental load. The results suggest that, although behaviorally unresponsive, the autistic children responded physiologically, were generally in a lower state of arousal than the control group, and were labile in response to changes in stimulation.