Ebola Care and Lack of Consensus on Personal Protective Respiratory Equipment.

The Ebola epidemic in West Africa presents a considerable occupational risk to the health personnel involved. The principal mode of virus transmission to health care personnel is through direct contact with the patient, although transmission by aerosols through the air may also occur. Many safety protocols have been suggested relating to personal protection and particularly respiratory protection. It is generally agreed that all health care workers should have easy access to personal protective equipment. However, the degree of respiratory safety escalates from a mask, to an adequate respirator, and finally to a whole body suit with integrated helmet and positive air pressure. Recent publications demonstrate a lack of consensus on the degree of safety necessary. The step from "safe enough" to being "absolutely safe" seems, in most countries, insurmountable because of costs and logistics.

Duties performed by occupational physicians in Norway.

BACKGROUND: Occupational health care for all is a global aim but has not yet been achieved. Further development should be based on knowledge of specific alternative models of occupational health services (OHS). Little is published on different OHS models and work as a physician in these services. AIMS: To describe duties for Norwegian physicians working in two different OHS models: internal and external. In the internal model, the physician is employed in an OHS located at the company served, whereas in the external model, OHS time is shared between several companies and the physician is often located outside the companies. METHODS: A web-based survey was sent to all members of the Norwegian Occupational Medicine Association. RESULTS: There were 206 responses (response rate of 73%). Only those working as OHS physicians were included (54%). Physicians in external OHS performed individual health examinations to a greater extent, otherwise few differences between physicians working in internal and external OHS were found. Changes in the priority of the physicians' duties through a period of 20 years seem to be related to changes in legislation and official guidelines related to OHS practice. CONCLUSIONS: In this study, OHS physicians in Norway performed a large number of individual-based health examinations but this was seen more in the external OHS model. Otherwise physicians' duties had similar priority in the external and internal models. Legislation and official guidelines seem to be of major importance to the duties performed.

Relation of occupational exposure to respiratory symptoms and asthma in a general population sample: self-reported versus interview-based exposure data.

The objective of this study was to examine how the consistency of self-reported exposure to dust or gas, asbestos, and quartz varied between subjects with and those without respiratory symptoms and asthma in a Norwegian community sample () in 1987-1988. Exposure characterization obtained in a structured work history interview was used as the "gold standard." The authors also wanted to assess how the exposure-disease relation differed when the exposure was based on self-reported versus interview-obtained data. The prevalence of self-reported exposure to dust or gas, asbestos, and quartz was 28%, 5%, and 4%, respectively. The sensitivity of the self-reported exposure data varied from 21% to 64% and was higher in those with than in those without the respiratory disorders. The specificity varied from 78% to 100% and was lower in those with than in those without the respiratory disorders. The sex-, age-, and smoking-adjusted odds ratios of the respiratory disorders in those with exposure to dust or gas and to asbestos were only slightly reduced when misclassification was taken into account. The corresponding numbers for exposure to quartz were halved and lost their statistical significance when the misclassification was allowed for. In this general population sample, the self-reported occupational, airborne exposure data were differentially misclassified by disease status.

[Immunoglobulin E, viral antibodies and obstructive lung disease in adults. The relation between antibody level in serum, lung function and non-specific bronchial reactivity]. / Immunglobulin E, virusantistoffer og obstruktiv lungesykdom hos voksne. Forholdet mellom antistoffnivå i serum, lungefunksjon og uspesifikk bronkial reaktivitet.

We have measured immunoglobulin E levels and respiratory virus antibodies and examined their possible role as risk factors for obstructive lung disease in adults. We observed that increased total serum IgE levels were associated with reduced lung function in subjects with obstructive lung disease, but not in asymptomatic subjects. Subjects sensitised to indoor allergens (house dust mites, cats and mould) had reduced lung function and increased, non-specific, bronchial responsiveness compared with individuals who were not sensitised to indoor allergens. Similar relationships were not observed for subjects sensitised to outdoor allergens (birch and timothy). The presence of respiratory virus antibodies was vaguely associated with reduced lung function, but was not related to increased, non-specific, bronchial responsiveness. In adults in this community sensitisation to indoor allergens is a strong predictor of reduced lung function and increased, non-specific, bronchial responsiveness, which are again closely associated with obstructive lung disease.

Educational level and obstructive lung disease given smoking habits and occupational airborne exposure: a Norwegian community study.

The relation of educational level to obstructive lung disease, spirometric airflow limitation, and respiratory symptoms was examined in a two-phase cross-sectional study of a Norwegian general population aged 18-73 years in 1985-1988. The first phase was a questionnaire survey. In the second phase, a stratified sample of those who responded in the first phase was invited to a clinical and respiratory physiologic examination. Altogether, 714 subjects attended, representing 84% of those invited. The prevalences of obstructive lung disease and spirometric airflow limitation were 7.8% and 4.5%, respectively. A total of 18% of the population had completed college, a further 60% had completed secondary school, and 21% had obtained a primary school education alone. The prevalence of both smoking and occupational airborne exposure decreased with increasing educational level. The sex-, age-, smoking-, and occupational exposure-adjusted odds ratio of obstructive lung disease in primary-versus university-educated subjects was 2.9 (95% confidence interval (CI) 1.3-6.5); in secondary- versus university-educated subjects it was 1.4 (95% CI 0.7-2.8). The corresponding values for spirometric airflow limitations were 5.2 (95% CI 2.0-13.4) and 1.8 (95% CI 1.2-2.7). All of the respiratory symptoms except breathlessness grade 2 were significantly associated with educational level after allowing for sex, age, smoking, and occupational airborne exposure. The survey indicates that educational level is a risk factor for airway disorders independent of smoking and occupational airborne exposure.

Respiratory virus antibodies in adults of a Norwegian community: prevalences and risk factors.

BACKGROUND: The aims were to examine prevalences as well as demographic and environmental predictors of respiratory virus antibodies in serum. METHODS: In a cross-sectional study of 18-73 year old Norwegian adults a random stratified sample (n = 1512) was invited to attend an examination at an outpatient clinic. Seven respiratory virus antibodies were assessed by the complement fixation test. RESULTS: The attendance rate was 84%. The most frequent virus antibodies with titre of > or = 1:8 were influenza virus type A with a population standardized prevalence of 44%, adenovirus 25% and influenza virus type B 22%. The prevalences of antibodies against parainfluenza virus type 1, 2 and 3 increased with age. Smokers compared to non-smokers had an adjusted odds ratio (OR) of 1.7 (95% confidence interval [CI]: 1.3-2.4) for having one or more of the seven examined virus antibodies. The presence of one or more of the virus antibodies increased from summer to winter months (adjusted OR = 1.3 per month; 95% CI: 1.2-1.4) and it was higher in occupational dust or gas exposed smokers (adjusted OR = 2.0; 95% CI: 1.1-3.7) compared with unexposed smokers. CONCLUSIONS: Ageing, smoking, occupational dust or gas exposure as well as season of the year may thus be predictors for levels of respiratory virus antibodies in adults. These observations should be taken into account when comparing prevalences of virus antibodies in various communities as well as when examining the relationship between presence of virus antibodies and airway disease.

Total and specific serum IgE levels in adults: relationship to sex, age and environmental factors.

We studied total and specific serum IgE levels cross-sectionally, potential predictors of obstructive lung disease, in a stratified random sample of 18-73-year-old adults (n = 1512). The attendance rate was 84%. The total IgE level and prevalences of specific IgE antibodies against house dust mite and cat were higher for men than for women. Specific IgE levels decreased by increasing age, while total IgE decreased in women only. Smokers had a higher IgE level than non-smokers, while non-smokers had more often specific IgE antibodies against timothy and birch than smokers. Subjects with occupational dust or gas exposure had a higher total IgE level than unexposed. The general population prevalences were for specific IgE antibodies against timothy 4.5%, house dust mite 3.2%, birch 2.6%, cat dander 1.6% mould 0.2% and against any of these 7.6%. In a multivariate analysis age, occupational dust or gas exposure as well as the interaction terms between sex and age and between smoking and pack-years were independent predictors for total IgE levels. Male sex, young age, never having smoked and the season of the year were independent predictors for having one or more of the five specific IgE antibodies. Subjects with total serum IgE in the highest quintile (> or = 66 kU/l) had an adjusted odds ratio of 37 (95% confidence interval: 11-120) for having one or more of the specific IgE antibodies examined, compared with those in the lowest quintile (< 5 kU/l). Demographic and environmental factors were thus predictors of total and specific IgE levels in this adult community.(ABSTRACT TRUNCATED AT 250 WORDS)

[Obstructive lung disease in a Norwegian population group--risk factors and occurrence]. / Obstruktiv lungesykdom i en norsk befolkning--risikofaktorer og forekomst.

In an ordinary Norwegian population which we studied, one in 13 persons suffered from an obstructive lung disease--bronchial asthma or chronic obstructive lung disease. The prevalence of the disease was the same in both sexes, but increased with age. There was a strong association between smoking and the disease. Occupational airborne pollution was an important risk factor. Taking the longest job held as a basis for the study, the adjusted odds ratio for obstructive lung disease in those exposed to a high degree of airborne pollution was 2.5 relative to those not so exposed. There was no difference between urban and rural areas in the frequency of the disease. Allergy and bronchial hypersensitivity were both associated with obstructive lung disease. Greater efforts should be put than at present into preventing obstructive lung disease.

Occupational airborne exposure of the general population of a Norwegian county.

Occupational airborne exposure was examined for a stratified sample (N = 1275) of the general population aged 18-73 years in Hordaland County, Norway. The subjects identified all jobs of more than six months since leaving school and stated whether they had been occupationally exposed to specific agents and work processes potentially harmful to the lungs. The prevalence in the population ever having been exposed was 18% for asbestos, 9% for quartz, 5% for aluminum dust, 6% for wood dust, 12% for metal gases, 12% for welding, 9% for soldering, and 1% for hairdressing. According to occupational title (last job), 3% of the population had held a job with a high degree of airborne exposure, 26% a job with moderate exposure, and 70% a job with no airborne exposure. During their worklife both the men and the women tended to leave polluted jobs more often than unpolluted jobs. Occupational exposure to airborne pollutants potentially harmful to the lungs is widespread in this Norwegian general population.

Prevalence of obstructive lung disease in a general population: relation to occupational title and exposure to some airborne agents.

BACKGROUND: The importance of occupational exposure to airborne agents in the development of obstructive disease is uncertain. Studying the relation in a community population has the benefit of reducing the healthy worker effect seen in studies of working populations. METHODS: The prevalence of obstructive lung disease was examined in a Norwegian general population aged 18-73 in a two phased cross sectional survey. In the second phase a stratified sample (n = 1512) of those responding in the first phase was invited for clinical and spirometric examination (attendance rate 84%). Attenders were asked to state all jobs lasting greater than 6 months since leaving school and to say whether they had been exposed to any of seven specific agents and work processes potentially harmful to the lungs. RESULTS: The prevalence of asthma and chronic obstructive lung disease was 2.4% and 5.4%, respectively; spirometric airflow limitation (FEV1/FVC less than 0.7 and FEV1 less than 80% of predicted values) was observed in 4.5% of the population. All jobs were categorised into three groups according to the degree of potential airborne exposure. Having a job with a high degree of airborne exposure increased the sex, age, and smoking adjusted odds ratio for obstructive lung disease (asthma and chronic obstructive lung disease) by 3.6 (95% confidence interval 1.3 to 9.9) compared with having a job without airborne exposure; the association with spirometric airflow limitation was 1.4 (0.3 to 5.2). Occupational exposures to quartz, metal gases, aluminium production and processing, and welding were significantly associated with obstructive lung disease after adjusting for sex, age, and smoking habit, the adjusted odds ratios varying between 2.3 and 2.7. Occupational exposure to quartz and asbestos was significantly related to spirometric airflow limitation in people older than 50. CONCLUSION: Occupational title and exposure to specific agents and work processes may be independent markers of obstructive lung disease in the general population.

Occupational dust or gas exposure and prevalences of respiratory symptoms and asthma in a general population.

The relationship of occupational airborne, exposure to respiratory symptoms and asthma was examined using a self-administered questionnaire in a cross-sectional survey of a random sample (n = 4,992 subjects) of the general population aged 15-70 yrs of Hordaland county, Norway. The response rate was 90%. Twenty nine percent of the population had a history of occupational dust or gas exposure, 5% reported having been exposed to asbestos at work, and 4% reported quartz exposure. A history of occupational dust or gas exposure was associated with morning cough, chronic cough, phlegm when coughing, breathlessness on exercise, occasional wheezing and a physician's diagnosis of asthma after adjusting for sex, age, smoking habits and urban-rural area of residence. The adjusted relative odds ratios for the respiratory disorders in subjects exposed to dust or gas ranged from 1.6-1.9. The population attributable risk of occupational dust or gas exposure for the respiratory disorders ranged from 11-19%. The study indicates that respiratory disorders are independently associated with occupational airborne exposure in a Norwegian general population sample.

Postal survey on airborne occupational exposure and respiratory disorders in Norway: causes and consequences of non-response.

STUDY OBJECTIVE: The aim was to examine causes for non-response in a community survey, and how non-response influences prevalence estimates of some exposure and disease variables, and associations between the variables. DESIGN: This was a cross sectional questionnaire study with two reminder letters. The questionnaire asked for information on smoking habits, occupational airborne exposure and respiratory disorders. SETTING: A random sample of 4992 subjects from the general population aged 15-70 years of Hordaland County, Norway. MAIN RESULTS: The overall response rate was 90%, with a 63% response to the initial letter. The response rates to the first and second reminder letters were 56% and 36% respectively. In 20% of the non-respondents an uncompleted questionnaire was returned with cause for non-response; in two thirds of these the cause for non-response was that the subject was not resident at the mailing address. A home visit to a random sample of 50 urban non-respondents provided further information on 29 subjects. A wrong address at the Central Population Registry and the subject's feeling of lack of personal benefit from a postal survey were the major reasons for non-response. Smokers were late respondents and subjects with respiratory disorders tended to be early respondents. CONCLUSION: The main reasons for non-response were a wrong mailing address and a feeling of lack of personal benefit from responding. Using only the initial letter would have changed the estimated prevalence of smokers from 39% to 35%. Otherwise, the estimated prevalence of the exposure and disease variables as well as the associations between them were only slightly changed after including the respondents to the first and second reminder letters.

Smoking habits and lifetime occupational exposure to gases or dusts, including asbestos and quartz, in a Norwegian community.

Past or present occupational airborne exposure was recorded with a self-administered questionnaire sent to a random sample (N = 4992) of the 15- to 70-year-old population of Hordaland County, Norway. Completed questionnaires were returned by 90% of the sample. The respondents comprised 39% smokers, 20% ex-smokers, and 41% nonsmokers. Altogether 46% of the men and 12% of the women had a history of occupational gas or dust exposure. Occupational asbestos exposure was reported by 10% of the men and 0.4% of the women, and quartz exposure had been experienced by 8% of the men and 0.4% of the women. Smokers with a history of asbestos exposure represented 5% of the male population. Thirty percent of the smokers reported having been advised to stop smoking by a physician. The asbestos-exposed smokers had not received such advice more often than the smokers not exposed to asbestos. The findings indicate that airborne occupational exposure is widespread in the Norwegian County of Hordaland.

[Doctors' assessment of occupational injuries. Regulations and working methods]. / Legenes oppgaver i yrkesskadesaker. Regelverk og arbeidsmåter.

Many medical practitioners deal with occupational injuries and diseases. Norwegian employees, military servicemen, fishermen, students and schoolchildren are entitled to specific social insurance benefits in the event of occupational injury (injury at school) or occupational disease. In most cases the social insurance office requires a medical assessment from the doctor. Adequate knowledge of the social insurance regulations and good working methods for medical assessment contribute to fair administrative decisions and help the doctor to deal with such cases. The authors present the part of the regulations most relevant for medical practitioners, and describe suitable working methods.

[Occupational pneumoconiosis and x-ray check-ups performed by the National Board of Occupational Protection]. / Yrkesrelatert støvlungesykdom og Arbeidstilsynets røntgenkontroll.

In Norway the Directorate of Labour Inspection's pneumoconiosis panel consists of two radiologists. Pneumoconioses are notifiable diseases, and doctors are required by law to notify suspected and confirmed cases to the Directorate of Labour Inspection. Chest films are sent to the Directorate. The pneumoconiosis panel reads and classifies the cases according to ILO-standards. During a 9 months' period, 177 chest films were examined, 162 of which were from persons exposed mainly to asbestos. In this group of 162, 96 persons had parietal pleural plaques only, and 21 or 17% had pleuropulmonary asbestosis with visceral pleural thickening from which fibrous streaks radiated into the lung. Ten persons had pulmonary asbestosis alone or combined with pleural plaques. This group included one mesothelioma. The notification form used by the doctors demands adequate information on occupational history and exposures. More specific information would facilitate the work of the panel.

[The Kings Bay accident, November 5, 1962]. / Kings Bay-ulykken 5. november 1962.

The Kings Bay Coal Company at Spitzbergen was taken over by the Norwegian government in 1933. The rough arctic conditions caused many difficulties. Over the years, the coal mine had already experienced some explosions when the disaster struck in 1962. 21 miners were killed. The disaster was investigated by two governmental commissions. Little by little, more and more attention was paid to the fact that the employer and owner was the government. The final commission accused the employer of violating the working environment and safety regulations. The disaster was debated in the Norwegian parliament in 1963. The Labour Government had to resign on a vote of no confidence. But what was the working environment at Kings Bay like? Were the accusations of violations of regulations substantiated? The direct cause of the disastrous explosion has never been identified.