Psychosocial and clinical risk factor profiles in managers.

OBJECTIVES: Over the past 10 years the IAS Foundation has performed more than 15,000 PREVENT check-ups on managers. In addition to a comprehensive clinical program of preventive examinations, the main emphasis is placed on extensive counseling. This counseling centres not only on personal behaviour patterns affecting the individual's health, but also on the psychomental capabilities of the patient within the context of the psychosocial stresses in managerial positions. METHODS: Three cross-sectional studies examined: (1) the major cardiovascular risk factors (n = 974), (2) the psychosocial structure (n = 2,800) and (3) the relationships between clinical risk factors and psychological structural features (n = 200). RESULTS: According to expectations, managers showed somewhat lower cardiovascular risk levels than did other professional groups. However, nearly 70% of them reported various unspecific, psychovegetative complaints. Managers were subdivided into four psychological types, each representing roughly one quarter of the series: Type 1: anxiety, tension (20.5%); Type 2: repression, lack of self-control (22.2%); Type 3: challenge, ambition, self-control (27.6%); Type 4: healthy living, with self-control (29.7%). Type 3 resembles most closely classic type A behaviour and is seen in a good quarter of the overall cohort. This may indicate that not only people showing type A behaviour are predestined to occupy managerial positions, but that people with a type B structure also take up managerial positions. It is, however, in particular the type B behavioural patterns that are also associated with increased psychovegetative complaints. The relationships between psychosocial structural variables and clinical risk factors such as hypercholesteremia and high blood pressure are not very strong. CONCLUSIONS: Occupational health measures in organisations should also be established for managers, as they present an important employee group within the enterprise. In addition to examining them for cardiovascular risks, counseling and coaching programmes on preventive measures and recommended behaviour at work should be a primary concern.

[Rate of absenteeism--value and modification by work disability data]. / Die Fehlzeitenquote--Aussagekraft und Beeinflussbarkeit von Arbeitsunfähigkeitsdaten.

Data on pre-retirement invalidity and incapacity to work are simple process-data gathered from routine procedures within our social system. It is therefore an obvious step to use them in describing the prevalent morbidity and relations between work and the incidence of illnesses. However, closer examinations have shown that the analysis of such secondary data does not provide particularly well-founded results, especially regarding causal relations between work itself and the so-called work-related diseases. All in all, the rate of incapacity for work is a product of illness, personal well-being, individual attitude towards work, and the social environment. The latter is influenced in particular by the management and organisational structures within a company. Therefore, few of the programmes designed to reduce the rate of incapacity to work have any great effect. They aim at the symptoms without really tackling the real causes. Low rates of incapacity to work accompanied by a lasting improvement in the overall productivity of the whole staff can only be achieved by a organisational culture that is based on raising motivation, personal well-being, and health.

[Cost-benefit analysis of practical occupational medicine service]. / Kosten-Nutzen-Analyse der praktischen arbeitsmedizinischen Tätigkeit.

Cost problems in business, industry and government service force everyone to probe into the economy of traditional patterns of work and procedures. Occupational medicine is no exception. However, there has been a lack of criteria for assessing the economic aspects of occupational medicine. We are therefore suggesting an approach. Caring for the "human capital" factor is a cornerstone of free socioeconomy. Workers should not only be suitably qualified for their job but there must be the smallest possible minimum of absenteeism. Occupational medicine can do something to positively influence the following factors: by preventing incapacity to work by preventing job accidents and professional diseases by reducing the time required to cover distances between or within workflow phases or stages by reducing waste of time by waiting. Model calculations, based on highly plausible basic postulates, show that fully integrated occupational medical services are throughout economic and cost-saving. Using a concrete example, we arrived at a cost/benefit ratio of 1:2 while confining ourselves to benefits attainable within a relatively short time. We ignored other, future benefits requiring certain preventive measures, as well as other parameters that are difficult to assess, such as corporate identity. At present occupational medicine faces a certain amount of identity crisis which should not be counteracted by pointing to legislation that justifies its existence, but rather by proving that it is indeed highly economical because it saves time and money.

External and internal antimony exposure in starter battery production.

In the production of lead batteries two antimony compounds occur: in the casting of grids antimony trioxide (Sb2O3), and in the formation of lead plates stibine (SbH3). Seven workers from the grid-casting area and 14 workers from the formation area were examined with regard to the antimony concentration in blood (Sb-B) and urine (Sb-U). Antimony air concentrations (Sb-A) were measured by means of personal air samplers. Urine samples were collected at the end of the working week, at the beginning (U1) and the end (U2) of the shift, and at the beginning of work following a weekend without Sb exposure (U3). At U2 among the casters, the median Sb-A exposure was 4.5 (1.18-6.6) micrograms Sb/m3 and among the formation workers, 12.4 (0.6-41.5) micrograms Sb/m3. The exposure in both groups is more than 10 times lower than the present threshold limit values. The median Sb-B concentrations in the preshift samples was 2.6 (0.5-3.4) micrograms Sb/l for the casters and 10.1 (0.5-17.9) micrograms Sb/l for the formation workers. The average Sb-U values (U2) were 3.9 (2.8-5.6) micrograms Sb/g creatinine in the casting area and 15.2 (3.5-23.4) micrograms Sb/g creatinine in the forming area. Our investigation indicates that the two antimony compounds show virtually equal pulmonary absorption and renal elimination. The statistically significant correlations between Sb-A/Sb-B and Sb-A/Sb-U form the basis for proposals regarding appropriate biological exposure limits for occupational antimony exposure.

Lead exposure in starter battery production: investigation of the correlation between air lead and blood lead levels.

The threshold limit value (TLV) for lead (in Germany, the MAK value) is based on a certain blood lead concentration (in Germany BAT value = biological tolerance value for working materials) that is not to be exceeded; thereby a statistically significant association between air lead (PbA) and blood lead (PbB) is assumed. On the basis of a 10-year period of (1982-1991) biological and ambient monitoring of 134 battery factory staff and their workplaces, a PbA/PbB correlation with the regression equation PbB = 62.183 + 21.242 x Log 10 (PbA) (n = 1089, r = 0.274, P < 0.001) was calculated. These results are in line with those of several other investigations. The shape of the regression curve and the wide scattering of values led to the assumption that PbA values above the MAK value (0.1 mg/m3) do not necessarily result in increased PbB values. Similarly, PbA values lower than the MAK value do not guarantee PbB levels below the BAT value in every case. These observations are influenced by numerous confounders and intervening variables. It is concluded that lowering MAK values as a consequence of lowering BAT values is not mandatory.

Changes in external and internal lead load in different working areas of a starter battery production plant in the period 1982 to 1991.

Our investigation was based on routine ambient and biological monitoring data in a starter battery production plant from 1982 to 1991. This retrospective longitudinal study included 134 blue collar workers in seven main production areas (casting, lead oxide production, bunker, pasting, formation, plate stacking, assembly). Over the whole period a statistically significant decrease in blood lead concentration in the whole sample, from 48.92 micrograms/dl (1982) to 22.99 micrograms/dl (1991), could be ascertained. This positive trend could also be proven for the most important production areas. The highest internal lead load was present in employees from the formation and adjoining production areas, followed by pasting, casting and assembly. In comparison to other battery factories our results are in the lower range. Furthermore, we carried out a data linkage between air and blood lead concentrations. We were able to demonstrate a decrease in external lead load in most of the production areas, but this reduction was not so distinct as that in the blood lead concentration. These results indicate the efficiency of preventive efforts in technical work protection and especially in intensive medical supervision of the exposed workers. Influencing personal hygienic behaviour and intervention at blood lead levels of 50 micrograms/dl promises the best success in worker protection.

Identification and prevention of work-related diseases and premature incapacity.

In many cases, the increasing knowledge about the causes of occupational diseases has led to improved preventive actions at the working place. This made it possible to achieve a general decrease in the incidence of occupational diseases--except for some illnesses such as asbestos-related and obstructive lung diseases. An opposite trend can be noticed in the field of work-related illnesses, which especially includes cardiovascular, psychiatric and psychovegetative diseases, and musculoskeletal disorders. In contrast to the occupational diseases, in this context work factors are only of less importance and interact with intrapersonal, social and environmental aspects. Since the associations between the working world and the disease are normally too weak due to the multiple causes involved, what is therefore required for researching these multifactorial relationships are most sensitive epidemiological examination methods including large populations and at the same time avoiding or controlling bias and confounding. Most of the recent studies are based on secondary evaluations of already existing data (premature incapacity, inability to work, results from special preventive checks at the working place). Although this leads to large populations, a considerable bias is caused at the same time since these data in most cases are collected for administrative purpose rather than for epidemiological reasons. Moreover, when looking at the different load factors, only the work aspects are mainly taken into consideration, which leads to considerable confounding due to the omitted other concurring causes. Thus, most of the associations discovered so far are not strong enough to allow for a general deduction of special preventive measures at the working place. For further investigation of these relationships, prospective cohort and intervention studies are therefore required.

[Social dependence of early retirement statistics]. / Zur Sozialabhängigkeit der Frührentenstatistik.

In the current discussion of health care policy, the trend in early retirement figures is frequently taken as an indicator of the efficiency of the health care services in our country, or of the disease promoting factors at the workplace. The present study shows that no such direct monitoring of these two problem complexes by reference to the early retirement figures is possible. On the contrary, the high degree of dependence of these figures on social factors is demonstrated. The development of early retirement figures substantially depends on supreme court legislation, job market situation and exceptional demographic alterations. These and others reservations make the invalidity figures basically unsuitable for tracing developments in health care policy.

The influence of passive smoking on pulmonary function--a study of 1,351 office workers.

Until now it has been difficult to ascertain how much passive inhalation of tobacco smoke affects bronchopulmonary function. To answer this question, an investigation involving 1,351 white collar workers was carried out. Information about active and passive tobacco smoke exposure was obtained by a standardized questionnaire. This made it possible to subdivide the overall group into five subgroups: Never smokers, passive smokers, ex-smokers, current smokers, and other smokers. Forced expiratory vital capacity (FVC) and maximal expiratory flow-volume (MEFV) curves were used for lung function analysis. From these curves FVC, forced mid-expiratory flow (FEF 25/75), forced end-expiratory flow (FEF 75/85), and maximal mid-expiratory flow (MEF 25/75) were determined and standardized for sex, age, height, and body weight. Passive smokers evaluated by this method showed essentially no decrease in parameters describing ventilatory function. It is concluded from the dose-and time-effect relationships obtained in active smokers between the lung function parameters and the duration of tobacco smoke exposure on the one hand and the daily consumption of cigarettes on the other that passive smoking in small doses may have no essential effect on pulmonary function.