Occupational Health Practice This page intentionally left blank Occupational Health Practice Fourth edition H.A. Waldron PHD MD MRCP FFOM MAE Consultant Occupational Physician Occupational Health Department, St Mary's Hospital, London, UK C. Edling PHD MD Professor Department of Occupational and Environmental Medicine, Uppsala University Hospital, Sweden A member of the Hodder Headline Group LONDON Distributed in the United States of America by Oxford University Press Inc., New York Fourth edition published in Great Britain in 1997 by Butterworth Heinemann. This impression published in 2004 by Arnold, a member of the Hodder Headline Group, 338 Euston Road, London NW1 3BH http://www.arnoldpublishers.com Distributed in the USA by Oxford University Press Inc., 198 Madison Avenue, New York, NY10016 Oxford is a registered trademark of Oxford University Press ©2001 Arnold All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronically or mechanically, including photocopying, recording or any information storage or retrieval system, without either prior permission in writing from the publisher or a licence permitting restricted copying. In the United Kingdom such licences are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London WIT 4LP. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however, it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies' printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN 0 7506 2720 4 3456789 10 Printed and bound in India by Replika Press Pvt. Ltd. What do you think about this book? Or any other Arnold title? Please send your comments to [email protected] Contents Contributors vn 12 Cancer in the workplace 161 H Vainio Preface to the fourth edition ix Preface to the third edition xi 13 Male reproductive effects 171 M-L Lindbohm, M Sallmen and A Anttila Richard Schilling 1911-1997 xiii Preface to the first edition xv 14 Pregnancy and work 183 H Taskinen and M-L Lindbohm 1 The medical role in occupational health 15 The management of occupational asthma C Edling and HA Waldron and hyperreactive airways disease in the workplace 200 2 Preplacement screning and fitness to P Sherwood Burge work 10 16 Occupational skin diseases 215 P-J Coenraads and C Timmer 3 Basic toxicology 18 B Hellman 17 Musculoskeletal disorders 231 E-P Takala 4 Principles of occupational epidemiology 35 O Axelson 18 Noise 241 A Kjellberg 5 Risk assessment 57 VT Covello 19 Psychosocial factors in the work environment - an occupational medicine 6 Risk communication 82 perspective 257 VT Covello T Theorell 1 Survey design 101 20 Substance abuse 278 KM Venables Ch Mellner 8 Sickness absence 112 21 Preventing occupational injury 283 SJ Searle N Carter and E Menckel 9 Biological monitoring: general principles 126 22 Rehabilitation and prevention of work-related P Hoet, V Haufroid A Bernard and musculoskeletal disorders 294 R Lauwerys K Ekberg 10 Biological monitoring and genotoxicity 143 B Hellman Appendix: Occupational medicine resources on the Internet 303 11 Current occupational health problems 152 C Edling Index 305 This page intentionally left blank Contributors A Anttila PhD C Edling PhD MD Epidemiologist, Finnish Institute of Occupational Professor, Department of Occupational and Health, Department of Epidemiology and Environmental Medicine, Uppsala University Biostatistics, Helsinki, Finland Hospital, Sweden O Axelson MD K Ekberg PhD Professor of Occupational and Environmental Department of Occupational and Environmental Medicine, University Hospital, Department of Medicine, Centre for Public Health Sciences, Occupational and Environmental Medicine, Linkoping, Sweden Faculty of Health Sciences, Linkoping, Sweden V Haufroid Pharm. A Bernard PhD Pharmacist, Industrial Toxicology and Industrial Toxicology and Occupational Medicine Occupational Medicine Unit, Catholic University Unit, Catholic University of Louvain, Brussels, of Louvain, Brussels, Belgium Belgium B Hellman PhD P Sherwood Burge DIH MFOM FRCP FFOM Toxicologist, Department of Occupational and Consultant Physician; Director of Occupational Environmental Medicine, Uppsala University Lung Disease Unit; Lecturer of Occupational Hospital, Sweden Health, Department of Respiratory Medicine, Birmginham Heartlands Hospital, Birmingham, P Hoet MD MIH MSc UK Industrial Toxicology and Occupational Medicine Unit, Catholic University of Louvain, Brussels, N Carter Belgium Department of Occupational and Environmental Medicine, Uppsala University Hospital, Sweden A Kjellberg PhD P-J Coenraads MD MPH Professor, National Institute for Working Life, Professor of Occupational and Environmental Solna, Sweden Dermatology, Groningen University Hospital, The Netherlands R Lauwerys MD DSc Professor of Occupational Medicine and VT Covello PhD Industrial Toxicology, Catholic University of Center for Risk Communication, New York, USA Louvain, Brussels, Belgium viii Occupational Health Practice M-L Lindbohm DrPH T Theorell MD PhD Epidemiologist, Finnish Institute of Occupational Professor and Director, National Institute for Health, Department of Epidemiology and Psychosocial Factors and Health, Stockholm, Biostatistics, Helsinki, Finland Sweden Ch Mellner MD C Timmer MD Medical Adviser, Pripps Brewery AB, Stockholm, Dermatologist, Occupational and Environmental Sweden Dermatology Unit, University Hospital, Groningen, The Netherlands £ Menckel PhD Associates Professor; Specialist in Occupational Health Psychology, National Institute for H Vainio MD Working Life, Solna, Sweden Chief, Unit of Chemoprevention, International Agency for Research on Cancer, Lyon, France M Sallmen MSc Epidemiologist, Finnish Institute of Occupational KM Venables MD FRCP FFOM MFPHM Health, Department of Epidemiology and Senior Lecturer, Department of Occupational and Biostatistics, Helsinki, Finland Environmental Medicine, Imperial College School of Medicine at the National Heart and Lung SJ Searle MD MSc MBA FFOM Institute, London, UK The Post Office, Occupational Health Service, Birmingham, UK HA Waldron PhD MD FRCP FFOM MAE E-P Takala MD Consultant Occupational Physician, Department Specialist in Physiatrics, Finnish Institute of of Occupational Health, St Mary's Hospital, Occupational Health, Musculoskeletal Research London, UK Unit, Helsinki, Finland H Taskinen MD Professor of Occupational Health, Department of Occupational Medicine, Finnish Institute of Occupational Health and Tampere University Public School of Health, Helsinki, Finland TTTTTTTT Occupational medicine is changing, especially in Since the objectives of this present edition are the countries of the western world where exposure completely different from its predecessors, the to toxic substances has generally been greatly contents have been thoroughly reviewed and not reduced over the years and this has had a consid- many of the chapters from the previous edition erable effect on the types of occupational diseases survive; we have recruited many new authors which are now seen. These days occupational phy- and, indeed, a second editor. Many of the chapters sicians need to know a great deal about stress- in the previous edition have been omitted, not related illnesses; they will need a good knowledge because we felt that the information which they and understanding of epidemiology and the man- contained was of no value, but simply for reasons ifestation of disease in populations; they will be of space and because there was little to add to required to know about the causes of museuloske- what was said then. Readers are, therefore, letal disorders; their knowledge of toxicology will advised, not to discard the old edition (if they have to encompass the effects of low levels of have it), but to use it in conjunction with this potentially toxic materials on the central nervous one, the two together forming a useful whole. system, on reproduction and on genetic material. We have directed the book towards the occupa- They will also need to be informed about the tional physician rather than towards any of the effects of industry on the general environment other professionals who practise occupational and on the health of the general population. In health, as they now have textbooks aplenty for this context we, the editors, note that many their own consumption; we hope, however, that departments of occupational health are now in occupational nurses, hygienists and ergonomists the process of renaming themselves as depart- may find something of interest in the book, per- ments of occupational and environmental health. haps something of value, and frequently areas for This is a trend which we feel is bound to continue. discussion and disagreement. There is not one We have tried to reflect the changes which have pure way to practise occupational medicine, and taken place in occupational medicine by concen- what we present here is one of the many possible trating the text on those areas which we consider ways, one which we consider to be a good reflec- to be of most relevance to practitioners now and tion of how health and work interact in contem- for a few years to come. Thus, there are no chap- porary occupations and of how occupational ters on what are sometimes referred to as the physicians can best preserve the health of those 'classic' occupational diseases which few occupa- for whom they are responsible. tional physicians are likely to see; we leave this to Richard Schilling, the first editor of this book, some other textbooks which seem more concerned tells how he was once asked by one of his employ- to preserve the history of occupational medicine ers, 'Whose side are you on, doc?' The whole of his rather than deal with its actuality. life as an occupational physician provided the very