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Abc of Occupational and Environmental Medicine ABC OF OCCUPATIONAL AND ENVIRONMENT OF OCCUPATIONAL This ABC covers all the major areas of occupational and environmental ABC medicine that the non-specialist will want to know about. It updates the OF material in ABC of W ork Related Disorders and most of the chapters have been rewritten and expanded. New information is provided on a range of environmental issues, yet the book maintains its practical approach, giving guidance on the diagnosis and day to day management of the main occupational disorders. OCCUPATIONAL AND Contents include ¥ Hazards of work ¥ Occupational health practice and investigating the workplace ENVIRONMENTAL ¥ Legal aspects and fitness for work ¥ Musculoskeletal disorders AL MEDICINE ¥ Psychological factors ¥ Human factors ¥ Physical agents MEDICINE ¥ Infectious and respiratory diseases ¥ Cancers and skin disease ¥ Genetics and reproduction Ð SECOND EDITION ¥ Global issues and pollution SECOND EDITION ¥ New occupational and environmental diseases Written by leading specialists in the field, this ABC is a valuable reference for students of occupational and environmental medicine, general practitioners, and others who want to know more about this increasingly important subject. Related titles from BMJ Books ABC of Allergies ABC of Dermatology Epidemiology of Work Related Diseases General medicine Snashall and Patel www.bmjbooks.com Edited by David Snashall and Dipti Patel SNAS-FM.qxd 6/28/03 11:38 AM Page i ABC OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE Second Edition SNAS-FM.qxd 6/28/03 11:38 AM Page ii SNAS-FM.qxd 6/28/03 11:38 AM Page iii ABC OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE Second Edition Edited by DAVID SNASHALL Head of Occupational Health Services, Guy’s and St Thomas’s Hospital NHS Trust, London Chief Medical Adviser, Health and Safety Executive, London DIPTI PATEL Consultant Occupational Physician, British Broadcasting Corporation, London SNAS-FM.qxd 6/28/03 11:38 AM Page iv © BMJ Publishing Group 1997, 2003 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publishers. First published in 1997 as ABC of Work Related Disorders This edition published as ABC of Occupational and Environmental Medicine—Second edition 2003 by BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR www.bmjbooks.com British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library The cover shows an scanning electron micrograph of asbestos fibres. With permission from Manfred Kage/Science photo Library ISBN 0 7279 1611 4 Typeset by Newgen Imaging Systems (P) Ltd, Chennai, India Printed and bound in Malaysia by Times Offset SNAS-FM.qxd 6/28/03 11:38 AM Page v Contents Contributors vi Preface vii 1 Hazards of work 1 David Snashall 2 Occupational health practice 6 Anil Adisesh 3 Investigating the workplace 12 Keith T Palmer, David Coggon 4 Fitness for work 17 William Davies 5 Legal aspects 24 Martyn Davidson 6 Back pain 30 Malcolm IV Jayson 7 Upper limb disorders 35 Mats Hagberg 8 Work related stress 41 Tom Cox 9 Mental health at work 45 Rachel Jenkins 10 Human factors 53 Deborah Lucas 11 Physical agents 58 Ron McCaig 12 Noise and vibration 65 Paul Litchfield 13 Respiratory diseases 72 Ira Madan 14 Occupational infections 77 Dipti Patel 15 Occupational cancers 86 John Hobson 16 Occupational dermatoses 94 Ian R White 17 Work, genetics, and reproduction 98 Nicola Cherry 18 Pollution 101 Robert Maynard 19 Global issues 105 Tony Fletcher 20 Occupational and environmental disease of uncertain aetiology 109 Andy Slovak Appendix I: Features of some important occupational zoonoses 115 Appendix II: Important occupationally acquired infections from human sources 118 Index 120 v SNAS-FM.qxd 6/28/03 11:38 AM Page vi Contributors Anil Adisesh Paul Litchfield Consultant in Occupational Medicine, BT Group Chief Medical Officer, Trafford Healthcare and Salford Royal London Hospitals NHS Trusts, and Honorary Clinical Lecturer in Occupational and Deborah Lucas Environmental Medicine, Centre for Head of Human Factors Team, Occupational and Environmental Health, Hazardous Installations Directorate University of Manchester, Manchester Health and Safety Executive, Bootle, Merseyside Nicola Cherry Chair, Department of Public Health Sciences, Ron McCaig University of Alberta, Canada Head of Human Factors Unit, David Coggon Better Working Environment Division Policy Group, Professor of Occupational and Health and Safety Executive, Bootle, Environmental Medicine, MRC Merseyside Environmental Epidemiology Unit, Community Clinical Sciences, University of Ira Madan Southampton, Southampton Consultant Occupational Physician, East Kent Hospitals NHS Trust, Tom Cox Canterbury Professor of Organisational Psychology, Institute of Work, Health and Organisation, Robert Maynard University of Nottingham, Nottingham Senior Medical Officer, Department of Health, Skipton House, London Martyn Davidson Chief Medical Adviser, John Keith T Palmer Lewis Partnership, London MRC Clinical Scientist and Consultant, William Davies Occupational Physician, Consultant Occupational Physician, MRC Environmental Epidemiology Unit, Occupational Health Unit, Community Clinical Sciences, South Wales Fire and Local Authorities, Pontyclun, Wales University of Southampton, Southampton Tony Fletcher Dipti Patel Senior Lecturer, Department of Public Consultant Occupational Physician, Health and Policy, London School of Hygiene and British Broadcasting Corporation, Tropical Medicine, London London Mats Hagberg Andy Slovak Professor, Chief Physician, and Director, Company Chief Medical Officer, Department of Occupational and Environmental British Nuclear Fuels plc, Warrington, Medicine, Sahlgrenska Academy at Gothenburg Cheshire University and Sahlgrenska University Hospital, Gothenburg, Sweden David Snashall Senior Lecturer in Occupational John Hobson Medicine, Guy’s, King’s and St Thomas’s Consultant Occupational Physician, School of Medicine, London; Honorary MPCG Ltd, Stoke on Trent Consultant and Head of Service, Malcolm IV Jayson Occupational Health Department, Guys’ Emetrius Professor of Rheumatology and and St Thomas’s Hospitals NHS Trust, Professorial Fellow, University of London; Chief Medical Advisor, Health Manchester, Manchester and Safety Executive, London Rachel Jenkins Ian R White Director of WHO collaborating Centre, Consultant Dermatologist, Institute of Psychiatry, St John’s Institute of Dermatology, King’s College, Denmark Hill, London London vi SNAS-FM.qxd 6/28/03 11:38 AM Page vii Preface Although work is generally considered to be good for your health and a healthy working population is essential to a country’s economic and social development, certain kinds of work can be damaging. Occupational health is the study of the effect—good and bad—of work on peoples’ health and, conversely, the effect of peoples’ health on their work: fitness for work in other words. Work places are specialised environments, capable of being closely controlled. Generally, it is the lack of control imposed by employers that is the cause of ill health because of exposure to hazardous materials and agents at work, and of injury caused by workplace accidents. Working life does not, however, begin and end at the factory gate or the revolving office door: many people walk, cycle, or drive to work—a journey that often constitutes the major hazard of the day. Others have to drive or travel by other means as part of their job, live away from home, be exposed to other food, other people, other parasites. Even work from home, increasing in some countries, can have its problems. Occupational health practitioners deal with all these aspects of working life. A working population consists of people mainly between 15 and 70 years (disregarding for the moment the ongoing scandal that is child labour), who may be exposed for 8-12 hours a day to a relatively high concentration of toxic substances or agents, physical or psychological. At least that population is likely to be reasonably fit—unlike those who cannot work because of illness or disabilities, the young, and the very old, who are more vulnerable and spend a lifetime exposed to many of the same agents in the general environment at lower concentration. This enters the realm of environmental medicine of such concern to those who monitor the degradation of our planet, track pollution and climate change, and note the effect of natural disasters and man made ones, especially wars. This book was first published in 1997 as the ABC of Work Related Disorders. It is a much expanded and updated version that attempts, in a compressed and easy to assimilate fashion, to describe those problems of health relating to work in its widest sense and to the environment. The pattern of work is changing fast. There is pretty full employment in most economically developed countries now. Manufacturing industry is now mainly concentrated in developing countries where traditional occupational disease such as pesticide poisoning and asbestosis are still depressingly common. Occupational accidents are particularly common in places where industrialisation is occurring rapidly as was once the case during the industrial revolution in 19th century Britain. Work is also more varied, more intense, more service oriented, more regulated, and more spread around the clock in order to serve the 24 hour international
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