254 Occup Med. Vol. 47, 1997
Insight: Answers
The Insight questions and answers are designed to test your knowledge of the fields
covered by papers in this issue and are intended as a contribution to your personal,
continuing, occupational medicine education. The questions answered here are on
the preceding pages.
1.
The following zoonoses can be
transmitted from cattle to man:
3.
Post-traumatic stress disorder
(PTSD):
a. True. Before that the combination of
physical and psychological symptoms
occurring after an acute traumatic event
was known as 'shell shock'.
a. True. Worldwide the most common
reservoirs are cattle, sheep and goats.1
b. False. Rats are the reservoir of this organism.
c. False. This is transmitted by aerosols
contaminated by rodent excreta or through
the bites of rodents.
b. False. Repeated exposure to lower
magnitude stressors (e.g., working in
emergency services) has been reported to
give rise to PTSD; this is sometimes
described as 'complex PTSD'.
d. False. The organism of Lyme disease is
Borrellia Burgdorferia which is transmitted
by ioxid ticks.
c. False. It is reported to occur in 30% of
people exposed to an acute traumatic event.
d. False. PTSD can be diagnosed if symptoms
are present at any time from 4 weeks after
the traumatic event. If PTSD is present
less than 3 months from the traumatic
event it is described as chronic. If the
features of PTSD do not develop until at
least 6 months after the traumatic event it
is described as delayed onset.
e. True. Direct contact with animals may
result in transmission. Persons with
occupational exposure to cattle, sheep and
other farm animals are at increased risk of
infection.2
2.
You are advising a food company on
the employment of food handlers:
a. False.3
b. True.
c. False.
d. False. Most arise from the failure to follow
good manufacturing practice such as
proper temperature controls.4
e. True.
4.
Regarding workplace health
promotion the following statements
are true:
a. False. Ergonomics has a much wider scope.
Murrel describes ergonomics as follows: 'the
scientific study of the relationship between
people and their working environments.
Environment is taken to cover not only the
ambient environment in which they work
but also their tools, materials, methods of
work and the organization of work either as
all individual or within a working group. All
these are related to the nature of people
themselves to their abilities capacities and
limitations'.5
Insight: Answers 255
False. Under the 1995 Disability
Discrimination Act the employment rights
of ambulance workers are protected, but
those of fire brigade members and police
officers are not.
b. True. 1994 figures.
c. True. 6
d. False. There is no legislative requirement to
provide a professional occupational health
service.
7.
e. False. In the United States of America
employers who undertake workplace health
promotion may benefit financially because
medical insurance premiums for their
employees will be reduced. In the United
Kingdom the NHS obviates the need for
employer based medical insurance. The
scope for a reduction in employers hability
insurance does however offer an incentive
to employers to ensure the health of their
employees.
5.
a. True.
b. True. Electroplaters are at risk of developing
both allergic and irritant dermatitis in
addition to skin burns and ulceration.10
c. False. There are only a small number of
isolated reports of lung cancer associated
with electroplating.11
In chronic fatigue syndrome:
d. True. Chromium compounds are
well-documented causes of ulceration
and perforation of the nasal septum.
a. True. The population point prevalence is
quoted as varying between 0.1 and 0.9%
using restrictive criteria that exclude patients
with psychiatric disorders and 2.6% in
primary care using the Oxford criteria.7
b. False. There is no clear link to social class
or occupational group. Associations relate
to attendance at tertiary centre clinics not
prevalence in the general population.
6.
Employees in the electroplating
industry:
e. False. The article in this journal indicates
the lack of knowledge among employees.
8.
Proportional mortality studies:
a. False.
c. False. Abnormalities have been reported.8
b. False.
d. True. 9
c. False.
e. True.
d. True.
Disability:
e. False. They may be regarded as a special
type of cross-sectional or case-control
study.12
a. False. Disability only occurs if the impairment
has a significant effect on the ability to
carry out normal day-to-day activities.
b. True. Therapeutic strategies should be
aimed at preventing impairment becoming
disability, and disability becoming handicap.
c. True. OPCS report (1989) on employment
of disabled male adults showed that only
33% were currently working. See reference
in the accompanying paper.
d. False. Employers with less than 20
employees are exempt.
9.
Screening tests:
a. False. A sensitive test detects a high
proportion of true cases. If a policy of
maximizing sensitivity exists there may be
an unacceptably low specificity with the
resultant referral for investigation of
patients with false positives.
b. True. Based on balancing the consequences
of low sensitivity (missed cases) and low
specificity (economic costs and medical
consequences of false positive results).
256 Occup Med. Vo) 47, 1997
c. True. This reflects the proportion of test
positives that are truly positive.
d. False. Patient survival may be a misleading
reflection of-the benefit of screening and
early treatment.
e. True. The only valid outcome measure for
assessment of the benefits of a screening
programme is the mortality rate in the
population offered screening compared to
that in the population which would be
expected in the absence of screening. The
design of choice to determine this is the
randomized controlled trial.13
10. Enzymes: 14
a. True. They are used as meat tenderizers and
in bread manufacture.
b. True.
c. True. Since the introduction of a granulated
form of B subtilis the levels of airborne
dust have been reduced and the numbers
of cases of occupational asthma have fallen.
d. False.
e. True.
11. In occupational asthma:15
a. False. The diagnosis is suggested by the
history.
b. True. Reliable self-recorded serial peak flow
records that show consistent deterioration
in relation to work and improvement
during absences are most useful.
c. False. This type of investigation should be
carried out only very specific circumstances
and under appropriate specialist
supervision. It is not without risk.
d. True.
e. True.
REFERENCES
1. MarrieTJ. Coxiella Bumetri. In: MandellCL, BennettJE,Dolin
R, eds. MandeU, Douglas and Bennett's Principles and Practice
of Infectious Disease. Edinburgh, UK: Churchill Livingstone,
1995: 1727-1735.
2. Blaser MJ. Campylobacter and related species. In: MandeD
GL, Bennett JE, Dolin R, eds. MandeU, Douglas and Bennett's
Principles and Practice of Infectious Disease. Edinburgh, UK:
Churchill Livingstone, 1995: 1948-1956.
3. World Health Organisation. WHO Health Surveillance and
Management Procedures for Food Handling Personnel Report of a
WHO Consuhation. Technical Report Services, 1989, No. 785.
4. Roberts D. Sources of infection in food. Lancet 1990; 335:
859-861.
5. Parry S, ed. Occupational Health. London, UK: Chapman and
Hall, 1995.
6. Health and Safety Executive. The Costs to the British Economy
of Wbrk Accidents and Wbrk-relatedlU Health. London, UK: HSE,
1994.
7. Chronic Fatigue Syndrome. Report of a joint working group
of the Royal Colleges of Physicians, Psychiatrists and General
Practitioners, 1996.
8. Cleare AJ, Beam J, All-in T, et aL Contrasting neuroendocrine
responses in depression and the chronic fatigue syndrome. J
Affective Disorder 1995; 35: 283-289.
9. Vercoulen JH, Swanink CM, Fennis JF, et aL Prognosis in the
chronic fatigue syndrome: A prospective study on the natural
course. J Neurol Neurosurg Psychiatry 1996; 60: 489-494.
10. Foissereau J, Benexra C, et al. Occupational contact dermatitis
clinical and chemical cal aspects. Electroplating 1982; 34: 184188.
11. Hery M, Hubert C, et aL Electroplating Industry Evaluation of
Atmospheric Exposure to Chromium and NickeL London, UK:
Health and Safety Executive, 1992.
12. Rose G, Barker BD. Epidemiologyfor the Uninitiated,2nd Edition.
London: BMA, 1986: 51-55.
13. Issues in the assessment and evaluation of screening programs.
J Occup Med 1986; 10: 966-967.
14. Newman Taylor AJ, Pickering CAC. In: Parkes WR, ed Occupational Lung Disorders. Oxford, UK: Butterworth Heinemann,
1994: 720.
15. Newman Taylor AJ, Pickering CAC. In: Parkes WR, ed. Occupational Lung Disorders. Oxford, UK: Butterworth Heinemann,
1994: 728.