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Apprenticeship is a period of increased risk of developing work-related respiratory allergic diseases. There is a need for documents to provide appropriate professional advice to young adults aiming to reduce unsuitable job choices and prevent impairment from their careers. The present document is the result of a consensus reached by a panel of experts from European and non-European countries addressed to allergologists, pneumologists, occupational physicians, primary care physicians, and other specialists interested in this field, which aims to reduce work-related respiratory allergies (rhinoconjunctivitis and asthma) among allergic or nonallergic apprentices and other young adults entering the workforce. The main objective of the document is to issue consensus suggestions for good clinical practice based on existing scientific evidence and the expertise of a panel of physicians.

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Returning to work after transplantation is a much-discussed topic today, especially as a measure to avoid permanent work disability. Many transplant patients regain their ability to work 2-6 months after transplantation. However, returning to work should not endanger their health. This means that occupational risks such as occupational exposure to Aspergillus spores must be evaluated. We evaluated the community-acquired aspergillosis risk and in particularly the occupational aspergillosis risk, using the example of a 39-year-old construction worker immunosuppressed after renal transplantation. On one hand the risk is linked to the exposure to microorganisms that the individual is likely to be subjected to, and on the other hand to the factors that modify his state of susceptibility or resistance to these infectious agents. The necessity of immunosuppressive therapy after transplantation elevates the aspergillosis risk, especially 1-6 months after transplantation. There are many professions in which exposure to Aspergillus spores can occur. The risk of acquiring aspergillosis at work exists, but is not quantifiable today. Nevertheless, the risk should be minimized during the period of vulnerability by preventive measures such as restriction of certain activities, changing work methods and reorganizing the work day to adapt to the risk, and wearing personal protective equipment, as well as attention to information about aspergillosis risk and about the likelihood of exposure in the patient's professional and leisure activities.

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A brief screening questionnaire has been administered to 791 patients consulting a primary health care physician, to discover job-related health problems. Among the 791 patients, 43 percent estimate subjectively that their job has an unfavorable influence on their health. The study participants were patients from the general consultation of the outpatient department of the medical universitary policlinic of Lausanne and from 10 private medical practices in the french part of Switzerland. Among the 791 patients, 401 were interviewed seconderly in a more detailed questionnaire. These questionnaires were evaluated by 3 reviewers of the Institute of Occupational Health Sciences. 25 percent (one of four patient) was identified for having a job-related health problem. For the primary health care physician, the question is: how to manage such job-related problems and how to orient patient to use the adequate services and institutions.

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The group of man-made mineral fibres includes slagwool, glasswool, rockwool, glass filaments and microfibres, as well as refractory ceramic fibres. The toxicity of mineral fibres is determined by several factors such as the diameter (< or = 3-3.5 microns) and the length of the fibres (< 100 microns), their biopersistence, which is much shorter for man-made mineral fibres than for asbestos fibres, their physicochemical structure and surface properties, and the exposure level. The chemical composition of the various types of man-made mineral fibres depends directly on the raw material used to manufacture them. While naturally occurring fibres are crystalline in structure, most man-made mineral fibres are amorphous silicates combined with various metal oxides and additives. Observations using intracavitary administration have provided evidence that some types of man-made mineral fibres are bioactive in cellular and animal experiments and may induce lung tumours and mesothelioma. It is difficult to extrapolate these results to humans since they bypass inhalation, deposition, clearance and translocation mechanisms. Inhalation studies show more realistic results but differences are observed between animal species regarding their sensibility to tumours. There is no firm evidence that exposure to various wools is associated with lung fibrosis, pleural lesions or nonspecific respiratory disease in humans. A possible exception may be mentioned for refractory ceramic fibres. A slightly elevated standard mortality ratio for lung cancer has been documented in large cohorts of workers (USA, Europe and Canada) exposed to man-made mineral fibres, especially in the early technological phase. It is not possible to determine from these data whether the risk of lung cancer is due to the man-made mineral fibres themselves, in particular due to the lack of data on smoking habits. No increased risk of mesothelioma has been demonstrated in these cohorts. Epidemiological data are insufficient at this time concerning neoplastic diseases in refractory ceramic fibres.

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In the debate on chronic effects of solvent use, it is often difficult to find information on the cerebral health status of subjects before any exposure has occurred. The objective of this study was to obtain baseline data by examination of workers at the beginning of their occupational lives. This study compares the performance of 57 apprentice painters, mean age 16.6 +/- 1.2 years, with that of 62 apprentices, mean age 16.2 +/- years, drawn from other manual trades involving no significant exposure to solvents. Their performances were compared twice over a period of 3 years using a series of behavioral tests chosen from a translated version of the Neurobehavioral Evaluation System (NES). There were no major differences in performance between the apprentices, except for the verbal ability test, which showed lower results for painters. This can be explained by factors such as socioeconomic background, previous schooling, or mother tongue, and raises the question of whether it is appropriate to use such a test to adjust for the influence of premorbid ability in elderly exposed workers.

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The inability to characterize more precisely the extent of occupational diseases limits the implementation of an effective preventive policy. Furthermore, not all work-related conditions are reported by the Swiss workers' compensation system. A seven-year (1986 to 1992) retrospective study of medical visits in an Institute of Occupational Health Sciences is presented. The objective of this study is to expand data on occupational diseases for clinical and public health intervention. 298 patients have been examined for a possible work-related condition. In 140 cases (47%), an occupational disease according to the Swiss Law was found. Respiratory tract was the main target of industrial pollutants. Respiratory irritations, solvent intoxications, contact dermatitis and asthma were the most frequent conditions seen. 97 workplace visits (32% of all medical visits) were necessary for diagnostic purposes. Painters (construction, cars) and other solvent exposed workers were at particular risk. Rare alpha-1-antitrypsin phenotypes were found several times in workers with respiratory diseases confirming the value of this test in occupational medicine. Despite many referral biases, direct clinical and public health applications of the data are possible. This study confirms the hypothesis that occupational respiratory diseases and intoxications are probably underreported in the workers' compensation statistics. Activities with an increased risk of work-related diseases have been identified so workplace intervention could be highly targeted. This study shows also that a more intense collaboration between primary care physicians, hospital services and occupational medical specialists is necessary to improve clinical and epidemiological surveillance of work-related health conditions.

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Statistical data obtained from insurance companies give certainly a good picture of work effects on health in the field of accidents. This is different for occupational diseases, which are more difficult to diagnose and which are recognized on the basis of medicolegal criteria. Statistics do not involve other aspects than diseases, such as discomfort, ergonomical questions, psychophysiological consequences and situations where there is a limited role of occupation. Prevention of work related health problems has to consider these characteristics and needs to be based on risk analysis, a prospective procedure. The advantage of such an approach is the possibility of adjustment to a changing work environment and to new technologies.

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A total of 264 workers participated in a cross-sectional study concerning the toxicity of hydrocarbons. The clinical examination shows an increased prevalence of smell and/or taste disturbances in the heavily exposed group. These symptoms appear to be generally transitory and reversible. They seem to be due to concentration peaks rather than to a long exposure duration. They are associated with acute depressor effects and not with symptoms which could belong to a hydrocarbon-induced chronic toxic encephalopathy.

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The value of the glycosaminoglycans (GAG) determination in urine was examined in a population of hydrocarbon-exposed workers and compared to the usefulness of the fractional albumin clearance (FAC). Blood pressure and hydrocarbon exposure interact to increase the FAC but the GAG concentration seems less useful because too many other variables influence it as well.

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In the frame of a study on hydrocarbon-induced toxic effects, the knee morbidity and the prevalence of work-related arthralgias, gonalgias, myalgias and skin anomalies were investigated in a group a floor-layers. The results show that a previous history of knee morbidity is distinctly higher in floor-layers and that these workers have a higher prevalence of musculoskeletal and cutaneous disturbances than the comparison group. Owing to the fairly high prevalence of these troubles, it seems that this pathology deserves more attention and that more efficient preventive measures are indicated.

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A total of 21 consecutive patients who underwent surgery for carpal tunnel syndrome in a regional hospital were analysed for their trade and serum alpha 1-antitrypsin phenotypes. The majority of these cases were women and mostly manual trades and professions were involved. Furthermore, heterozygous antitrypsin phenotypes were more frequent among the surgical cases than among the general Swiss population. In a second stage, the incidence of carpal tunnel syndrome in Switzerland was studied for 1 year from June 1988 through May 1989 using the sentinel system developed by the Federal Office of Public Health Administration. In all, 188 cases were found, most of whom were women, which was compatible with the frequency in other countries. A complementary questionnaire that was filled out by 65 cases and their matched controls showed that housewives and shop clerks were overrepresented among the patients. Likewise, exposure to vibrating tools and frequent extensions and/or flexions of the wrist were mentioned more often by the cases than by the controls. The present study confirms previous findings that women are at greater risk of developing carpal tunnel syndrome especially in jobs requiring repetitive movements or operation of vibrating tools. A constitutional element in pathogenesis was suggested by observations that the mothers of the cases had often also been afflicted with carpal tunnel syndrome and that the frequency of distribution of antitrypsin phenotypes in patients differed from that in the general population.

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Out of a cohort of 1200 apprentices in Switzerland, 781 boys and 417 girls completed a questionnaire on their perceived health and health problems in their selected apprenticeship. Each participant was interviewed afterwards by the school nurses in three state-owned professional schools where the apprentices attended their classes. Ninety-five per cent of the respondents enjoyed excellent health, 28 cases had nervous system or psychological problems, 17 cases had problems of a locomotor nature, 12 subjects had gastrointestinal or endocrinological symptoms, and there was one with a past history of a malignant disease. Twelve cases also had respiratory symptoms or diagnoses. One hundred and nineteen apprentices reported that they had been troubled by the workplace. Exposure to solvents, chemicals in general, dust, smoke and noise were often mentioned as causes. Thirty-eight of them had contacted their family physician in connection with these problems. The cohort had experienced, mostly during their first year, 191 cases of accident necessitating medical care. Cuts, shocks and falls were the most common occurrences. Meat cutters and butchers had the highest frequency of accidents. Near-accidents had been experienced so far by 46 per cent of the respondents. At the interviews, school nurses provided counsel and intervened in flagrant cases of occupational risks. It seems that an ordinary medical certificate does not predict accident-proneness or possible medical problems, while in-school health programmes could provide rapid intervention and support.

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The data on hydrocarbon induced pancreatitis are conflicting. This question was therefore studied in a non-selected population exposed to hydrocarbons and in "formerly" exposed workers. Neither the past clinical history nor the pancreatic tests provided any evidence for a causal relation between exposure and pancreatitis. No signs of hydrocarbon induced liver damage were seen either. As a healthy worker effect cannot be totally excluded, however, a case-control study in a group of patients suffering from non-alcohol induced pancreatitis could give useful indications for finally excluding the possibility of pancreatitis being induced by hydrocarbons.

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