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Potential health hazards related to the use of VDTs are discussed. Various studies have suggested that a poorly designed workplace can cause muscoloskeletal problems and visual fatigue. Other studies have speculated that radiation from the terminals might cause adverse health effects, such as cataracts and skin rashes. Some alleged hazards such as radiation have been discounted, while other allegations, for which there is some evidence, such as dermatitis and epilepsy, may be dealt with satisfactorily. Based on present knowledge, no VDT-related factors have been identified as possible causes of adverse pregnancy outcome. It has been suggested that stress from VDT work may result in spontaneous abortion. This has, however, not been verified. The use of VDTs does not, by itself, appear to be a primary cause of adverse pregnancy outcome.

Thermodynamic parameters for double strand formation have been measured for the sixteen double helices of the sequence dCA3XA3G.dCT3YT3G, with each of the bases A, C, G and T at the positions labelled X and Y. The results are analyzed in terms of nearest-neighbors and are compared with thermodynamic parameters for RNA secondary structure. At room temperature the sequence (Formula: see text) is more stable than (Formula: see text) and is similar in stability to (Formula: see text) and (Formula: see text) are least stable. At higher temperatures the sequences containing a G.C base pair become more stable than those containing only A.T. All molecules containing mismatches are destabilized with respect to those with only Watson-Crick pairing, but there is a wide range of destabilization. At room temperature the most stable mismatches are those containing guanine (G.T, G.G, G.A); the least stable contain cytosine (C.A, C.C). At higher temperatures pyrimidine-pyrimidine mismatches become the least stable.

In an attempt to examine the neurochemical changes of lead exposure, a study was conducted on 106 lead workers and a control group of 25 nonexposed workers. The urinary excretion of major catecholamine metabolites, homovanillic acid (HVA), and vanillylmandellic acid (VMA) were measured. Workers exposed to lead had a mean blood lead concentration of 43.2 micrograms/100 ml, whereas the concentration for workers not exposed to lead was 12.7 micrograms/100 ml. Urinary HVA was significantly elevated in the exposed group when compared with controls (p less than 0.01). HVA was also found to be associated with an increase of lead in blood. Although not statistically significant, the VMA excretion was also noted to be moderately elevated; however, it is recognized that the present study was unable to establish a highly significant dose-response relationship between lead exposure and HVA excretion, as has been reported earlier in lead-poisoned children.

Summary Introduction Eosinophil cationic protein (ECP) has been widely investigated as a potential biomarker of airway inflammation. Method A systematic review was performed using Medline with key terms eosinophil cationic protein and asthma , limiting the search to titles or abstracts. Out of 688 potential papers found, abstracts were reviewed based on the following criteria: (1) ECP was used as a biological marker, (2) asthma was the index disease studied, (3) it was a controlled clinical study and (4) ECP was assessed as a diagnostic, assessment or management tool. One hundred and sixty-nine articles satisfied the selection criteria and their full-text versions were reviewed. Only 53 papers were found to provide clinically useful information. Results ECP has been measured in serum, plasma, sputum, saliva and broncho-alveolar lavage fluids but serum and sputum are the most established. Levels of ECP in normal and asthmatic subjects in various body fluids were identified. ECP correlates well with airway inflammation but not airway hyper-responsiveness. It is raised in other atopic diseases and hence is not diagnostic for asthma. However, it has been shown to be useful in assessing asthma severity, compliance with anti-inflammatory asthma therapy and as a guide to tailing down inhaled corticosteroid therapy. Although there is some evidence that ECP levels are affected by age, smoking, circadian rhythm and seasonal variation, only smoking appears to be of clinical significance. Discussion Despite its limitations, ECP remains potentially useful in asthma management. Future research on ECP should focus on using serial measurements and combining it with other markers of asthma which may increase its clinical usefulness.

Indirect standardisation is a statistical method for the adjustment of confounding bias in the comparison of rates and proportions. This article describes a microcomputer program, written in BASIC, to carry out the computations for the Indirect standardisation method. The program outputs the crude rate, covariates-adjusted rate and standardised mortality/morbidity ratio (SMR) and its confidence limits for each comparison group. The program listing and other pertinent information on the use of the program are available from the authors.

Objective To investigate the association between leptin levels and body mass index in Bruneian secondary school students. Methods The body mass index of Bruneian secondary school students (aged 11–18 years) was determined before collecting their saliva using the passive drool technique. Salivary leptin concentration was determined by ELISA. Results Correlation and partial correlation (controlled for age) analyses showed no significant differences between the levels of salivary leptin of normal weight and overweight students. Conclusions No significant increase in the salivary leptin concentration was observed in overweight compared with normal weight Bruneian secondary school students.

The rapid improvements in microcomputer systems have contributed to ease of performance of epidemiological research in occupational health. Computers now available can aid in all stages of research- from the early stages of literature review to data collection, analysis and presentation. Optical storage devices now allow large occupational health data bases to be stored on a single compact disc, with the information accessible by microcomputer. Hand-held computers and optical scanners allow paperless collection of field data. Epidemiological analysis and data presentation is easily done with software packages, some of which are in the public domain. However, there are limitations in the use of computers for any epidemiological research. Investment of time is required to learn the use of a computer. Care needs to be taken to ensure accurate data entry, and correct choice has to be made of methods for subsequent statistical analysis. Microcomputers are valuable as labour saving devices, but cannot replace proper planning, execution and appropriate data analysis in epidemiological research in occupational health.

The anthropometric dimensions of three major ethnic groups in Singapore were studied on 94 female VDU operators. The postural preferences at the VDU work stations were also investigated. Few anthropometric differences were noted for the Chinese, Malays arid Indians. However, when compared to data from Germany and the U.S.A., the three Asian cohorts are smaller in body size. Owing to the smaller body build, the Singapore operators preferred to have a sitting height of about 46 cm, and a working height of about 74 cm, compared with the 47 cm and 77 cm, respectively, preferred by European operators. Despite the anthropometric differences, the Singapore VDU operators, like their counterparts in Europe and the U.S.A. also preferred to sit in a pronounced backward leaning posture with a slightly open elbow angle. This sitting posture seems to ignore the traditional recommended upright trunk position of 90°.

Methodologic research is often concerned with determining whether two methods (procedures, laboratory instruments) can be used interchangeably for measuring some quantitative variable of interest. Logically, one method can be used as a surrogate of another provided the methods show high agreement on the measured results. Although the product-moment correlation ( r ) is often used as an indicator of agreement, this index is in fact inappropriate for this purpose. The intraclass correlation ( r 1 ) is the correct statistic for assessing agreement or consistency between two methods. Another criterion sometimes used for supporting interchangeability is the similarity of the mean measured results obtained by the two methods. However, similarity of means (aggregate agreement) does not necessarily indicate individual-subject agreement, and it is the latter that is the pre-requisite for interchangeability. On the other hand, a marked difference between two means (lack of aggregate agreement) does necessarliy indicate lack of individual-subject agreement and therefore non-interchangeability. Herein we suggest that two methods for measuring a quantitative variable can be judged interchangeable provided all of the following conditions are met: first the methods must not exhibit marked additive or nonadditive systematic bias; second the difference between the two mean readings is not “statically signficant”; third, the lower limit of the 95% confidence interval of the intraclass correlation is at least 0.75. Statistical procedures to evaluate these conditions of interchangeability are described in detail. A computer program coded in SAS to carry out the procedures is listed in the Appendix. A similar program coded in DBASE III PLUS for the microcomputer is available upon request.

Direct standardisation is a method that is commonly employed for the statistical removal of confounding bias in the comparison of occurrence rates. The procedure is useful in clinical and epidemiological research. This paper presents a microcomputer program written in BASIC for the significance testing of the difference between statistically adjusted rates obtained by the direct standardisation method.

Family medicine and occupational medicine share close similarities in their focus on disease prevention and health promotion. The opportunities for mutual learning and collaboration in patient care abound, with far-reaching implications on the standard of patient care that can be offered. Unfortunately, a gap exists between family medicine and occupational medicine in day-to-day practice as well as in continuing medical education. It is important that we actively seek to bridge this gap. The workforce constitutes a significant part of the population and thus the patient load of a typical primary healthcare practice. Moreover, with an ageing population and rising retirement age, we can expect that there will be an increasing number of health issues to be addressed among older working people. Both occupational and non-occupational factors are important in determining an individual’s health. Thus, family physicians need to adequately understand occupational medicine and vice versa. Key words: Occupational health, Primary healthcare

In coping with severe acute respiratory syndrome (SARS), infection control measures are a key aspect of protecting healthcare workers. We conducted a survey concerning perception of risk and countermeasures for SARS in 7 tertiary hospitals in Japan from July through September 2003, immediately after the SARS epidemic in neighboring countries. Based on 7,282 respondents out of 9,978 questionnaires administered, we found the perception of risk to be relatively high and the perception of countermeasures at the institutional level to be relatively low. Knowledge of preventive measures, concept of (opinions regarding) institutional measures, and perception of risk differed substantially among the 3 job categories, notably between physicians and nurses. The concept of institutional measures was the most important predictor of individual perception of risk. In view of the potential for future epidemics, planning and implementing institutional measures should be given a high priority.

The Southeast Asia and Western Pacific regions contain half of the world's children and are among the most rapidly industrializing regions of the globe. Environmental threats to children's health are widespread and are multiplying as nations in the area undergo industrial development and pass through the epidemiologic transition. These environmental hazards range from traditional threats such as bacterial contamination of drinking water and wood smoke in poorly ventilated dwellings to more recently introduced chemical threats such as asbestos construction materials; arsenic in groundwater; methyl isocyanate in Bhopal, India; untreated manufacturing wastes released to landfills; chlorinated hydrocarbon and organophosphorous pesticides; and atmospheric lead emissions from the combustion of leaded gasoline. To address these problems, pediatricians, environmental health scientists, and public health workers throughout Southeast Asia and the Western Pacific have begun to build local and national research and prevention programs in children's environmental health. Successes have been achieved as a result of these efforts: A cost-effective system for producing safe drinking water at the village level has been devised in India; many nations have launched aggressive antismoking campaigns; and Thailand, the Philippines, India, and Pakistan have all begun to reduce their use of lead in gasoline, with resultant declines in children's blood lead levels. The International Conference on Environmental Threats to the Health of Children, held in Bangkok, Thailand, in March 2002, brought together more than 300 representatives from 35 countries and organizations to increase awareness on environmental health hazards affecting children in these regions and throughout the world. The conference, a direct result of the Environmental Threats to the Health of Children meeting held in Manila in April 2000, provided participants with the latest scientific data on children's vulnerability to environmental hazards and models for future policy and public health discussions on ways to improve children's health. The Bangkok Statement, a pledge resulting from the conference proceedings, is an important first step in creating a global alliance committed to developing active and innovative national and international networks to promote and protect children's environmental health.

Teck Yee Wong, David Koh, Andrew Wee, Vivian Ng, Yong Tat Koh, Zhenjie Sum, Gerald KohDepartment of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeBackground: Salivary eosinophil cationic protein (ECP) level has the potential to be an assessment tool for asthma. Its measurement is not well-established and needs standardization. We studied how passive drool (PD) and two commercial devices, Salivette® (cotton-based device) and Sorbette® (cellulose–cotton-based-device), may affect ECP levels during collection among healthy subjects.Methods: Study I (n = 10) involved direct sampling of healthy adult subjects with Salivette® and Sorbette®. Study II (n = 33) involved ‘indirect’ sampling of previously collected PD by both devices.Results: In study I, ECP levels were detected in all PD samples but only in three with Sorbette® and none with Salivette® (collection order: PD, Sorbette® and Salivette®). We changed the order of collection (Salivette®, Sorbette®, PD) and the results were similar (ECP levels detected in all PD samples, three with Sorbette® and only one with Salivette®). In study II, ECP levels in saliva collected by PD was 12.8 μg/L (median) and using Sorbette® and Salivette® were< 2.0 μg/L and 3.4 μg/L respectively (p

AH employers are ethically required to provide a safe and healthy workplace for their employees. Health and safety professionals (HSP) may of ten be employed either full-time or part-time to achieve this end. The HSP should be viewed as a non-partisan provider of safety and health services at the workplace. He is equally on the side of management and worker in discharging his duties. His primary goal is to achieve a safe and healthy workplace and to improve the health of the workforce. Ethical dilemmas may surface in the course of the HSP's work largely because there may be occasions when there are conflicts of interest and loyalty derived from the different roles of the HSP. The best way to resolve such dilemmas is to prevent them from arising. However, when this is not possible, management's understanding of the professional ethical considerations of the HSP will help to improve the working relationship and professional results of these staff. Several aspects in the HSP's work require management's understanding. These include subjects such as communicating information on staff medical examinations to management, and the disclosure of commercially confidential information to assess related health risks. Management should also be aware that guidelines have been developed by a number of professional health and safety organizations for their members. In the instances when answers to ethical questions cannot be resolved, these guidelines can be consulted, in conjunction with discussions with senior HSP colleagues.

The coastal zone of the Pacific Rim is home for about one-third of the world's population. Disproportionate growth of Far Eastern economies has produced a disproportionate share of related environmental difficulties. As the region searches for acceptable compromises between growth and environmental quality, its influence on global environmental health is certain to increase. Consequences of global environmental change such as habitat alteration, storms, and sea level rise will be particularly acute among Pacific Rim nations. Adverse health effects from arsenic exposure in Pacific Rim nations have been used to justify drinking water standards in the United States and elsewhere. As global manufacturing in the Pacific Rim increases, the centroid of global air quality and waste management issues will shift further toward Far Eastern nations. The Eleventh International Conference of the Pacific Basin Consortium (PBC) was held in September 2005 in Honolulu, Hawaii. The purpose of the conference was to bring together individuals to discuss regional challenges to sustainable growth. The historic emphasis of the conference on hazardous wastes in relation to human health makes the PBC an ideal forum for discussing technical aspects of sustainable economic growth in the Pacific region. That role is reflected in the 2005 PBC conference themes, which included management of arsenic in potable waters, air quality, climate change, pesticides, mercury, and electronics industry waste-each with emphasis on relationships to human health. Arsenic management exemplifies the manner in which the PBC can focus interdisciplinary discussion in a single technical area. The conference program provided talks on arsenic toxicology, treatment technologies, management of arsenic-bearing residuals from water treatment, and the probable societal costs and benefits of arsenic management.

In the last two decades, there have been dramatic developments in the field of occupational health. With it, the importance of occupational health training and education is greatly appreciated. In a worldwide questionnaire survey on occupational health teaching in schools of medicine, 69.9% of the schools have some form of occupational health teaching for medical undergraduates. The total number of hours varies considerably but on average is 32.7 hours. Some occupational health teaching might however have been classified under other subject headings. In the Asia-Pacific region, several postgraduate degree courses were recently established. Continuing educational courses and short courses are on the rise. To take advantage of the existing primary health care systems, special courses for public health workers and primary health care personnel have been conducted. In the past, interest in occupational health education and training tended to be overshadowed by advances in epidemiology and pathogenesis of occupational diseases. Based on our experience over the past few years, occupational health training and education will gather greater momentum worldwide and in the Asia-Pacific region in particular.

We believe that there is a case for developing, improving, and harmonizing national indicators for the occupational health status of populations. Several indicators are available in the field of public health. They include infant mortality rate, life expectation, number of physicians per 100 000 population, and the like. For occupational health, the International Labour Office maintains statistics for fatal and nonfatal occupational injuries in several countries. However, there are, at present, no widely accepted, internationally approved, uniformly collected data sets that allow the production of occupational health status indicators that are comparable between countries. Two examples of such indicators are (i) the prevalence and incidence rate of occupational diseases and (ii) manpower and other resources for occupational health, for example, number of hygienists, occupational physicians, occupational health nurses, ergonomists, and so forth. These indicators would measure the progress of some of the priority objectives proposed by the World Health Organization (WHO) in its document Global Strategy on Occupational Health for All (1). The document proposes 2 global strategies: (i) the establishment of registration and data systems, the development of information services for experts, effective transmission of data, and the raising of public awareness through public information and (ii) the development of human resources for occupational health. There is a need to encourage coordination between international agencies involved in occupational health such as WHO and the International Labour Organisation (ILO) in their efforts to harmonize health-related statistics. A problem with collecting and comparing statistical indices and data in occupational health lies in the basis and methods of collecting such data. Differences in national regulations, criteria, and practices contribute to this difficulty. For example, such problems have been observed in 2 European Union (EU) projects aimed at the production of comparative statistics on work accidents (2) and occupational diseases (3). Although national statistics may indicate the availability of social resources more than the state of occupational health, comparative indicators are valuable because they can stimulate discussion on the appropriateness of recording systems, data, and practices. They may also encourage international collaboration and the harmonization of such activities and result in more-complete reporting and in better-quality occupational health information. One hurdle that needs to be overcome is agreement on the terminology and criteria for including data. For example, there should be some uniformity in the criteria for diagnosing occupational diseases. There should also be some commonality in systems for collecting such data. In regard to criteria for diagnosis, the EU has produced information notices on the diagnosis of occupational diseases (4). Systems for collecting data on the occurrence of occupational diseases often result in considerable underreporting. All of these practical issues need to be discussed and approved before progress towards developing comparable occupational health indicators is possible. The WHO European Regional Office has been periodically monitoring the national situation on progress towards the WHO health for all (HFA) strategy (5) in member states. As a monitoring exercise, "HFA indicators" have been produced and member states have been requested to provide data for these indicators. The "HFA indicators" monitor different aspects of national health level, some of which are related to occupational health. Useful examples and their sources of information are listed in table 1. The last 2 indicators to measure social resources could be translated to occupational health units and occupational health expenditure, respectively, and perhaps adjusted for the size of the working population. Although initiated in Europe, we believe that this solution could be a good basis for extending efforts to produce occupational health indicators on a global scale. Some obstacles towards the development, collection, and utilization of national indicators in occupational health can readily be identified. ILO recognizes the limitations in even the existing indicators for occupational injuries in that "for various reasons, the national definitions of occupational injuries may differ from the recommended international standard definition, and they depend to a large extent on the source of the statistic" (6). This statement could be exaggerated for occupational diseases or there could be considerable underreporting, as has been shown in the United Kingdom with the statutory requirements for reporting occupational diseases (7). Despite these limitations, such indicators may be of value in the planning and evaluating of preventive activities. Internationally comparable indicators can be used to identify high-risk industries within a country to provide legislators and administrators with targets for preventive action. They can also be used to assess the comparative status of occupational health among countries and therefore provide international organizations with information with which to identify priority areas. From the point of view of prevention, the development of hazard surveillance, and hence exposure indicators, would also be valuable. Although this need is widely recognized, there are practical difficulties in producing exposure indicators. There are differences between countries in the legal requirement to report the presence of hazards in workplaces or the occurrence of occupational ill-health. Large-scale industry-wide studies and field standardized definitions and assessment procedures may be a more rapid and valid method for producing statistical data on occupational hazards. In conclusion, if national and international indicators for occupational health are to be developed beyond the reporting of occupational injuries, some important issues have to be resolved. These include determining the validity and benefit of indicators, facilitating the comparison of data from different countries, sorting out difficulties with disease registers, and considering options for developing countries to collect indicator information. These steps could stimulate research and discussion aimed at further improvements in global occupational health, based in part on the acquisition of comparable data and the use of experience from different countries.

August 2002 “Water, water, everywhere, Nor any drop to drink” Part II, Rime of the Ancient Mariner Samuel Taylor Coleridge Singapore, a tiny republic in the Far East, is situated at the southern tip of the Malay peninsula, just north of the equator. As an island nation, it is surrounded by water, but in spite of having water, water everywhere—it is still not self sufficient in this commodity, which is necessary for occupational and environmental reasons; and essential for everyday activity. Singapore still has to import a significant volume of its untreated water from its neighbouring Malaysia. With increasing societal demands for water, and to …