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Various occupations can lead to exposure to vibration, which can be transmitted to the whole body or localized to the hands. The main clinical effect of whole-body vibration exposure is low back pain. Effects from hand-transmitted vibration can be (1) vascular, with manifestations of secondary Raynaud’s phenomenon; (2) neurological, often presenting as paraesthesia and reduced sensory perception; and (3) musculoskeletal, including reduced grip strength and loss of manual dexterity. In tropical countries, as opposed to temperate climates, the clinical manifestations are predominantly neurological and musculoskeletal, instead of vascular. Management requires exclusion of differential diagnoses, and the identification and reduction of exposure to vibration at source. Diagnosis of an index case should prompt further investigation and where possible, modification of the system of work to prevent other cases from occurring.

Noise can affect hearing in the occupational setting but can have other effects where exposures are non-occupational. For clinical purposes, noise is measured in decibels weighted according to the sensitivity of the human ear (dB(A)). Regardless of source, the effects of overexposure to noise are similar. Initially there is a temporary threshold shift, where reversibility of hearing loss is possible with removal away from further noise. Noise-induced hearing loss occurs following prolonged or intense exposure, with poor prospects for improvement of hearing. The classical audiogram for noise-induced hearing loss shows a 4 kHz dip. Non-auditory effects of prolonged noise exposure include annoyance, sleep disturbance, hypertension, and cardiovascular disease, stress, and impaired cognitive performance. Prevention of noise-induced hearing loss is by reducing exposure to noise at source minimizing exposure time, using hearing protection, and participating in surveillance.

This chapter on health screening in occupational health describes common screening procedures in occupational health practice, such as pre-placement examination, health surveillance, and examinations prior to job reassignments. It covers biological monitoring and biological effects monitoring and discusses examples of specific screening tests such as executive health screening, genetic screening, and screening for drugs and alcohol. This chapter also reviews theoretical and technical issues in screening such as the characteristics of a screening test, for example, sensitivity, specificity, predictive value, likelihood ratios, and receiver operating characteristic (ROC) curves. The advantages and disadvantages of screening, practical and ethical aspects of screening, and finally the evaluation of screening programmes are discussed.

Breast cancer (BC) is a disease that has improved prospects for survival if detected and treated early. Delayed help-seeking behavior, with poor survival as a consequence, is an important public health issue in the Middle East. More than 75% of breast cancer patients in the United Arab Emirates (UAE) seek medical advice after experiencing a sign or symptom of the disease and many seek such advice late. Our aim was to explore factors influencing delayed presentation for treatment after self-discovery of symptoms consistent with breast cancer in Arab women in the United Arab Emirates (UAE), and to explore facilitators and barriers of women’s health seeking behavior in the complex religiously dominated society of the UAE. A qualitative descriptive approach using semi-structured interviews was used. We interviewed nineteen BC survivors aged 35–70 who have experienced delayed presentation to treatment after symptomatic recognition of BC. The time interval between initial experience of symptoms consistent with BC, and taking action to seek medical help was between three months to three years. The key themes that emerged from the interviews were varying responses to symptom recognition, fear of societal stigmatization, and concerns regarding abandonment by spouse because of BC. Culture has a strong influence on the decisions of women in the UAE society. The lack of awareness about signs and symptoms of BC and routine screening has an important effect on symptom appraisal and subsequently decision making regarding options for treatment., Highlights • Lack of awareness about breast health, screening, signs/symptoms and risk factors. • Culture/societal values have great influence on women׳s attitudes and behaviors. • Support of healthcare providers may reduce likelihood of delay.

The reasons advocated for conducting epidemiological studies in developing countries often include a need to improve the data base for prevention of ill health, including occupational diseases. Evidence based on research in developed countries may not be wholly relevant to developing countries because of differences in the environment, culture, health behaviour, health systems, and other factors. The obstacles to conducting occupational epidemiology studies in developing countries include: a) A lack of understanding of the purpose and nature of epidemiological studies. This often leads to potential study populations declining to participate. b) Difficulty in defining homogenous study populations. This is especially true in developing countries with diverse mutinational expatriate workers. c) The absence of an infrastructure and support for conducting epidemiologcal research. Ethical committees meet infrequently. Statistical advice is difficult to obtain. Laboratories for analysis of environmental and/or biological samples are often not readily available. d) Logistical difficulties include difficulty in contacting and recruiting study participants. Organising teams of interviewers and research assitants can also be problematic. e) The nature of the research. A questionnaire may well have to be translated into several languages. There may be a reluctance by study participants to provide biological samples such as a venous blood sample. If environmental monitoring devices are to be placed in workplaces, this can be viewed with apprehension. Despite these obstacles there are approaches to overcoming the hurdles identified, and increasing occupational epidemiology research in developing countries.

The United Arab Emirates (UAE) has experienced tremendous economic and industrial growth in the petroleum, airline, maritime and construction sectors, especially since the discovery of oil reserves. Mass recruitment of low skilled or unskilled laborers from less-developed countries has been utilized to satisfy the manpower demands of these fast paced industrial developments. Such workforce recruitment has created an unusual populace demographic, with the total UAE population estimated at 8.3 million, composed of 950,000 Emiratis, with the remainder being multinational expatriate workers, with varying educational qualifications, work experience, religious beliefs, cultural practices, and native languages. These unique characteristics pose a challenge for health and safety professionals tasked with ensuring the UAE workforce adheres to specific occupational health and safety procedures. The paper discusses two case studies that employ a novel multimedia approach to raising health and safety awareness among a multinational workforce.

Injury is a leading cause of morbidity and mortality in the United Arab Emirates (UAE). The UAE is a rapidly developing country with fast economic growth, demographical and environmental changes that are associated with new hazards emerging at a similar pace. The UAE as a federal entity has federal and local systems responsible for safety policy, regulations and enforcement. To set priorities for safety promotion and injury prevention, it is necessary to have data on the most frequent external causes of injury and the main individual, equipment and environmental risk factors that contribute to injury. However good quality data for injury prevention are scarce. The aim of this paper is to describe the scale of injury as a public health problem in the UAE, and the development of safety policies, regulations and promotion efforts with special emphasis on traffic, occupational and child safety.

Objective To explore and compare barriers to early presentation of self-discovered breast cancer in Singapore and Malaysia. Design A qualitative interview study with thematic analysis of transcripts. Participants 67 patients with self-discovered breast symptoms were included in the analysis. Of these, 36% were of Malay ethnicity, 39% were Chinese and 25% Indian, with an average age of 58 years (range 24–82 years). The number of women diagnosed at early stages of cancer almost equalled those at advanced stages. Approximately three-quarters presented with a painless lump, one-quarter experienced a painful lump and 10% had atypical symptoms. Setting University hospital setting in Singapore and Malaysia. Results Patients revealed barriers to early presentation not previously reported: the poor quality of online website information about breast symptoms, financial issues and the negative influence of relatives in both countries, while perceived poor quality of care and services in state-run hospitals and misdiagnosis by healthcare professionals were reported in Malaysia. The pattern of presentation by ethnicity remained unchanged where more Malay delayed help-seeking and had more advanced cancer compared to Chinese and Indian patients. Conclusions There are few differences in the pattern of presentation and in the reported barriers to seek medical care after symptom discovery between Singapore and Malaysia despite their differing economic status. Strategies to reduce delayed presentation are: a need to improve knowledge of disease, symptoms and causes, quality of care and services, and quality of online information; and addressing fear of diagnosis, treatment and hospitalisation, with more effort focused on the Malay ethnic group. Training is needed to avoid missed diagnoses and other factors contributing to delay among health professionals.

Background South Asian males constitute the largest proportion of the United Arab Emirates (UAE) population. Minimal data is available on the prevalence of hypertension among South Asian immigrants in the UAE. We determined the prevalence, associated factors, awareness, treatment, and control of hypertension among male South Asian immigrants from India, Pakistan and Bangladesh residing in the UAE. Methods We recruited a representative sample (n = 1375; 76.4 % participation rate) of South Asian adult (≥18 years) immigrant males, including Indian (n = 433), Pakistani (n = 383) and Bangladeshi (n = 559) nationalities in Al Ain, UAE (January-June 2012). Blood pressure, height, body mass, waist and hip circumference data were obtained using standard protocols. Information related to socio-demographics, lifestyle factors, history of diagnosis and treatment of hypertension was collected through a pilot-tested adapted version of the STEPS instrument, developed by the World Health Organization for the measurement of non-communicable disease risk factors at the country level . Results Mean age of participants was 34.0 years (95 % confidence interval (CI): 33.4, 34.5 years) and the overall prevalence of hypertension was 30.5 % (95 % CI 28.0, 32.8). In this study, 62 % of study participants had never had their blood pressure measured. Over three quarters (76 %) of the sample classified as hypertensive were not aware of their condition. Less than half (48.5 %) of the sample that were aware of their hypertension reported using antihypertensive medication and only 8.3 % had their hypertension under control (

Objectives To assess any recent change in the commitment to teaching of occupational medicine in UK undergraduate medical curricula. Design A questionnaire survey of the teaching of occupational medicine to undergraduates in all medical schools listed in the UK Universities and Colleges Admissions Service prospectus for 1999–2000 (n = 24). Results Nineteen UK medical schools returned a completed questionnaire, giving a response rate of 79%. A comparison of results from this survey with previous surveys of teaching of occupational medicine to undergraduates in the UK shows that fewer schools now provide lectures, project work or ward-based tuition in the subject. Workplace visits were not undertaken by any institution. Only two of the schools setting an examination question also had a syllabus. Conclusion Despite the prominence given to issues related to occupational health in recent UK government policy, this study suggests a declining commitment to occupational medicine on the part of UK medical schools. Urgent action needs to be taken to address the lack of training in occupational medicine in UK medical schools.

The British educational system of occupational medicine was compared to the Japanese system. Furthermore, a comparison was carried out between the certified occupational physician (COP) recognized by the Japan Society for Occupational Health in Japan and the Associateship of the Faculty of Occupational Medicine (AFOM) by the Faculty of Occupational Medicine (FOM) which is a part of the Royal College of Physicians in the United Kingdom. Judging from the comparison of the minimum total training period, the clinical training period, the occupational health training period, the method of examination and the success rate between COP and AFOM, it is suggested that the British system of occupational physicians may be better as a training system for occupational medicine and may regard occupational clinical training as more important than the Japanese system does. A comparison of a Diploma in Occupational Medicine (Dip Occ Med) approved by the FOM and the certification of occupational physicians by the Japan Medical Association has shown that the former has an examination but there is no test system in the latter. It should be discussed whether an examination system for the certification of occupational physicians should be introduced into the Japanese system in the near future.

The workforce of the only chromite ore processing plant in the United Kingdom at Eaglescliffe has been the subject of several epidemiological studies. There are also medical data available through a health surveillance program conducted by the plant's medical center. The clinical information has in part been collected to fulfill the requirements of health and safety legislation. Through this system, 18 cases of lung cancer among the workforce have been identified. The mean age at diagnosis was 57 years, with all but two cases occurring in smokers. There were no obvious histological or clinical features that could allow differentiation between the occupational and nonoccupational cancers. The epidemiological studies indicated an excess lung cancer risk among the workers beginning employment on the site before 1960. The risk appeared to have diminished after a major process change in 1960 which removed the addition of calcium carbonate to the process. Further studies including case-control analyses and construction of a job exposure matrix through use of recall by long-term workers and pensioners are in progress. The feasibility of an updated cohort mortality study at Eaglescliffe and possibly using the same protocol for other similar cohorts in U.S. and European plants should be considered.

Background: The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. Methods: A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. Results: The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. Conclusion: The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases. Keywords: globalisation of public health; non-communicable disease; United Arab Emirates (Published: 5 February 2013) Citation: Glob Health Action 2013, 6 : 20100 - http://dx.doi.org/10.3402/gha.v6i0.20100 To access the supplementary material to this article please see Supplementary files in the column to the right (under ReadingTools).

After reading this chapter you will be able to understand the nature and scope of occupational health practice, and how efforts to protect and promote health in the workplace will contribute to general public health.

Health screening is a useful tool in occupational health practice, but theoretical and practical issues bear consideration before beginning such screening for any group of workers. Legal requirements will vary from country to country and will influence what is provided. Proper communication with the workforce, employer, and occupational health and safety professionals is essential for implementing successful health screening programmes.

There are large differences in socio-economic growth within the region of South East Asia, leading to sharp contrasts in health-systems development between countries. This study compares breast cancer presentation and outcome between patients from a high income country (Singapore) and a middle income country (Malaysia) in South East Asia. Within the Singapore Malaysia Breast Cancer Registry we identified all consecutive patients diagnosed with breast cancer between 1993 and 2007 at the National University Hospital in Singapore (high income country, n = 2,141) and the University of Malaya Medical Center in Kuala Lumpur, Malaysia (middle income country, n = 3,320). We compared demographics, tumor characteristics, treatment patterns, and survival between patients from both countries. In Malaysia, patients were less often diagnosed with in situ breast cancer (adjusted odds ratio [ORadj] 0.2; 95 % confidence interval [95 % CI] 0.1–0.3), more likely to be diagnosed with late stage (III and IV) disease (ORadj for stage III 1.6; 95 % CI 1.3–2.0; ORadj for stage IV 1.2; 95 % CI 1.1–1.4) as compared to patients from Singapore. Univariate analysis showed that Malaysian patients were at a 72 % increased risk of death as compared to Singaporeans. After adjusting for other prognostic factors, the risk decreased by only 5 % (ORadj 1.67, 95 % CI 1.44–1.92). Differences in way of presentation (except stage and tumor size) and treatment of breast cancer patients from the two countries are small. The overall survival of breast cancer patients from Malaysia is much lower than that of Singaporean patients.

Clinical and public health research depends on factors including national systems, socio-cultural influences, and access to organisations and individuals. As a 'new' country, the United Arab Emirates (UAE) has yet to develop strong support for population research. However, there is interest in research. The challenges for quantitative and qualitative research include the varied composition and mobility of the UAE population, with limited health records and disease registries. Long-term follow-up of patients, and tracing foreign workers who may only be in the UAE for a few years, are two major obstacles for longitudinal studies. There can also be a reluctance shown by parts of the population to participate in studies, especially those that require responding to what is perceived as sensitive questions. Successful execution of population research in the UAE requires an understanding of socio-cultural aspects of the study population, and good communication between researchers and participants.