Scandinavian Journal of Work, Environment and Health, 1999
The mission and tasks of occupational health services are reviewed in the context of the global m... more The mission and tasks of occupational health services are reviewed in the context of the global megatrends of productivity increase, population overgrowth, and the implications of changes in the technology of information and communication. Current trends in attempts to achieve harmonization with respect to the concept and tasks of occupational health services in the European Union are described, along with the basic features of occupational health services as a human service organization with implications for the setting of objectives and criteria for assessing quality and performance and ethics. The need to adopt a quality-focused approach to occupational health service programs is emphasized, and some of the inhibitions and obstacles to quality work are mentioned. The need for professional commitment to develop and implement quality concepts is outlined. Evidence-based health care in the setting of occupational health services and some salient aspects of professional ethics in the...
Scandinavian Journal of Work, Environment and Health, 1983
A cohort of 13,114 workers employed during 1930-1975 in two Swedish plants producing tires and in... more A cohort of 13,114 workers employed during 1930-1975 in two Swedish plants producing tires and industrial rubber goods was investigated with regard to cancer mortality and cancer incidence. Separate analyses were performed on the following subgroups of the cohort: mixers/weighers, other production workers, and white-collar employees. For all causes of death no increase of risk was observed in the population as a whole. Mixers/weighers showed however an increased overall standardized mortality ratio. The pattern of causes of death was not changed in the total cohort. An increased risk to die from liver cancer (risk ratio 4.12) and pancreatic cancer (risk ratio 2.70) was, however, observed for the category other production workers. An increased risk of death from tumors of the respiratory organs was also observed for the categories other production workers (risk ratio 1.89) and white-collar employees (risk ratio 2.63). For tumors in the urinary bladder (risk ratio 2.50) and for ischem...
Scandinavian Journal of Work, Environment and Health, 1981
A report on unusually many wasted pregnancies among women working at a laboratory in a paper indu... more A report on unusually many wasted pregnancies among women working at a laboratory in a paper industry gave rise to a cohort study on pregnancy outcome among all women working in the pulp and paper industry in Sweden during 1973--1977. A total of 890 deliveries were identified (899 infants born). The total number of malformed infants or perinatally dead infants was according to expectations. When the material was broken up according to occupation, it was found that, in the group of infants whose mothers worked in laboratories during pregnancy, the rate of malformed infants appeared high. These data, added to previously published data, seem to support the notion that work in laboratories represents a pregnancy hazard.
Scandinavian Journal of Work, Environment and Health, 1995
The objective of this study was to provide an extended follow-up of workers in three Swedish plan... more The objective of this study was to provide an extended follow-up of workers in three Swedish plants producing man-made vitreous fibers (MMVF). Mortality and cancer incidence was investigated among 3539 male and female workers, employed for at least one year before 1978. Mortality was followed from 1952 to 1990 and cancer incidence from 1958 to 1989. National and regional mortality and cancer incidence rates were used to calculate the expected numbers. Twenty-seven lung cancer deaths were observed compared with 23 expected (standardized mortality ratio 117, 95% confidence interval 81-176), based on regional mortality. With a latency time of 30 years, the lung cancer risk was significantly elevated, but not trend was found for the standardized mortality ratio with increasing duration of exposure to MMVF. The lung cancer and stomach cancer mortality was higher in the rock wool industry than in the fiber glass industry. Fiber exposure from 1938 to 1990 was estimated in the two rock wool...
Scandinavian Journal of Work, Environment and Health, 1995
A multiplicative model was developed to assess past exposure to respirable fibers among rock wool... more A multiplicative model was developed to assess past exposure to respirable fibers among rock wool and slag wool production workers in Sweden in 1938-1990. Information on the job titles, work tasks and employment times of 1487 workers exposed to man-made vitreous fibers was obtained from company records and interviews with older employees. A mathematical model developed earlier for assessing historical fiber exposure, based on factory averages, was further developed. Matrices of multipliers for each plant that were specific for job title were modified to assess fiber exposure with respect to job title and calendar period. The model was based on measurements made in 1977. Two methods of exposure assessment were compared, cumulative exposure based on factory average (model I) and cumulative exposure based on job title (model II). The exposure changed considerably in the two factories during the period 1938-1990, and it varied also between job titles. The estimated average fiber (f) exp...
Scandinavian journal of rehabilitation medicine, 1995
This study was designed to determine a cost-effective use of psychologist resources in multimodal... more This study was designed to determine a cost-effective use of psychologist resources in multimodal cognitive-behavioural treatments (MMCBT) for chronic neck/shoulder pain. A randomised controlled trial was conducted with 66 patients divided in two groups. The first group (A) was treated following the approach of MMCBT with the clinical psychologist only functioning as a "coach" to the other health professionals. In this group, the psychologist had on average 5 hours of input per patients. The second group (B) was treated with the same inpatient MMCBT but with the behavioural component administered by the clinical psychologist directly to the patients. In this second group the psychologist had on average 17 hours of input per patient in the entire intervention. The outcome variables included physical, emotional and social factors, and sick-leave. Both groups showed significant improvements over time. The improvements were evident only in sub-groups, specifically in women. Th...
The incidence of lung cancer among 280 silicotic men working in the ceramics industry and notifie... more The incidence of lung cancer among 280 silicotic men working in the ceramics industry and notified to the Swedish Silicosis Registry has been investigated. During the study period 1958-83, the risk of lung cancer (nine cases) was double that expected based on national rates. There was no increased incidence of cancer at any other site. The results are in agreement with those of both animal and epidemiological studies of quartz exposure and point to an increased risk of lung cancer, especially among silicotics. Various possible explanations of this increased risk are discussed, but further studies are required.
The principal techniques for the control of carcinogenic hazards are described. A sense of respon... more The principal techniques for the control of carcinogenic hazards are described. A sense of responsibility must be encouraged in the groups of people who are involved, such as manufacturers, importers, retailers or distributers. Relevant, evaluated information from the scientific community must be brought to the attention of responsible bodies in a systematic way. Information about sources of emission, pathways of spread and identification of populations at risk is essential. Estimates must be made of costs and benefits, whether tangible or intangible. Mechanisms of intervention are described, including registration, authorization, permission, notification and dissemination of information. Mechanisms of risk surveillance involve the monitoring of health indices and of exposure situations: techniques of data collection are outlined. It is important that such data be both accessible for evaluation by authorized persons and at the same time remain confidential. Education is basic to can...
It has been estimated that occupational exposures are responsible for about 4% of all human cance... more It has been estimated that occupational exposures are responsible for about 4% of all human cancers in industrialized countries. These cancers are concentrated among manual workers and in the lower social classes, thus contributing to the social class gradient in cancer incidence and mortality. On the basis of the 1971 cancer mortality data from England and Wales, it was estimated that occupational cancer is responsible for about a third of the total cancer difference between high (I, II and III-NM) and low (III-M, IV and V) social classes, and for about half of the difference for lung and bladder cancer. However, direct evidence on the extent of the contribution of occupational exposure to carcinogens to social class differences is lacking, and several problems, such as the possible interaction between carcinogens and the effect of extraoccupational confounding factors, add further elements of uncertainty.
Scandinavian Journal of Work, Environment and Health, 1999
The mission and tasks of occupational health services are reviewed in the context of the global m... more The mission and tasks of occupational health services are reviewed in the context of the global megatrends of productivity increase, population overgrowth, and the implications of changes in the technology of information and communication. Current trends in attempts to achieve harmonization with respect to the concept and tasks of occupational health services in the European Union are described, along with the basic features of occupational health services as a human service organization with implications for the setting of objectives and criteria for assessing quality and performance and ethics. The need to adopt a quality-focused approach to occupational health service programs is emphasized, and some of the inhibitions and obstacles to quality work are mentioned. The need for professional commitment to develop and implement quality concepts is outlined. Evidence-based health care in the setting of occupational health services and some salient aspects of professional ethics in the...
Scandinavian Journal of Work, Environment and Health, 1983
A cohort of 13,114 workers employed during 1930-1975 in two Swedish plants producing tires and in... more A cohort of 13,114 workers employed during 1930-1975 in two Swedish plants producing tires and industrial rubber goods was investigated with regard to cancer mortality and cancer incidence. Separate analyses were performed on the following subgroups of the cohort: mixers/weighers, other production workers, and white-collar employees. For all causes of death no increase of risk was observed in the population as a whole. Mixers/weighers showed however an increased overall standardized mortality ratio. The pattern of causes of death was not changed in the total cohort. An increased risk to die from liver cancer (risk ratio 4.12) and pancreatic cancer (risk ratio 2.70) was, however, observed for the category other production workers. An increased risk of death from tumors of the respiratory organs was also observed for the categories other production workers (risk ratio 1.89) and white-collar employees (risk ratio 2.63). For tumors in the urinary bladder (risk ratio 2.50) and for ischem...
Scandinavian Journal of Work, Environment and Health, 1981
A report on unusually many wasted pregnancies among women working at a laboratory in a paper indu... more A report on unusually many wasted pregnancies among women working at a laboratory in a paper industry gave rise to a cohort study on pregnancy outcome among all women working in the pulp and paper industry in Sweden during 1973--1977. A total of 890 deliveries were identified (899 infants born). The total number of malformed infants or perinatally dead infants was according to expectations. When the material was broken up according to occupation, it was found that, in the group of infants whose mothers worked in laboratories during pregnancy, the rate of malformed infants appeared high. These data, added to previously published data, seem to support the notion that work in laboratories represents a pregnancy hazard.
Scandinavian Journal of Work, Environment and Health, 1995
The objective of this study was to provide an extended follow-up of workers in three Swedish plan... more The objective of this study was to provide an extended follow-up of workers in three Swedish plants producing man-made vitreous fibers (MMVF). Mortality and cancer incidence was investigated among 3539 male and female workers, employed for at least one year before 1978. Mortality was followed from 1952 to 1990 and cancer incidence from 1958 to 1989. National and regional mortality and cancer incidence rates were used to calculate the expected numbers. Twenty-seven lung cancer deaths were observed compared with 23 expected (standardized mortality ratio 117, 95% confidence interval 81-176), based on regional mortality. With a latency time of 30 years, the lung cancer risk was significantly elevated, but not trend was found for the standardized mortality ratio with increasing duration of exposure to MMVF. The lung cancer and stomach cancer mortality was higher in the rock wool industry than in the fiber glass industry. Fiber exposure from 1938 to 1990 was estimated in the two rock wool...
Scandinavian Journal of Work, Environment and Health, 1995
A multiplicative model was developed to assess past exposure to respirable fibers among rock wool... more A multiplicative model was developed to assess past exposure to respirable fibers among rock wool and slag wool production workers in Sweden in 1938-1990. Information on the job titles, work tasks and employment times of 1487 workers exposed to man-made vitreous fibers was obtained from company records and interviews with older employees. A mathematical model developed earlier for assessing historical fiber exposure, based on factory averages, was further developed. Matrices of multipliers for each plant that were specific for job title were modified to assess fiber exposure with respect to job title and calendar period. The model was based on measurements made in 1977. Two methods of exposure assessment were compared, cumulative exposure based on factory average (model I) and cumulative exposure based on job title (model II). The exposure changed considerably in the two factories during the period 1938-1990, and it varied also between job titles. The estimated average fiber (f) exp...
Scandinavian journal of rehabilitation medicine, 1995
This study was designed to determine a cost-effective use of psychologist resources in multimodal... more This study was designed to determine a cost-effective use of psychologist resources in multimodal cognitive-behavioural treatments (MMCBT) for chronic neck/shoulder pain. A randomised controlled trial was conducted with 66 patients divided in two groups. The first group (A) was treated following the approach of MMCBT with the clinical psychologist only functioning as a "coach" to the other health professionals. In this group, the psychologist had on average 5 hours of input per patients. The second group (B) was treated with the same inpatient MMCBT but with the behavioural component administered by the clinical psychologist directly to the patients. In this second group the psychologist had on average 17 hours of input per patient in the entire intervention. The outcome variables included physical, emotional and social factors, and sick-leave. Both groups showed significant improvements over time. The improvements were evident only in sub-groups, specifically in women. Th...
The incidence of lung cancer among 280 silicotic men working in the ceramics industry and notifie... more The incidence of lung cancer among 280 silicotic men working in the ceramics industry and notified to the Swedish Silicosis Registry has been investigated. During the study period 1958-83, the risk of lung cancer (nine cases) was double that expected based on national rates. There was no increased incidence of cancer at any other site. The results are in agreement with those of both animal and epidemiological studies of quartz exposure and point to an increased risk of lung cancer, especially among silicotics. Various possible explanations of this increased risk are discussed, but further studies are required.
The principal techniques for the control of carcinogenic hazards are described. A sense of respon... more The principal techniques for the control of carcinogenic hazards are described. A sense of responsibility must be encouraged in the groups of people who are involved, such as manufacturers, importers, retailers or distributers. Relevant, evaluated information from the scientific community must be brought to the attention of responsible bodies in a systematic way. Information about sources of emission, pathways of spread and identification of populations at risk is essential. Estimates must be made of costs and benefits, whether tangible or intangible. Mechanisms of intervention are described, including registration, authorization, permission, notification and dissemination of information. Mechanisms of risk surveillance involve the monitoring of health indices and of exposure situations: techniques of data collection are outlined. It is important that such data be both accessible for evaluation by authorized persons and at the same time remain confidential. Education is basic to can...
It has been estimated that occupational exposures are responsible for about 4% of all human cance... more It has been estimated that occupational exposures are responsible for about 4% of all human cancers in industrialized countries. These cancers are concentrated among manual workers and in the lower social classes, thus contributing to the social class gradient in cancer incidence and mortality. On the basis of the 1971 cancer mortality data from England and Wales, it was estimated that occupational cancer is responsible for about a third of the total cancer difference between high (I, II and III-NM) and low (III-M, IV and V) social classes, and for about half of the difference for lung and bladder cancer. However, direct evidence on the extent of the contribution of occupational exposure to carcinogens to social class differences is lacking, and several problems, such as the possible interaction between carcinogens and the effect of extraoccupational confounding factors, add further elements of uncertainty.
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Papers by P. Westerholm