American Journal of Industrial Medicine 20:131-132 (1991)
LETTER TO THE EDITOR
Occupational Health Research Needs in Developing Countries Key words: occupational disease, long-term exposures, epidemiology
In their Commentary, Christiani et al. [1990] omit mention of the problems associated with occupational disease in other undeveloped countries, such as the so-called Eastern European Block, in particular Yugoslavia. In Yugoslavia, all industries of the developed world are represented, yet the socioeconomic status has created two conditions for the labor force: inability to migrate to other sectors or countries and unavailability of transfer to other jobs within the work setting. This situation has resulted in long-term low-level exposures to known or unknown hazards for a majority of industrial workers. In addition, although threshold limit values, with their accompanying regulations for protective controls and devices, and pre-employment and periodic examinations have been mandated since 1972 [WHO, 19861, there has been little or no possibility of enforcing these due to economic problems. Neither have personal or environmental safety measures been enforceable among employers or employees. Specialists in occupational health are aware of the hazards present in the working environment and regularly have testified on behalf of workers seeking compensation for disability arising from work-related conditions. In addition to the recommendations for further research, I would suggest that low-level exposures encountered over an entire working lifetime may occur not only due to the workers’ lack of awareness of the hazards but because of the near impossibility of changing their work or conditions of work. The situation can be viewed both as unfortunate, and as an opportunity of assessing the effects of long-term durations of exposure, durations measured not in number of hours, months, or years but in lengths of active working lives. Therein may lie the answer to the differing findings among various authors [Sanden and Axelsson, 1981; Waksvik et al., 1981; Stiller et al., 1986; Stucker et al., 1983; Milkovic-Kraus, 19901 and a challenge to use sadly gained knowledge to prevent future harm. Sanja Milkovic-Kraus, MD, PhD Institute for Medical Research and Occupational Health Zagreb, Yugoslavia Address reprint requests to Dr. Milkovic-Kraus, Institute for Medical Research and Occupational Health, Department of Occupational Diseases, M. Pijade 158, P.O. Box 291, YU-41004Zagreb Yugoslavia. Accepted for publication October 22, 1990.
0 1991 Wiley-Liss, Inc.
132
Milkovic-Kraus
REFERENCES Christiani DC, Durvasula R, Myers J (1990): Occupational health in developing countries: Review of research needs. Am J Ind Med 17:393-401. Milkovic-Kraus S (1990): Noise-induced hearing loss and blood pressure. Int Arch Occup Environ Health 62:259-260. Sanden A, Axelsson A (1981): Comparison of cardiovascular responses in noise-resistant and noisesensitive workers. Acta Otolaryngol 92:75-100. Stiller A, Obe G, Boll I, Pribilla W (1983): No elevation of the frequencies of chromosomal alterations as a consequenceof handling cytostatic drugs. Analysis with peripheral blood and urine of hospital personnel. Mutat Res 121:253-259. Stucker I, Hirsch A, Doloy T, Bastie-Sigeac I, Hemon D (1986): Mutagenic hazard and handling of cytostatic drugs. Int Arch Occup Environ Health 57:195-205. Waksvik H, Klepp, Brogger A (1981): Chromosome analysis of nurses handling cytostatic agents. Cancer Treat Rep 63:607-611. WHO (1986): “Early Detection of Occupational Disease.” Geneva: World Health Organization.
LETTER TO THE EDITOR
Occupational Health Research Needs in Developing Countries Key words: occupational disease, long-term exposures, epidemiology
In their Commentary, Christiani et al. [1990] omit mention of the problems associated with occupational disease in other undeveloped countries, such as the so-called Eastern European Block, in particular Yugoslavia. In Yugoslavia, all industries of the developed world are represented, yet the socioeconomic status has created two conditions for the labor force: inability to migrate to other sectors or countries and unavailability of transfer to other jobs within the work setting. This situation has resulted in long-term low-level exposures to known or unknown hazards for a majority of industrial workers. In addition, although threshold limit values, with their accompanying regulations for protective controls and devices, and pre-employment and periodic examinations have been mandated since 1972 [WHO, 19861, there has been little or no possibility of enforcing these due to economic problems. Neither have personal or environmental safety measures been enforceable among employers or employees. Specialists in occupational health are aware of the hazards present in the working environment and regularly have testified on behalf of workers seeking compensation for disability arising from work-related conditions. In addition to the recommendations for further research, I would suggest that low-level exposures encountered over an entire working lifetime may occur not only due to the workers’ lack of awareness of the hazards but because of the near impossibility of changing their work or conditions of work. The situation can be viewed both as unfortunate, and as an opportunity of assessing the effects of long-term durations of exposure, durations measured not in number of hours, months, or years but in lengths of active working lives. Therein may lie the answer to the differing findings among various authors [Sanden and Axelsson, 1981; Waksvik et al., 1981; Stiller et al., 1986; Stucker et al., 1983; Milkovic-Kraus, 19901 and a challenge to use sadly gained knowledge to prevent future harm. Sanja Milkovic-Kraus, MD, PhD Institute for Medical Research and Occupational Health Zagreb, Yugoslavia Address reprint requests to Dr. Milkovic-Kraus, Institute for Medical Research and Occupational Health, Department of Occupational Diseases, M. Pijade 158, P.O. Box 291, YU-41004Zagreb Yugoslavia. Accepted for publication October 22, 1990.
0 1991 Wiley-Liss, Inc.
132
Milkovic-Kraus
REFERENCES Christiani DC, Durvasula R, Myers J (1990): Occupational health in developing countries: Review of research needs. Am J Ind Med 17:393-401. Milkovic-Kraus S (1990): Noise-induced hearing loss and blood pressure. Int Arch Occup Environ Health 62:259-260. Sanden A, Axelsson A (1981): Comparison of cardiovascular responses in noise-resistant and noisesensitive workers. Acta Otolaryngol 92:75-100. Stiller A, Obe G, Boll I, Pribilla W (1983): No elevation of the frequencies of chromosomal alterations as a consequenceof handling cytostatic drugs. Analysis with peripheral blood and urine of hospital personnel. Mutat Res 121:253-259. Stucker I, Hirsch A, Doloy T, Bastie-Sigeac I, Hemon D (1986): Mutagenic hazard and handling of cytostatic drugs. Int Arch Occup Environ Health 57:195-205. Waksvik H, Klepp, Brogger A (1981): Chromosome analysis of nurses handling cytostatic agents. Cancer Treat Rep 63:607-611. WHO (1986): “Early Detection of Occupational Disease.” Geneva: World Health Organization.
