Johnson B, Baker E, Gilioli R, Seppalainen A, El-Batawi M, Hanninen H, Xintaras C, eds., NY: John Wiley & Sons, 1987 Jan; :1-275
In view of the multiple needs of both developed and developing countries, the World Health Organization, with assistance from its Collaborating Centers for Occupational Health, has prepared this monograph: Prevention of Neurotoxic Illness in Working Populations. It is an attempt to critically evaluate and consolidate existing information on the neurotoxicity of workplace chemicals, thus facilitating the transfer of technical information not otherwise available to health professionals in both developed and developing countries. It is hoped that the monograph will be widely disseminated and used by countries as a tool in developing national programs to prevent neurotoxic disorders, especially in support of national primary health care strategies. The first section provides the rationale for clinical, experimental and epidemiologic studies in assessing worker exposure to neurotoxic chemicals. A wide range of clinical reports, epidemiologic investigations and experimental studies are evaluated and salient findings summarized. Instrumental and statistical methods used in these various studies are described. Research findings are presented in relation to worker exposure to (1) organic solvents, (2) metals, (3) agricultural chemicals, (4) noxious gases, (5) irritants. (6) new chemicals being introduced to the workplace, (7) drugs at the workplace and (8) chemical interactions. Also discussed m this section is the field application of research findings in the early detection and prevention of neurotoxic diseases. International guidelines for use and testing of human subjects in research studies are considered especially as regards participants' rights. The second section describes consensus recommended methods (epidemiologic, neurobehavioral neurophysiological, diagnosis and treatment) to be used in the early detection and prevention of neurotoxic disorders. The central role of epidemiology and biostatistics in the prevention of neurotoxic illness in working populations is presented. Discussion is designed primarily to present a framework for those persons responsible for evaluating epidemiologic investigations and as a guide in the design and conduct of such studies. Diagnosis and treatment methods are divided into three parts that include; (a) an outline of the neurological symptoms and signs commonly associated with exposure to neurotoxic chemicals, (b) the diagnostic strategies leading to syndrome and etiologic diagnoses and (c) therapeutic strategies for both acute and chronic intoxicants for the commonly encountered neurotoxic workplace chemicals. Recommended neurobehavioral and neurological methods are also presented in Section II. Specific purposes for the use of neurological and neurobehavioral tests are defined and specific tests are identified that are simple, reliable and valid for detecting neurotoxic effects. Test batteries are identified that may be used in support of health surveillance programs, epidemiologic studies and health hazard evaluations. Significance of test measures in relation to health impairment and implications to worker performance and worker safety (injury) are also considered. The third section addresses the critical issue of strategies to prevent neurotoxic illness in working populations. Material on hygienic standards, industrial hygiene practices, engineering controls, work practices, materials substitution and other means by which to prevent the exposure of workers to neurotoxic substances is presented in Section III. Additionally, this section provides information on the basis upon which programs for training and education can be established (legal/voluntary); levels of training and education required (specialized, employer/management, employee and general public); and content of training and educational materials. Both basic and specifically oriented (tailored) training materials are identified. The monograph concludes with a fourth section which presents comments that reflect on the contents of Sections I- III.