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Air conditioning systems and health

Introduction

In the last few years the health problems related to air conditioning systems have become increasingly recognized by both the public and those responsible for public and industrial health.  There are two main problems arising from air conditioning systems although only one has been noted in New Zealand.

The first is caused by the organism Legionella pneumophila, which has been associated with humidified air conditioners, cooling towers and other areas of dampness in buildings throughout the world since the first reported cases after the American Legion Conference in Philadelphia in 1976.  An outbreak in a large hospital in Staffordshire in England last year has further highlighted the grave outcome that can be associated with this bacterium.  In New Zealand the death of the Speaker of the House of Representatives, Sir Basil Arthur, in 1985 has led to a call for better health standards after Legionella was implicated and later found to have infected several inhabitants of Parliament Building.

The second disease that has been noted is Humidifier Fever and although not fatal it leads to a significant productivity loss due to worker illness and absenteeism.  At this time no cases have been reported in New Zealand but our investigations have shown that it is likely to be present.

The condition of the air in the workplace in New Zealand is at present governed by Section 38 of the Factories and Commercial Premises Act, 1981.  This requires occupiers to ensure that reasonably comfortable atmospheric conditions exist for their employees.  It is the responsibility of the Department of Labour to inspect premises to check that these requirements are adhered to, although at present they only inspect those systems about which there have been complaints (Department of Labour, 1983).  The Health Department inspectors are also involved only when there is a necessity to investigate the source of a serious, usually notifiable diseases, such as Legionella.  Local City Health Inspectors have also not been heavily involved in ensuring that adequate standards are met and maintained.

In response to this upturn in awareness the Standards Association of New Zealand has recently produced a proposed New Zealand Standard Code of Practice for the Control of Hygiene in Air and Water Systems in Buildings (SANZ, 1986).  This has been drafted with the intention of gathering informed comment on its recommendations but unfortunately it appears that the report has been poorly distributed as many relevant people were unaware of its existence.

The Otago Regional Health Protection Committee has asked us to explore the present situation in Dunedin which involved both findings the systems and then asking questions about maintenance to those responsible.  All the systems were inspected and crude microbiological sampling performed on the air conditioning systems.  We have attempted to make some correlations between these parts of the project.

We have prepared a literature review which summarises overseas experience in preventing ill-health through effective maintenance.

The final task given to us was to prepare a critique of the proposed Standard and where possible to suggest improvements.  We hope that we have been able to highlight the important steps in preventing ill-health and also to provide some evidence for their effectivenss.

Authors of Report

Semisi Aioni, Robert Beulink, Ian Dittmer, Andrew Harrison, Jan Lavery, Jacques Marchand.

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Availability of data for the evaluation of an air ambulance proposal

Abstract

The transport of patients by air from a rural location to hospital is by no means a new concept.  The first know such flight in New Zealand occurred when a pregnant woman was flown by Fox Moth from Karangarua to Hokitika (4).  In the United States the use of aircraft in the role has evolved to such an extent that the use of helicopters to provide advanced emergency care services has become common place.  Such services not only provide a means of rapid patient transportation, but many, such services not only provide a means of rapid patient transportation, but many, such as that operated by the University of California Medical Centre, are staffed by advanced medical treatment crews, who are able to respond directly to the actual site of the injured or sick patient and provide major interventive treatment ranging from first aid to open thoracotomy(1).

Less advanced airborne emergency services do exist in New Zealand, e.g. that operated by Capitol Helicopters of Wellington but in the Otago/Southland region no such facilities exist.  Despite this a significant number of patients are airlifted into Dunedin from outlying areas.  Transfer of these patients usually requires the chartering of the nearest available aircraft and pilot.  The decision to airlift a patient, rather than utilize road transport, rests with the attending doctor.

Cooksley and Gilkinson in their 1985 study(2) looked at the feasibility of a helicopter air-ambulance service for Otago/Southland and attempted to determine this and recommended that a prospective study should be instigated.

It was however felt by some clinicians that the resources for a retrospective needs-benefit study did already exist and that an expensive, time consuming prospective study was unnecessary.

The aim of this study is to look again as the available records, i.e. undertake another retrospective study and attempt to assess the demand for an air ambulance, if it were available by showing that sufficient information is present within the available records to preclude the need for a prospective study.

Authors of Report

A Day, N Giblin, S Argent, P Harrop, B Anderson, C Marshall.

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Evaluation of strategies used for the prevention of coronary disease in high rick areas

Abstract

This study was designed to assess the General Practitioners attitudes toward the High Risk Strategy outlined in “The 1986 Advisory Committee to the Minister of Health – The Prevention of Cardiovascular Disease”, and to examine the current methods employed by General Practitioners for screening and interviewing with regard to the three main risk factors for Cardiovascular Disease; namely Smoking, Hypertension and Hyperlipidaemia.

A questionnaire was designed and twenty six General Practitioners were selected for the survey.  Eighteen General Practitioners responded.

Several trends were noted.  General Practitioners favoured having a central role in the “High Risk Strategy” over the concept of screening clinics.  Whilst most General Practitioners appeared convinced of the value of screening for and intervening in Hypertension and with smokers, they were considerably more ambivalent with regard to Lipids.

Authors of Report

David Asboe, Justine Barry-Walsh, Malcolm Bollen, Paddy Bhula, Mike Catton.

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Having a colostomy, ileostomy or urostomy:  A survey of Dunedin patients

Introduction

In the province of Otago there are approximately 160 colostomates, 65 ileostomates and 30 urostomates.  This survey was concerned with the ostomates living in the Dunedin – Mosgiel district.

The aims were to identify:

  • what the real needs of ostomates are;
  • whether these needs are being satisfactorily met;
  • where might improvements be made in the service to ostomates;
  • and in particular whether more information in the form of a pamphlet/book
  • was desired by ostomates and if so the form/content required.

It was planned to interview 60 ostomates; 20 colostomates, 20 ileostomates and 20 urostomates.  The survey was been broken up into different topics, namely pre-operative needs, post-operative needs, specific problems, social aspects, family and sexual matters and patients attitudes towards the ostomy society.  For the sake of continuity the results and discussion for each topic are grouped together into the same section.

Authors of Report

M Hay, A Herbison, M-J Houliston, K Kan, P McHugh, B McLaren, R Swaris.

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Hospital and community services as assessed by chronic psychiatric patients

Introduction

This project is in response to a request by Dr Romans-Clarkson for our group to determine the needs of chronic psychiatric patients in the community, with particular regard to the reorganization of the psychiatric health services in the Otago region.

Specifically, we were to examine the areas of:

  • Accommodation;
  • Finance;
  • Employment;
  • Transport;
  • Leisure;
  • Family and social support;
  • Health and social support;

In order to achieve this, we decided to interview patients who had recently been discharged from Wards 10, HB and 9B of the Cherry Farm Hospital group.  The interview attempted to gain their appraisals of the areas and services listed above.

Authors of Report

Clement Le Lievre, Teariki Maoate, Robert Murphy, Christine Page, Barry Turner.

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Is Dunedin Hospital suited to adolescent patients – a survey of adolescent inpatients

Introduction

The Otago Regional Child Health Committee has proposed that a special adolescent service be provided for adolescents wherever they are in hospital.  The eventual long-term goal being a separate inpatient unit for adolescents.

In considering the adaptation of hospital facilities to meet the needs of adolescents it seemed appropriate to explore the attitudes of adolescents themselves to the service provided.  This study reports a survey of opinions of teenage inpatients in Dunedin Public Hospital.

In recent years it has become increasingly evident that adolescents have needs and problems sufficiently distinguishable from those of children and adults to warrant consideration as a distinct group for health care provisions. (1), (2), (3), (4), (5).

In recognition of this the Otago Hospital Board Strategic Plan 1985-2001 cited the provisions of separate accommodation for adolescents as an area in which further discussion should be encouraged.  (6).  This recognizes that adolescents require an environment and ancillary staff appropriate to their age group.

There have been several studies of both adolescent wards and adolescent services.

In the survey by Rigg et. Al. (7) twenty hospitals throughout Canada were surveyed to investigate whether a separate adolescent wards was worthwhile.  Twelve hospitals had discrete adolescents wards.  The concensus of staff opinion in hospitals with and without adolescent wards, was strongly in favour of a separate ward for adolescents.  They felt there was an advantage in staff training and patient care.  It was considered that admission of adolescent patients was facilitated by having a separate ward; clinicians being glad to have a specific place to admit patients of this age, and patient acceptance also being high, a point emphasized by Schowalter and Lord (8).  Nursing staff surveyed by Rigg et. al.  were heavily in favour of a separate adolescent ward, feeling that advantages outweighed the problems of discipline and communication.  The reasons given for discipline problems were:

  1. staff inconsistency or inexperience;
  2. lack of activities leading to boredom and frustration;
  3. troubled adolescents from poor home situations.

Dividing a particular consultant’s patients into separate wards invariably becomes more time-consuming and inconvenient as regards ward rounds and medical management.  Communication problems are inherent.  To enable such an adolescent ward to be successful requires considerable staff effort.

Overseas studies have shown that even minor changes in ward design and hospital routine can meet adolescent needs (9).  These include:

  1. adolescents in a ward being grouped together as much as possible;
  2. recognition of age-related food preferences;
  3. recreational activities;
  4. a room set aside for teenagers to gather and enjoy common interests;
  5. provision to continue studies, especially for children needing repeated or prolonged stay in hospital;
  6. staff should allow adequate time to discuss illness and treatments.

Adolescents inpatient surveys (10), (11), have shown that adolescents tended to put up with the surroundings they found themselves in, albeit resignedly, but showed considerable appreciation of good staff communication, good recreational facilities; and the presence of peers; choosing “a ward for adolescents only” as their preferred inpatient situation.  In the areas of recreational facilities and peer support those patients on adolescent wards fared best.

There is no doubt that provisions of patient care and facilities aimed at this age group contributes to having more content patients and makes nursing care easier.

However, staff must be willing to overcome communication problems.

Authors of Report

Fiona Clendon, John Dockerty, Richard Fong, Malcolm Joblin, Alex Morgan, Mary Jane Sneyd.

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Pilot study of noise induced hearing loss in the engineers union

Introduction

Aims of the study in terms of:

  1. Community Project
    • Insight into the difficulties associated with carrying out epidemiological studies.
    • Insight into worker and management attitudes to their health and in the case of management, to their workers’ health with particular attention paid to preventive (occupational) health.
  2. The specific aims of the study:
    • Measure of hearing of a voluntary group of members of the Dunedin Branch of the NZ Engineers Union.
    • Refer those who have significant loss for further investigation.
    • Discuss the basis for hearing loss compensation in New Zealand and define the procedures involved.
    • Discuss the ways by which workers may get referred for ENT investigation because of hearing loss at work and delays involved.

Authors of Report

Garry Barron, Neil Bungard, Malcolm Legget, Ian Goodwin, John Goulden.

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'The fishing expedition' – a look at occupational health hazards in North Dunedin

Introduction and aims

North Dunedin, although a residential area, contains a number of industries.  The majority of these are smaller light industrial ventures interspersed with a few larger establishments.  The basis for this study lies in the fact that many of the industries in this area are not routinely inspected by the Health Department.

The client for this study was Mr S Bell, Senior Health Inspector for the area, who posed the question “How effective is the surveillance and support provided by the Health Department for small industry in North Dunedin?”  to answer this question the aims formulated for the study were:

  1. to evaluate the effectiveness of the Health Department in the North Dunedin area;
  2. to gain experience in the identification of potential or actual hazards present in the work-place;
  3. to design a questionnaire/check-list format which could be used by the Health or Labour Departments as a rapid and effective means of screening light industry in other areas.

Authors of Report

Ate Moala, Garry Nixon, Paul Norton, Duncan Watts.

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