A screening programme on chronic solvent-induced encephalopathy among Dutch painters.
BACKGROUND
Long-term exposure to organic solvents may lead to chronic solvent induced encephalopathy (CSE) in painters. In combination with reduction of exposure, a workers' health surveillance programme was developed, resulting in a three-stage CSE screening procedure for early neurobehavioural changes possibly predicting chronic health effects. The screening consists of a questionnaire (Neurosymptom Screening Checklist 60, NSC-60), computerised neurobehavioural functioning testing (Neurobehavioural Evaluation System; NES2) and multidisciplinary differential diagnostic evaluation by experts (called 'Solvent Team'). Results from the screening were compared with the results of the 'care as usual' (CAU), in which symptomatic patients were referred directly to the Solvent Team by occupational physicians, general practitioners or medical specialists. Parallel to the screening programme, a legal ban on indoor use of solvent-based paints resulted in lower exposure to solvents.


OBJECTIVE
To investigate the usefulness of the NSC-60 questionnaire as a screening tool for CSE among painters and to investigate the course of the number of CSE cases over the years as a potential consequence of improved prevention and control.


RESULTS
From 1998 to 2004, more than 40,000 painters were invited to participate in a health surveillance programme including a periodical occupational health examination (PHE) and 50% did participate. Four percent (N=794) of these had a positive score on the NSC-60. The Solvent Team assessed 101 of these for CSE, which resulted in 27 CSE cases diagnosed. CAU during the same period of the surveillance (1998-2004) yielded 619 painters and 75 of these had the diagnosis CSE. After 2002 the number of CSE diagnosed cases dropped considerably and in 2004 only one case of CSE could be diagnosed. The substantially lower prevalence of CSE diagnosed cases in painters after 2002 might partly be explained as a result of a successful participation in the screening procedure of most prevalent CSE cases during the years 1998-2002. A second reason for the reduction of new diagnosed cases of CSE can be the effectiveness of the ban on indoor use of solvent-based paints resulting in lower exposure levels at work.


CONCLUSIONS
The screening procedure is useful to screen for CSE among people taking part in the PHE programme. Control of CSE can be achieved by an integrated preventive approach with reduction of exposure and screening on early health effects.
Arbouw, 3840 AE Harderwijk, The Netherlands. spee@arbouw.nl
Ton
T
Spee
Evelien
E
van Valen
Cor
C
van Duivenbooden
Gert
G
van der Laan
D000328:Adult; D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D000704:Analysis of Variance; D001288:Attention / Q000187:drug effects; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology; D057189:Checklist; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003071:Cognition / Q000187:drug effects; D042241:Early Diagnosis; D061345:Early Medical Intervention; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects; D009426:Netherlands; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D020258:Neurotoxicity Syndromes / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D016273:Occupational Exposure / Q000009:adverse effects* / Q000517:prevention & control; D016272:Occupational Health; D010150:Paint / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011379:Prognosis; D015397:Program Evaluation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012997:Solvents / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014796:Visual Perception / Q000187:drug effects
D000395:Air Pollutants, Occupational; D012997:Solvents