Interstitial fibrosis resulting from workplace exposure to asbestos and crystalline silica persists throughout the world despite knowledge of the causes and effective means for prevention. Asbestosis and silicosis occurrence is predictable among people overexposed to dusts in various industries and occupations such as mining, construction, manufacturing, and building maintenance. Asbestosis and silicosis are incurable and may be progressive even after dust exposure has ceased, therefore early recognition and supportive interventions are important. Although current disease is a result of past exposures, effective control of current workplace exposures is the only way to prevent continued occurrence of these potentially debilitating diseases. Physicians can contribute to this effort through accurate diagnosis and disease reporting.

We describe the clinical evaluation of the nervous-system effects of solvent exposure. We review the current evidence in the epidemiological literature on neurotoxicological effects of solvents, and outline methods and issues to be taken into account in assessment of the patient whose symptoms may be related to solvent toxicity. Primary prevention of these disorders is essential, because treatment options are limited.

Pesticide exposures cause disorders varying from straightforward topical irritant reactions, such as those to synthetic pyrethroid insecticides, to complex systemic illness, such as that resulting from cholinesterase inhibition by organophosphate pesticides. The acute illness syndromes associated with pesticides most commonly encountered by clinicians are illustrated here by cases reported to the California Pesticide Illness Surveillance Program. The issues raised include asthma associated with exposure to contaminants in organophosphate insecticides, systemic toxicity of ingested pyrethroids (in children), and illnesses associated with spills or misuse of fumigants.

The two commonest forms of occupational skin disease are irritant and allergic contact dermatitis. Morphology and history are used to establish the diagnosis and the relation of the disorder to work exposure, respectively. Diagnostic patch tests are used to define further the diagnosis and aetiology of the dermatitis.

Only incomplete data are available to guide decision on anti-HIV treatment. A British HIV Association consensus is that guidance must draw on other evidence besides the randomised trial. Marker studies, work on disease pathogenesis and viral dynamics, and expanding knowledge of resistance patterns mean that the approach to therapy is constantly evolving. There is a need for well-informed dialogue between HIV-infected patient and physician to achieve rational, individualized treatment. However, the following broad principles have a wide consensus amongst HIV-treating physicians in the UK: (1) treatment should be offered before substantial immunodeficiency ensues; (2) initial treatment should include combinations of at least two drugs; (3) switches in therapy should involve substitution or addition of at least two new agents; (4) viral load and CD4 measurements are essential; (5) reduction in viral load to below the detection level of a sensitive assay represents the optimal treatment response and failure to achieve or sustain this control should prompt consideration of therapy modification. This response seems to be achieved most reliably with combinations of two nucleoside analogues plus a third agent (a protease inhibitor, a non-nucleoside reverse-transcriptase inhibitor, or a third nucleoside analogue) or of two protease inhibitors.

Sick-building syndrome (SBS) is an increasingly common problem. Although objective physiological abnormalities are not generally found and permanent sequelae are rare, the symptoms of SBS can be uncomfortable, even disabling, and whole workplaces can be rendered non-functional. In assessment of patients with SBS complaints, specific building-related illnesses suggested by history or physical examination should be ruled out. On-site assessment of buildings is extremely useful. Treatment involves both the patient and the building. Whenever possible, changes such as ventilation improvements and reduction of sources of environmental contamination should be initiated even if specific aetiological agents have not been identified.

Repetitive strain injuries (RSI) present an increasingly common challenge to clinicians. They consist of variety of musculoskeletal disorders, generally related to tendons, muscles, or joints, as well as some common peripheral-nerve-entrapment and vascular syndromes. These disorders generally affect the back, neck, and upper limbs, although lower limbs may also be involved. Although RSI may occur as a result of sports and recreational activities, occupational RSIs, affecting the patient's livelihood, are particularly important. These injuries result from repetitive and forceful motions, awkward postures, and other work-related conditions and ergonomic hazards. Occupationally induced RSIs are generally costly, creating a strong incentive for physicians to become familiar with the symptoms, signs, and risk factors so that they can be diagnosed early and appropriate interventions facilitated.