Beyond notification: A case study from Cloquet,Minnesota

All members of Local 158 of the United Paperworkers International Union in Cloquet. Minnesota, were invited to attend a meeting to notify them about the outcome of the Union's study concerning exposure to asbestos fiber. Union members and their families were contacted by letter, radio and television announcements, area newspapers, and word of mouth. They were informed about the medical screening that was being planned and about other information on asbestos-related diseases. During the meeting, they were asked to attend one of the educational sessions, to schedule an appointment for the screening, and to fill out a medical history. It was determined that paperworkers with asbestos-related disease might have rights to at least two types of compensation: worker's compensation from their employers and/or court- or jury-awarded compensation from asbestos manufacturers. Other sources of compensation such as social security of disability pensions might also be available to eligible individuals. The Union did not have a complete listing of all the individuals who worked at plants or in operations where asbestos exposure may have occurred. The Union solicited the aid of the Minnesota Department of Health to help identify former asbestos-exposed workers and to develop an ongoing screening and medical program for workers who were exposed but did not develop symptoms of asbestos-related disease; these illnesses usually take 20 years or more to develop. However, the Union was able to follow-up the notification and subsequent screening by sending members and their families the results of the initial screenings and other information concerning the status of any legal actions taken on behalf of the exposed. The Minnesota Department of Health provided information about that Department intentions and goals for the future. In addition, the Union asked members and families who participated in the education and screening activities for feedback about the program. © 1993 Wiley-Liss, Inc.     

Social aspects of high-risk notification among chromium-exposed workers

This study, based on 169 telephone interviews, explores how a sample of chromium-exposed workers responded to notification of their cohort's elevated risk of lung cancer. It is important to recognize that notified workers do not react as isolated individuals. Their responses are social, actively constructed through interaction with others, unfolding over time within a context of relationships and shared symbols that mediate the risk information. This report illustrates some of the ways that socially-based beliefs and interaction with the social environment can influence worker response, and suggests a more sociologically sophisticated concept of notification to fit the realities of workers' lives. © 1993 Wiley-Liss, Inc.     

The ethics of choice in the struggle against industrial disease

This article argues that broad recognition of the ethical basis for society's decisions about the reduction of the risks of workers, including notification, has been, is, and will be a more persuasive method of establishing programs implementing the rights to know and act in controlling the industrial vector in human disease than sheer power politics. If the argument is correct, then attention needs to be focused on the nature of the ethics of choice. The moral dialectic in the history of science and medicine is traced to the metaphysically assumed values of open and closed models of knowledge and action that determine how we weigh genetic and environmental factors in the process of choosing who shall live and who shall die of disease, with strong industrially generated vectors. The author suggests that we escape from the concepts of the closed systems of the past, whose grammar reflects values repugnant to the empowerment of those notified of risk, to open systems that enhance community-ecologic values of life and freedom. © 1993 Wiley-Liss, Inc.     

Dioxin: A case study

The need to notify individuals of a possible health risk from their past exposure to potentially hazardous agents frequently extends beyond workers to include community groups. The issues to consider in community notification are frequently similar to those that are important for worker notification but may include some that are unique. This case study traces the evolution of one company's strategy for communicating with the public about possible dioxin contamination associated with its operations. Early communications tended to emphasize the technical aspects of the issues in the fashion of scientists talking to other scientists. This was interpreted by some to be symptomatic of an arrogant and uncaring attitude. Beginning in the early 1980s, the company's management recognized the need to reach out to a variety of audiences on multiple levels, and shifted to a more comprehensive communications strategy. A similar shift is now occurring throughout the chemical manufacturing industry as top managers realize that, if they expect to continue to operate, they must become more accountable and responsive to the public. © 1993 Wiley-Liss, Inc.     

Gender differences among spouses of surgeons

BACKGROUND: The goal of this study was to identify whether gender differences exist regarding the degree of spousal support for, satisfaction with, and perception of surgeons' careers. METHODS: A survey was performed of spouses of academic surgeons in the United States and Canada. RESULTS: Female respondents were significantly less likely to work outside of the home and were significantly more likely to be the major decision-makers at home. They were less likely to credit their surgeon spouses with contributing to household duties and childcare. If both spouses worked outside of the home, the female spouse was still more likely to be the major decision maker. Overall, male and female respondents rated their role in and their satisfaction with their spouses' career choices similarly. CONCLUSIONS: Male and female spouses contribute equally to the career choices of their surgeon spouses. However, female spouses, both surgeon and nonsurgeon, are more likely to make the majority of the decisions at home and contributions to household care.     

Spousal influence on smoking behaviors in a US community sample of newly married couples

Among married couples, partners often have similar characteristics and behaviors. Among individuals who smoke cigarettes, it is not uncommon for them to have a partner who also smokes. In fact, having a partner who smokes can influence the spouse's initiation of smoking, or return to smoking after a previous quit attempt. Additionally, it is possible that a nonsmoking partner can influence his/her spouse to stop smoking. Participants for this research are from a community sample of couples in the United States. They were recruited at the time they applied for their marriage license and followed through to their second wedding anniversary. Logistic regression models, controlling for demographics, were utilized to determine if a partner's smoking status predicted smoking initiation or relapse over the early years of marriage. Overall, there was some support that a partner's smoking status did influence the other's smoking, although more support was found for spousal influence on relapse than cessation. There was more support for husband's influence compared to wife's influence, nonsmoking wives were more likely to resume smoking in the early years of their marriage if their partners were smokers. Wives' smoking, however, did not predict husband initiation of smoking. These findings suggest that during the transition into marriage, spouses do influence their partners' behaviors. In particular, women are more likely to resume smoking, or return to smoking if their partners smoke.     

Long-term impact of worker notification: qualitative assessment of a community-based notification and screening program in Augusta,Georgia

BACKGROUND: Evaluation of high-risk worker notification programs often focuses on their immediate effectiveness in communicating information to individual workers. This approach leaves unexamined some important social processes that can influence worker notification's impact and public health consequences over time. METHODS: To explore long-term effects, ethnographic methods were used for qualitative assessment of a community-based program carried out by the National Institute for Occupational Safety and Health (NIOSH) in Augusta, Georgia, during the early 1980s. More than a decade after the original NIOSH intervention, lengthy taped interviews were conducted with 70 members of the notified cohort (chemical workers exposed to beta-naphthylamine (BNA)) and 32 members of their families. RESULTS: The notified workers expressed extremely positive feelings about having received the risk information. However, for non-obvious and unanticipated reasons, most had failed to implement the notification's primary health advice (annual screening for bladder cancer). Both the workers and their family members reported a number of ongoing concerns related to the program. CONCLUSIONS: The study findings suggest four strategies, all relatively low in cost, that are likely to increase the long-term public health benefits of worker notifications that rely on individually mailed written materials: (1) in designing worker notifications, take into account the information (accurate or not) that the workers already have, and determine what kind of information they most want and need; (2) define the notification audience broadly to include not only the study cohort but also family members and/or other similarly exposed workers; (3) when notifications recommend secondary disease prevention measures over long time periods, follow up the notification health advice with periodic reminders; (4) inform a wide range of community organizations and service providers (non-medical as well as medical) about the notification, and encourage them to provide appropriate support to the notified workers and their families.     

Knowledge of disease notification among doctors in government hospitals in Benin City,Edo State,Nigeria

STUDY OBJECTIVE: Notifiable diseases are conditions where regular, frequent and timely reporting of individual cases is considered necessary for the prevention and control of the disease. They can be classified into immediate, routine, international, and occupational notifiable diseases. Despite its importance, notification suffers some setbacks, as shown by worldwide studies. This study was carried out from August to November 1999 to assess the knowledge of disease notification among doctors at the University of Benin Teaching Hospital and Central Hospital, Benin City, Edo State, Nigeria. DESIGN: A cross-sectional study design was used, and a self-administered questionnaire, which was pretested, was used to collect data. SETTING: All doctors from the University of Benin Teaching Hospital and Central Hospital, Benin City, Edo State, Nigeria were included in the study. PARTICIPANTS: In total, 134 doctors participated in the study. MAIN RESULT: Only 11.9% of doctors had a good knowledge of disease notification. Thirty-one (23.1%) doctors knew where to obtain notification forms, and 32 (23.9%) knew how to complete these forms. CONCLUSION: Knowledge of disease notification among doctors in these major institutions is poor. It has therefore been recommended that quarterly seminars should be conducted to update doctors' knowledge and serve as reminders about disease notification.     

Automated laboratory reporting of infectious diseases in a climate of bioterrorism

While newly available electronic transmission methods can increase timeliness and completeness of infectious disease reports, limitations of this technology may unintentionally compromise detection of, and response to, bioterrorism and other outbreaks. We reviewed implementation experiences for five electronic laboratory systems and identified problems with data transmission, sensitivity, specificity, and user interpretation. The results suggest a need for backup transmission methods, validation, standards, preserving human judgment in the process, and provider and end-user involvement. As illustrated, challenges encountered in deployment of existing electronic laboratory reporting systems could guide further refinement and advances in infectious disease surveillance.