Occupational safety and health: progress toward the 1990 objectives for the nation

Occupational safety and health is 1 of 15 areas addressed in the Public Health Service's Objectives for the Nation. This area represents 104 million working men and women and the deaths, diseases, and injuries that result from exposures to hazards in their work environment. Characteristics of public health practice are compared with characteristics of occupational safety and health practice. The National Institute for Occupational Safety and Health (NIOSH), created by the Occupational Safety and Health Act, is discussed. NIOSH has developed a list of 10 leading work-related diseases and injuries. The list is headed by occupational lung diseases. Twenty Objectives for the Nation in the area of occupational safety and health are reviewed, and the status of NIOSH efforts toward their attainment is discussed. Five categories of objectives are covered: (a) improved health status, (b) reduced risk factors, (c) improved public and professional awareness, (d) improved service and protection, and (e) improved surveillance and evaluation. The potential for achieving these objectives is discussed, with special attention given to the lack of a data base for monitoring progress. A major conclusion is that surveillance in occupational safety and health needs to be strengthened.     

Global Estimates of the Burden of Injury and Illness at Work in 2012

This article reviews the present indicators, trends, and recent solutions and strategies to tackle major global and country problems in safety and health at work. The article is based on the Yant Award Lecture of the American Industrial Hygiene Association (AIHA) at its 2013 Congress. We reviewed employment figures, mortality rates, occupational burden of disease and injuries, reported accidents, surveys on self-reported occupational illnesses and injuries, attributable fractions, national economic cost estimates of work-related injuries and ill health, and the most recent information on the problems from published papers, documents, and electronic data sources of international and regional organizations, in particular the International Labor Organization (ILO), World Health Organization (WHO), and European Union (EU), institutions, agencies, and public websites. We identified and analyzed successful solutions, programs, and strategies to reduce the work-related negative outcomes at various levels. Work-related illnesses that have a long latency period and are linked to ageing are clearly on the increase, while the number of occupational injuries has gone down in industrialized countries thanks to both better prevention and structural changes. We have estimated that globally there are 2.3 million deaths annually for reasons attributed to work. The biggest component is linked to work-related diseases, 2.0 million, and 0.3 million linked to occupational injuries. However, the division of these two factors varies depending on the level of development. In industrialized countries the share of deaths caused by occupational injuries and work-related communicable diseases is very low while non-communicable diseases are the overwhelming causes in those countries. Economic costs of work-related injury and illness vary between 1.8 and 6.0% of GDP in country estimates, the average being 4% according to the ILO. Singapore's economic costs were estimated to be equivalent to 3.2% of GDP based on a preliminary study. If economic losses would take into account involuntary early retirement then costs may be considerably higher, for example, in Finland up to 15% of GDP, while this estimate covers various disorders where work and working conditions may be just one factor of many or where work may aggravate the disease, injury, or disorders, such as traffic injuries, mental disorders, alcoholism, and genetically induced problems. Workplace health promotion, services, and safety and health management, however, may have a major preventive impact on those as well. Leadership and management at all levels, and engagement of workers are key issues in changing the workplace culture. Vision Zero is a useful concept and philosophy in gradually eliminating any harm at work. Legal and enforcement measures that themselves support companies and organizations need to be supplemented with economic justification and convincing arguments to reduce corner-cutting in risk management, and to avoid short- and long-term disabilities, premature retirement, and corporate closures due to mismanagement and poor and unsustainable work life. We consider that a new paradigm is needed where good work is not just considered a daily activity. We need to foster stable conditions and circumstances and sustainable work life where the objective is to maintain your health and work ability beyond the legal retirement age. We need safe and healthy work, for life.     

Cost of Compensated Injuries and Occupational Diseases in Agriculture in Finland

Abstract

Although agriculture is one of the most hazardous industries, the costs of agricultural injuries and illnesses are not well known. This study aimed to determine the cost burden from compensated injuries and occupational diseases in Finnish agriculture using workers compensation records.

The incidence rates in 1996 were 7.4/100 for injuries and 0.61/100 for occupational diseases. Men had a higher risk of injury (RR = 1.89; 95% CI: 1.81-1.97), but a lower risk of an occupational disease (RR = 0.68; 95% CI: 0.60-0.78), compared to women. The total cost burden was €75 (Euros) per person in 1983, increasing to €215 in 1999. The total insurance cost in 1996 was €23.5 million consisting of medical care (16%), per diem (lost time compensation within one year from the incident) (37%), pension (lost time compensation after one year from the incident) (23%), survivors pension (3%), impairment allowance (7%), rehabilitation (6%), and other costs (9%). The total cost was 0.7% of the national gross farm income and 2.2% of the net farm income. The mean cost of 1996 cases was €1340 for injuries and €6636 for occupational diseases. Injuries represented 92% of the claims and 71% of the total costs. Occupational diseases represented 8% of the claims and 29% of the costs. Twenty percent of the most severe claims represented 79.5% of the total insurance costs.

Injuries and occupational diseases result in significant costs in agriculture. Lost time was the largest cost item. Overall, injuries were more costly than occupational diseases. This study indicates that the 20%-80% rule applies to agricultural injury and illness costs, and from the cost standpoint, it is important to focus prevention efforts on the most severe incidents.     

Agricultural Medicine Core Course: Building Capacity for Health and Safety Professionals

ABSTRACT

In 1987 the University of Iowa began training health care professionals to care for farmers' occupational health needs. The training enables health professionals from various disciplines to function in the anticipation, diagnosis, treatment, and prevention of occupational illnesses and injuries in the farm community. A grant from National Institute for Occupational Safety and Health (NIOSH) entitled “Building Capacity for Health and Safety Professionals” allowed for the expansion of this training to other states. This paper describes the challenges, successes, and lessons learned from dissemination of Agricultural Medicine Core Course.     

2019—2021年淮安区职业健康检查结果分析

目的 评价职业病危害防治工作现状,为制定本区相关防治措施,明确职业健康工作重点和方向提供数据支撑及对策建议。方法 通过江苏省职业病防治信息管理平台收集2019—2021年淮安区职业健康监护资料,包括企业基本信息、人员体检情况、职业禁忌证及疑似职业病等数据,采用描述流行病学方法进行分析。结果 2019—2021年淮安区共有20 018名作业工人开展了职业健康检查,其中上岗前检查4 253人、在岗期间检查15 425人、离岗检查340人。接触物理因素体检9 672人,占48.32%;接触化学物质4 189人,占 20.92%,接触粉尘6 157人,占30.76%。共检出疑似职业病 14 人,其中12人接触物理因素(职业性噪声聋)、2人接触化学物质;检出职业禁忌证277人,其中接触粉尘11人,接触物理因素256人,接触化学物质10人;不同危害因素间疑似职业病、职业禁忌证检出率比较差异均有统计学意义(χ2疑似职业病=9.216,P<0.01、χ2职业禁忌证=218.845,P<0.01),检出率由高到低分别为物理因素、化学物质、粉尘。结论 本区职业健康检查企业及人数逐年上升,但与本区摸底调查数仍有差距,应重点关注由噪声引起的职业目标疾病,做好防治工作。     

Occupational sentinel health events: an up-dated list for physician recognition and public health surveillance

An occupational sentinel health event (SHE[O]) is a disease, disability, or untimely death, which is occupationally related and whose occurrence may: 1) provide the impetus for epidemiologic or industrial hygiene studies; or 2) serve as a warning signal that materials substitution, engineering control, personal protection, or medical care may be required. Following survey of scientific literature, a list of 50 disease conditions linked to the workplace was presented in 1983; these were codable within the framework of the International Classification of Diseases system (ICD-9). Three criteria were used for inclusion: documentation of associated agent(s), of involved industries, and of involved occupations. The up-dated list contains 64 diseases or conditions and a bibliography of literature citations. The list is useful for the practicing physician in occupational disease recognition, for occupational morbidity and mortality surveillance, and as a periodically up-dated database of occupationally related diseases.     

Injury and illness in the American workplace: A comparison of data sources

Setting priorities for workplace health and safety research depends upon accurate and reliable injury and illness data. All occupational health databases have limitations when used to summarize the national scope of workplace hazards. The comparison of data from multiple sources may produce more credible estimates of the leading occupational injuries and illnesses. The purpose of this paper is to describe the strengths and weaknesses of six data collection systems that record occupational injuries and illnesses on a national level and to compare the leading estimates from these systems for 1990. The six systems are: 1) National Traumatic Occupational Fatalities database, 2) the Bureau of Labor Statistics Census of Fatal Occupational Injuries, 3) The Bureau of Labor Statistics Annual Survey data, 4) a large workers' compensation database, 5) the National Council on Compensation Insurance data, and 6) The National Electronic Injury Surveillance System. Occupational injuries, as defined herein, predominate over illnesses in terms of the number of cases and the overall costs. Databases that provide information on the antecedents of injuries suggest how these injuries may be prevented and warrant more attention and refinement. © 1996 Wiley-Liss, Inc.     

The ten leading work-related diseases and injuries proposed by the National Institute for Occupational Safety and Health (NIOSH)

Ten leading work-related diseases and injuries were proposed by the NIOSH to be controlled. These diseases and injuries are occupational lung diseases, musculoskeletal injuries, occupational cancers (other than lung), amputations, fractures, eye loss, lacerations, and traumatic deaths, cardiovascular diseases, disorders of reproduction, neurotoxic disorders, noise induced loss of hearing, dermatologic conditions, and psychologic disorders. Current topics regarding these diseases and injuries are discussed.     

手术中血源性职业暴露特点分析

目的分析手术中血源性职业暴露的特点,为制定预防和控制对策提供依据。方法调查某三甲医院2016年6月—2017年1月发生的手术中血源性职业暴露病例,调查内容包括医务人员一般资料、职业暴露方式、暴露源及锐器伤器械种类及操作环节等。结果手术中发生血源性职业暴露的医务人员共100名。主要为护士64名(64.00%),其次为医生30名(30.00%)。暴露方式主要为锐器伤88例(88.00%)、眼黏膜暴露10例(10.00%)。暴露源病种主要为乙型肝炎36例(36.00%)、梅毒11例(11.00%)。导致锐器伤的锐器主要为输液器针头(31例,35.23%),其次为注射器针头(24例,27.27%)、缝合针(14例,15.91%)等。锐器伤发生的操作环节主要为术中操作(31例,35.23%)。结论应加强医务人员的职业暴露培训,完善职业暴露的登记和报告流程;严格要求医务人员,尤其是护士在手术过程中应严格按照操作流程规范操作,从而减少手术中血源性职业暴露的发生。     

金属制造业非致死性职业伤害流行特征分析

目的了解金属制造业非致死性职业伤害流行特征，为有效控制职业伤害的发生提供科学依据。方法采用随机整群抽样方法，抽取7家金属制造工厂中的2487名工人进行问卷调查，分析非致死性职业伤害发生特征和影响因素。结果调查人群非致死性职业伤害的年发生率为15．08％；事故类型以机器伤害（16．80％）、物体打击（13．60％）和热／火烫（11．47％）为主；伤害部位主要为手指／脚趾（78．16％）。多因素L0gistic回归分析显示，个性维度中的N分较高（情绪稳定性差）、年龄小、文化程度及技术等级低、采用计件／计时方式计算工资等因素。可使职业伤害发生的危险性升高。结论职业伤害已成为重要的公共卫生问题。应引起社会的广泛关注。     

Death certificate-based occupational mortality surveillance in the United States

Surveillance of cause-specific mortality patterns by occupation and industry through the use of death certificate records is a simple and relatively inexpensive approach to the generation of leads as to potential occupational disease problems. Researchers from the National Institute for Occupational Safety and Health (NIOSH) have been working with the National Center for Health Statistics, other federal agencies, and state health departments on a number of programs to foster the development of standardized, routine coding of occupation and industry entries on death certificates by state health departments. Thirty-one states and the District of Columbia are now doing such coding. These data are being analyzed currently by investigators at NIOSH and at individual state health departments for the purpose of hypothesis generation on occupation-disease relationships. The proportionate mortality ratio method is the predominant method being used, as appropriate denominator data are not generally available. This type of surveillance is particularly useful for the study of occupation and industry groups for which it is difficult to assemble cohorts, such as groups that are predominantly non-union and in small workplaces. Limitations of this surveillance include its inappropriateness for monitoring those occupational diseases which are not often fatal, and the limited scope and accuracy of death certificate information.     

2005年山东省部分企业职业病防治管理状况调查

[目的]了解企业职业病防治管理措施和职业健康监护制度的建立状况，查找职业卫生监督薄弱环节，加大对重点行业企业的监督工作力度。[方法]2005年10月，在山东省抽取青岛市、淄博市、枣庄市、临沂市的350家企业进行调查。[结果]被调查企业中接触职业病危害因素的人数占职工总数的35．56％；79．71％的企业设立了职业卫生管理机构，84．86％的企业建立了健康监护制度；不同行业、不同类型企业职业病管理措施和职业健康监护制度的建立情况有差异。[结论]山东省企业职业病防治管理措施建立情况较好，建材、化工行业及中小型企业的职业病防治工作有待加强。     

Advancing epidemiologic studies of occupational injury—Approaches and future directions

Despite increased attention to the epidemiology of occupational injuries and work-related musculoskeletal disorders, little is known about the relative contribution of risk factors for specific injuries and diseases and effective ways to prevent them. Building on the knowledge and ideas presented in the previous papers in this special issue, this paper describes the salient issues regarding the needs and the opportunities in design, conduct, and analysis of epidemiologic research on occupational injury. There is a clear need for standardization of definitions on exposure variables and health outcomes, since basic terminology is not used consistently across studies. Improved surveillance systems with linkage to other databases offer excellent opportunities to evaluate trends in risk factors and occupational injuries. New opportunities for etiologic studies include the case-crossover design, which focuses on relations between intermittent exposures and injuries, as well as several hybrid designs that combine advantages and strength of the traditional case-control and cohort study designs. Various suggestions are presented to capture the dynamics of exposure, including both intermittent and continuous factors in the assessment strategy. The importance of cohort studies is emphasized to clarify the temporal relations between causes and effects in work-related injury research. Finally, intervention studies are much needed and a hierarchical approach is suggested, starting with observational surveys, continuing with quasi-experimental studies and concluding with randomized controlled experiments of those interventions that hold the largest promise. Am. J. Ind. Med. 32:180–183, 1997. © 1997 Wiley-Liss Inc.     

2010年山东某化工企业甲烷氯化物生产项目职业病危害预评价

[目的]通过对山东某化工企业甲烷氯化物建设项目职业病危害因素的识别、分析和评价,提出合理、可行的防护对策,以保护劳动者健康。[方法]根据拟建项目投产后生产过程中可能产生的职业病危害因素的特点,采用职业病危害预评价方法的类比法和检查表分析法进行定性和定量分析。[结果]拟建项目的选址、总平面布局、职业病危害防护设施、生产工艺与设备布局、建筑卫生学要求、卫生专项经费概算等设计基本符合卫生学要求;职业卫生管理、应急救援、个人防护、辅助用室等设施也基本能够符合相关职业卫生标准的要求。[结论]该项目中存在化学毒物和其他有害物品,属职业病危害严重的建设项目,但在采取控制职业病危害的补充措施后,在职业病危害控制方面是可行的。     

职业病预防与工伤保险

从工伤保险的预防、赔偿和康复三大功能角度,在理论、法律和实践三方面论述职业病防治与工伤保险的关系;针对职业病防治特殊性提出利用费率杠杆加强职业病防治,整合职业病诊断鉴定与劳动能力鉴定程序,维持对职业病患者长期的合理保障以及分享利用职业病防治信息等建议。     

Current topics for occupational and environmental medicine and physiology in the U.S.A.--with special reference to occupational lung diseases

Current topics for occupational and environmental medicine and physiology in the U.S.A., especially in the National Institute for Occupational Safety and Health (NIOSH), and the University of California, San Francisco, are reviewed. Reduction of the rate for occupational lung diseases is one of the national objectives for occupational safety and health in the U.S.A., and NIOSH has rated it as the top disease of ten-leading work-related diseases and injuries. Current topics for occupational lung diseases--asbestosis, byssinosis, silicosis, coal worker's pneumoconiosis, lung cancer, and occupational asthma & hyperreactivity, and for pathophysiology of airway hyperreactiveness and pulmonary edema are discussed.     

护理人员职业暴露调查分析及对策

目的 分析护理人员职业暴露情况并寻求减少职业暴露的对策。方法 运用随机抽样的方法,对四家医院211名护理人员进行问卷调查,包括暴露类型、次数,医院是否采取防护措施及其防护效果等。结果 职业暴露类型以锐器伤和意外直接接触血液为主,暴露频繁,大部分医院采取防护措施但效果不显著等。结论 应强化职业安全教育、提高自我防护意识、提倡普及性预防、改进医疗器械、完善和健全防护措施,以减少职业损伤、促使优质护理服务工作持续稳定开展。     

某钢铁企业职业伤害调查研究

[目的]探讨某钢铁股份公司职业伤害的发生特点、分布、主要原因及发生趋势。[方法]根据对某钢铁股份公司1999年1月至2002年12月间职工人数及发生的职业伤害事故调查资料进行分析。[结果]该公司2002年职业伤害发生率为22．39／万，职业伤害类型以物体打击(24．39％)、灼烫(17．56％)、高处坠落(17．32％)和机械伤害(15．37％)为主。而操作不当(22．20％)和安全意识不强(15．85％)是其主要原因。[结论]职业伤害防制应从提高职工安全意识和技术水平着手，针对不同类型作业场所采取相应的措施。     

职业病防治体系构建之管见——以公共产品理论为视角

文章运用公共产品理论对职业病防治体系加以分析,认为职业卫生技术服务是准公共产品,应由企业和国家共同分担其出资;职业病患者保障是私人产品,但其责任主体和支付主体是企业;职业病防治监督是纯公共产品,应由国家承担.要将获取职业卫生技术服务的"谁出资,谁受益"原则变为"共同出资,共同受益"原则,并通过制度设计,鼓励企业主动开展或购买职业卫生技术服务,并应当调整对职业卫生技术服务机构的补偿办法.     

Occupational Injury and Disease Incidence and Risk Factors in Finnish Agriculture Based on 5-Year Insurance Records

ABSTRACT

The aim of this retrospective cohort study was to evaluate the incidence of and risk factors for compensated occupational injuries and diseases in agriculture. The study population consisted of 78,679 Finnish farmers, spouses, and salaried family members covered by mandatory workers' compensation insurance. This population had a total of 24,424 occupational injuries and 1684 diseases from 2000 to 2004. In the 5-year period, 20.2% of the population had (one or more) injuries and 2.0% had occupational diseases. Multiple claims were common particularly among livestock producers. Using Poisson regression analyses, we identified several personal and farm-related risk factors, with relative risk estimates ranging from 1.07 to 3.08 for injuries and from 1.45 to 3.01 for diseases. Cattle-intensive geographic regions, occupational health service membership, large farm size, and farming alone were identified as risk factors for both outcomes. Further, male gender, higher number of insurance years, and residing on the farm were among risk factors for injury. These risk factors identified from a large longitudinal data set can be considered for developing and targeting interventions for farmers at highest risk of occupational injury and disease.