Continuing education and residency program of occupational medicine in U. S. A

To investigate postgraduate education of occupational medicine in the U. S. A., the author was sent to take some courses in occupational medicine continuing education supported by the National Institute of Occupational Health (NIOSH) in February and March of 1988. The course participants were mainly industrial hygienists. The contents of the courses were approximately the same as those of the Three-Month Course in Fundamental Occupational Health held in UOEH for medical doctors. The physicians in occupational medicine in the U. S. A. take mainly mini-residency courses from the NIOSH programs. The Curriculum of the Intensive Residency Program at the University of California San Francisco (UCSF) is presented in this report as a reference. According to the information I acquired, well-trained industrial hygienists are maintaining a high standard of control over the workplace environment. I received the impression that the industrial hygienists are playing an important part in occupational health in the U. S. A. Physicians specializing in occupational medicine are interested more in the clinical diagnosis of occupational diseases than in preventive measures such as environmental control of the workplace.     

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.     

National occupational health research priorities,agenda and strategy of Japan: invited report in NORA symposium 2001, USA

An invited report on national occupational health research priorities, agenda and strategy of Japan was delivered in the NORA (National Occupational Research Agenda) Symposium 2001, USA. The third NORA Symposium was held by the US National Institute for Occupational Safety and Health (NIOSH) in Washington DC on June 27, 2001. The national conference in Japan entitled "Conference on Occupational Health Research Strategies in the 21st Century" was organized by the Japanese Ministry of Labour (Currently, Ministry of Health, Labour and Welfare) in the years 1998-2001, and the national occupational health research agenda and strategy for the next decade in Japan was identified. A total of 50 Conference members, i.e., representatives from various fields of occupational health in Japan, ranked 58 comprehensive research topics, yielding short-term (5-year) and long-term (6-10 year) priority research topics. Overall (10-year) priority research topics were calculated by combining the short-term and long-term priority scores. Together with the ranking by 145 extramural occupational health specialists, it was identified that work stress (i.e., one of the 58 research topics) was the first overall priority research topic for the next 10 years in Japan. Three other topics, i.e., elderly workers, women workers and maternity protection, and mental health and quality of work and life, were the second group of priority topics; and hazard and risk assessment and biological effect index were the third priority group. Based on the scores for the short-term and long-term priority research topics, all 58 research topics were classified into three key research areas with 18 key research issues (National Occupational Health Research Agenda, NOHRA). Finally, eight implementation measures of national strategy for the Japanese Government to promote occupational health research were introduced.     

The attributable annual health costs of U.S. occupational lead poisoning

Background: U.S. occupational lead standards have not changed for decades, while knowledge about lead’s health effects has grown substantially.

Objective: The objective of this analysis was twofold: to estimate the attributable annual societal costs of health damages associated with occupationally lead-exposed U.S. workers and, more broadly, to develop methods for a fuller valuation of health damages.

Methods: I combined data voluntarily reported to NIOSH on the number of highly exposed workers with published literature on the health effects of lead in adults to estimate the potential health benefits of lowering the U.S. occupational limit. I developed simple algorithms for monetizing more fully both the direct medical and indirect (productivity) damages associated with those high lead exposures.

Results: I estimated direct medical costs of $141 million (2014US$) per year for 16 categories of health endpoints, and combined direct and indirect costs of over $392 million (2014US$) per year for the 10,000 or so U.S. workers with high occupational lead exposures.

Conclusions: Reducing allowable occupational lead limits produces annual societal benefits of almost $40,000 per highly exposed worker. Given underreporting of actual exposures and the omission of important health effects, this is likely a severe underestimate.     

Summary of "Proposed national strategies for the prevention of leading work-related diseases and injuries, Part 1"

Strategies for the prevention of leading occupational health problems have been proposed by the National Institute for Occupational Safety and Health (NIOSH). NIOSH prepared these strategies following publication in 1983 of its suggested list of ten leading work-related diseases and injuries. At a national symposium in 1985, occupational health experts from academia, organized labor, management, professional associations, and voluntary organizations conducted an in-depth evaluation of the prevention strategies for the first five conditions on the list: occupational lung diseases, musculoskeletal injuries, occupational cancers, severe occupational traumatic injuries, and occupational cardiovascular diseases. The strategies were then revised to incorporate improvements suggested at the symposium and were published in booklet form. A summary of the revised strategies is provided.     

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.     

National surveillance of occupational fatalities in agriculture

Agriculture is one of the most hazardous industries in the United States. Although estimates vary, all reporting agencies show agriculture having an occupational fatality rate three to five times higher than that of the general private sector. The National Institute for Occupational Safety and Health (NIOSH), Division of Safety Research's National Traumatic Occupational Fatalities (NTOF) data base monitors occupational fatal injuries in all industries in the United States through death certificates. Uniform case-selection criteria are applied nationwide. NTOF shows that for the years 1980 through 1985, agriculture had a work-related fatality rate of 20.7 deaths per 100,000 workers compared with 7.9 deaths per 100,000 workers for the private sector U.S. work force. Age-specific rates indicate that the risk of fatal occupational injury increases with age for agricultural workers. Workers over 64 years old have an average annual rate of 55.7 deaths per 100,000 workers. Other uses of the surveillance system, as well as its limitations, are discussed.     

Mortality patterns among electrical workers employed in the U.S. construction industry, 1982-1987

BACKGROUND: Studies of electrical workers in the utility and manufacturing industries have reported excess site-specific cancer. No previous studies of electrical workers in the construction industry have been conducted. METHODS: Our study evaluated the mortality patterns of 31,068 U.S. members of the International Brotherhood of Electrical Workers who primarily worked in the construction industry and died 1982-1987. RESULTS: Comparison to the U.S. population by using the NIOSH life table showed significantly elevated proportionate mortality for many causes. Excess mortality for leukemia (proportionate mortality ratio (PMR)=115) and brain tumors (PMR=136) is similar to reports of electrical workers with occupational exposure to electric and magnetic fields in the electric utility or manufacturing industry. Excess deaths due to melanoma skin cancer (PMR=123) are consistent with findings of other PCB-exposed workers. A significantly elevated PMR was observed for the diseases caused by asbestos: lung cancer (PMR=117), asbestosis (PMR=247), and malignant mesothelioma (PMR=356) and from fatal injuries, particularly electrocutions (PMR=1180). The findings of statistically significant excess deaths for prostate cancer (PMR=107), musculoskeletal disease (PMR=130), suicide (PMR=113), and disorders of the blood-forming organs (PMR=141) were unexpected. CONCLUSIONS: Results suggest that more detailed investigations of occupational risk factors and evaluation of preventive practices are needed to prevent excess mortality in this hazardous occupation. Am. J. Ind. Med. 36:630-637, 1999. Published 1999 Wiley-Liss, Inc.     

Responsibilities and activities of the Advisory Board on Radiation and Worker Health

As noted in the introductory editorial by Moeller and Toohey, the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) was passed by the U.S. Congress in October 2000 and became effective on 31 July 2001. The Act provides a lump-sum compensation of $150,000 to workers who contracted certain diseases due to exposures to beryllium, silica, or radiation while working for the U.S. Department of Energy (DOE), its contractors, or subcontractors, in the nuclear weapons industry. The Secretaries of DOE, the U.S. Department of Health and Human Services (HHS), and the U.S. Department of Labor (DOL) share responsibilities for administering this program. In accordance with the provisions of EEOICPA, the President, in October 2001, appointed an Advisory Board on Radiation and Worker Health. The work of the Board, which began in January 2002, is conducted with staff support provided by the National Institute for Occupational Safety and Health (NIOSH). NIOSH is responsible for establishing scientific guidelines for determining whether a worker's cancer is "at least as likely as not" related to occupational exposure to radiation (probability of causation) and developing methods to estimate worker exposure to radiation (dose reconstruction). During its first 5 years of operation, the Board has provided substantial input on the rulemaking activities of NIOSH. It also is establishing methodologies for auditing the validity and quality of the dose estimates. The Board expects to sample and examine approximately 2-3% of the completed dose reconstructions. Random audits of approximately 1% of these are now underway.     

The health of middle aged and older workers: a review of recent literature.

A selection has been made from the competent literature currently available concerning the health of the mature working population. Part A discusses the few important advances in basic science since 1973 which may help prevent degenerative and chronic diseases. Practical advances in diagnosis of the pre-morbid stage of these diseases are reviewed. Part B examines the coming to maturity of occupational medicine and hygiene. Many excellent epidemiological papers are being published. Knowledge of chemical damage, particularly to the lungs, and of chemical carcinogenesis is increasing. Etiology proven by pathological and toxicological studies defines cause. Prevention becomes possible. The Occupational, Safety and Health Act (OSHA) and the National Institute of Occupational Safety and Health (NIOSH) in the U.S.A. have sparked rapid advances in workplace standards and in the health of workers. Their techniques are summarized. Part C studies environmental diseases. It emphasizes the enormous knowledge gap that exists and reviews the work where expertise of the health disciplines has recently added to the world pool of essential data.     

Comparison of NIOSH noise criteria and OSHA hearing conservation criteria

BACKGROUND: This study was conducted to compare noise exposure measurements based on the recently revised noise exposure criteria recommended by the U.S. National Institute for Occupational Safety and Health (NIOSH) and the current U.S. Occupational Safety and Health Administration (OSHA) Hearing Conservation Amendment to the occupational noise standard. METHODS: Daily 8-hour time-weighted average (TWA) personal noise exposures were obtained for 61 workers using dosimeters set simultaneously to the NIOSH and OSHA Hearing Conservation Amendment (OSHA-HCA) criteria. A variety of work groups with the potential for noise exposure were evaluated as a part of this investigation. RESULTS: Noise dose based on the NIOSH criteria was higher than the corresponding OSHA-HCA noise dose with differences in noise exposures measured under the two criteria equal to 6.6 dBA. Should the new NIOSH recommendation on noise measurement be adopted as standard, the number of workers to be enrolled in a hearing loss prevention program was estimated to increase by 2. 7-fold from 23% to 75% of the study population. CONCLUSIONS: The results of this study indicate that if the NIOSH criteria are to be adopted as an OSHA standard, there is likely to be a substantial increase in the number of workers in hearing conservation programs.     

Monitoring the changing organization of work: international practices and new developments in the United States

Recent trends in the organization of work have raised concerns about their implications for safety and health in the workplace. Capacity for monitoring of these trends from an occupational safety and health perspective (also known as hazard surveillance) varies considerably across countries and regions. This forum article discusses current practices for monitoring the organization of work, noting strengths, limitations, and needs for improvement. Particular attention is given to the status of monitoring practices in the U.S., and new initiatives by the National Institute for Occupational Safety and Health (NIOSH) to improve upon these practices.     

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.     

Monitoring the changing organization of work: international practices and new developments in the United States

Recent trends in the organization of work have raised concerns about their implications for safety and health in the workplace. Capacity for monitoring of these trends from an occupational safety and health perspective (also known as hazard surveillance) varies considerably across countries and regions. This forum article discusses current practices for monitoring the organization of work, noting strengths, limitations, and needs for improvement. Particular attention is given to the status of monitoring practices in the U.S., and new initiatives by the National Institute for Occupational Safety and Health (NIOSH) to improve upon these practices.     

Work: disease and health. The role of occupational medicine

To assess the role of Occupational Medicine in the promotion of workers'health over the last forty years, the author studied the evolution of this discipline from a clinical-diagnostic approach to the current emphasis on prevention. However, it is stressed that in Occupational Medicine even preventive measures are based on clinical methodology, as for example in health surveillance, where the main tasks are the identification of individual hyper-susceptibility and the assessment of early and reversible health effects due to occupational risks. Moreover, the traditional clinical-diagnostic approach is still of utmost importance. In fact, the classical occupational diseases do not present with the specific clinical features of the recent past. Instead, today it is necessary to evaluate whether occupational risk factors play a concomitant role in the origin of diseases that affect the general population. Moreover, new occupational diseases are emerging, due to the continuous changes in manufacturing processes and work organization. To assess the role that Occupational Medicine has played in the binomial expression "disease-health", topics which particularly suit the Author's cultural background are considered and are used as "indicators" of the various scientific, cultural, social, economic, and legislative aspects that contribute to the professional development of Occupational Physicians. Important results have been achieved over the last 40 years, however Occupational Physicians face new problems that impose a continuous updating process, not only on medical topics but also on the development of technological processes. The laws and the recommendations of the most prestigious national and international organizations and the principles of the ICOH Code of Ethics should guide Occupational Physicians in their profession and their actions must imply full professional independence. They must acquire and maintain the necessary competence for their duties and adequate conditions to carry out their tasks according to good practice and professional ethics.     

Recent advances in occupational health research in Korea

Korea has a short history in research on occupational health like as short history of industrialization. During last four decades, however, Korea has experienced what developed countries have experienced for more than a hundred year. Research on occupational health in Korea has also drastically developed. Since industrialization in 1970s, many workers were exposed to hazardous working environment and suffered from occupational accidents and diseases. The main research topics were pneumoconiosis, noise-induced hearing loss and some chemical poisoning. However, improving working condition was not the top priority until the late 1980s. Carbon disulfide poisoning gave a big impact to the society. It made the government take many actions to improve working condition through regulation, enforcement, supporting academia, raising research fund, and establishing a research institute. Recently, classical occupational diseases have decreased and the interest from researchers has also reduced. Many claims for stress-related cardio-cerebrovascular diseases brought much concern and research on job stress. Work-related musculoskeletal disease became a major issue. Many workers are interested in quality of life, such as health promotion. Therefore, research on health promotion, job stress, and psychological problem from work organization would be the main research topics in the future, although research on occupational diseases, such as asthma, cancer and various diseases caused by chemicals are still attractive to researchers.     

From conjecture and refutation to the documentation of occupational diseases in Taiwan.

The documentation of occupational diseases in a developing country like Taiwan is a challenge to an occupational physician. For lack of a system including material safety data sheet (MSDS), workers are usually not aware of what chemicals they are exposed to. Since many occupational diseases have long latencies and do not show any specific symptoms and signs, recognition and identification of the occupational origin are often very difficult. Using databases which provide a relatively complete list of industrial chemicals and a set of specific signs and/or symptoms, combined with the epidemiologic approach of conjectures and refutations--i.e., considering and ruling out all possible alternative explanations--we have documented eight kinds of occupational diseases and an outbreak of botulism. We recommend that a similar approach be applied to any other country with a similar situation, and that a system involving an identification sheet (e.g., MSDS) for each chemical be advocated and implemented in such countries as one means to enable prompt recognition and prevention of occupational diseases.     

Investigation of occupational cancer clusters: theory and practice.

Local and federal government agencies are often asked to investigate apparent clusters of cancer in communities or workplaces. Often these investigations cannot utilize the methods that have been developed for evaluation of disease clusters because the clusters are too small, and the populations to be studied and the periods of time to be covered are determined in an a posteriori manner. Still, government investigators are called upon to render an official opinion of the apparent clusters. Application of a theoretical approach to cluster analysis must give way to a more pragmatic approach. A review of 61 investigations of apparent clusters conducted by the National Institute for Occupational Safety and Health (NIOSH) during the period 1978-84 showed that most of the clusters contained five or fewer cases and had no plausible occupational etiology. Despite the few clusters that were identified, these investigations generally provided a service to workers and employers who were concerned about occupational cancer.     

Review of the Federal Child Labor Regulations: updating hazardous and prohibited occupations

BACKGROUND: Child labor regulations are intended to protect our young and most vulnerable workers. While regulations are not the only strategy for providing a safe and healthy work environment for young workers, they are the first step in setting the community standard to protect them. The world of work has changed since the first child labor laws were issued in 1939. The U.S. Department of Labor (DOL) enlisted assistance from the National Institute for Occupational Safety and Health (NIOSH) to evaluate the current list of hazardous and prohibited occupations and to make recommendations for changes to the regulations. METHODS: A group of national experts reviewed the recommendations made by NIOSH. The consensus review process identified areas of agreement, disagreement, and priorities for the DOL's Wage and Hour Division. Gaps in the hazardous orders not addressed in the recommendations were also identified. RESULTS: This commentary describes the background of the Hazardous Orders under the Fair Labor Standards Act, the evaluation by NIOSH, the process used to review it, and recommendations for further action. CONCLUSIONS: The NIOSH report is a valuable resource for anyone working to prevent occupational injuries-among adult and young workers alike. It is crucial that the DOL use the guidance provided by NIOSH and the Young Workers Safety and Health Network to improve the protections for young workers.     

Respiratory predictors of disability days: a five year prospective study of U.S. coal miners

A 5-year prospective analysis tests the hypothesis that coal miners who have impaired respiratory health also experience greater numbers of disability days due to occupational injury. Occupational and respiratory health information collected for the period 1977 through 1981 by the National Institute for Occupational Safety and Health (NIOSH) on 1,118 U.S. underground coal miners was linked to coal miner injury records collected under a mandatory reporting system by the Mine Safety and Health Administration (MSHA). Respiratory impairment, based on spirometric measures, and a questionnaire measure of chronic bronchitis symptoms, after adjustment for cigarette smoking and total years of underground mining, did not provide statistically significant prediction of average disability days. In addition, respiratory impairment did not predict the number of episodes of occupational injuries resulting in days lost from work.