Sentinel Health Events (occupational): a basis for physician recognition and public health surveillance.

A Sentinel Health Event (SHE) is a preventable disease, disability, or untimely death whose occurrence serves as a warning signal that the quality of preventive and/or therapeutic medical care may need to be improved. A SHE (Occupational) 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. The present SHE(O) list encompasses 50 disease conditions that are linked to the workplace. Only those conditions are included for which objective documentation of an associated agent, industry, and occupation exists in the scientific literature. The list will serve as a framework for developing a national system for occupational health surveillance that may be applied at the state and local level, and as a guide for practicing physicians caring for patients with occupational illnesses. We expect to update the list periodically to accommodate new occupational disease events which meet the criteria for inclusion.     

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.     

Work-related infectious disease reported to the Occupational Disease Intelligence Network and The Health and Occupation Reporting network in the UK (2000-2003)

BACKGROUND: Infectious diseases remain an important cause of self-reported work-related illness, with socio-economic consequences, including sickness absence. Reporting of infectious disease by occupational and specialist physicians is an important tool in the investigation of occupationally related infections and is relevant in their management. AIMS: To examine the reporting of cases of infectious disease by occupational and specialist physicians to schemes collecting data on occupational ill-health. METHODS: Cases of infectious disease reported by occupational and specialist physicians to the UK based schemes, Occupational Disease Intelligence Network (ODIN) and The Health and Occupation Reporting network (THOR), from 2000 to 2003 were analysed by reporting patterns, diagnosis, single case or outbreak reporting and industry. RESULTS: The total number of estimated cases of infectious disease reported to ODIN and THOR from 2000 to 2003 was 5606; 74.9% cases were diarrhoeal disease, and 11.1% scabies. The majority (81.4%) of cases were reported in SIDAW, where the participation rate for reporters was 55%. Reporting rates were much higher in OPRA, SWORD and EPIDERM (ranging from 86 to 96%). The most frequently reported industrial sectors were social care (39.5%) and health (29.4%); while the manufacture of chemical products contributed 4.3% overall, but 33.8% to estimated cases in OPRA. CONCLUSIONS: Despite limitations related to under reporting, the occupational and specialist physician schemes in ODIN and THOR provide data that may be used to look at patterns of case reporting for occupational ill-health, including infectious disease. The reporting schemes also provide an important means of alerting peers about potential novel causes, precipitating factors, or industrial sectors associated with occupational disease.     

Certification of occupational diseases as common diseases in a primary health care setting

BACKGROUND: It is often difficult to discern whether a disease is an occupational or common disease, especially in a primary care setting. METHODS: From a randomly selected sample of 322 workers attending a Primary Health Care Center, 207 workers (response rate of 64.3%) agreed to participate. An occupational questionnaire was administered. General practitioners provided medical records for each worker. Medical records and occupational questionnaires were independently reviewed by three professionals. They assessed whether a relationship between disease and working conditions was probable or improbable. RESULTS: Thirty-three of the 207 cases (15.9%) were considered probably related to working conditions according to the expert's opinion. The most frequent were musculoskeletal diseases (20 cases). Of the 207 workers, 74 (35.7%) judged that their diseases could be related to their working conditions. CONCLUSIONS: A significant proportion of diseases attended in primary care setting was not recognized as occupational, and they were hence not reflected in official statistics.     

Reported occupational respiratory diseases in Catalonia

Objectives

A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system.

Methods

In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician''s opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia.

Results

Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system.

Conclusions

The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary reporting by physicians may provide better understanding of the incidence and characteristics of these diseases. Persulphates and cleaning products, besides isocyanates, were the most reported causes of occupational asthma. Metal industries and cleaning services were the occupations most frequently involved in acute inhalations with a remarkably high incidence in our register.     

Use of death certificates in epidemiological studies, including occupational hazards: variations in discordance of different asbestos-associated diseases on best evidence ascertainment.

There is extensive information on discordance in general between accuracy of medical diagnoses on death certificate categorization of cause of death and available clinical and histopathological data. This is as true for occupational disease as for other conditions. But occupational illnesses bear a special problem. Discordance is not equal across the board--it may vary with each occupationally related disease, and no single formula can be applied. It may be high for angiosarcoma and low for acute hydrogen sulfide poisoning, low for bladder cancer, high for unsuspected methyl mercury poisoning. We have found that for one agent--asbestos--there were different rates of discordance for different asbestos-related diseases (e.g., lung cancer, mesothelioma, asbestosis, kidney cancer) among 4,951 deaths studied prospectively from 1967 to 1986. Caution is therefore required before accepting generalizations concerning (unstudied) discordance in occupational mortality studies, and in their use in risk assessment models.     

Quebec and Canadian governments end their historic support of the asbestos industry

Abstract

In the absence of systematic occupational disease surveillance, other data collected by governmental agencies or industry is useful in the identification ofoccupational diseases and their control. We examined data on occupationaLdiseases reported by non-governmental employees to the national workers' social security organization in Malaysia, 2002-2006. The overall incidence rate of occupational disease was 2.8 per 100,000 workers. There was an increase in theannual number and rates of occupational disease over time. The most frequently reported conditions were hearing impairment (32%) and musculoskeletal disorders (28%). Workers in the non-metallic manufacturing industry had the highest average incidence rate of hearing impairment (12.7 per 100,000 workers) and musculoskeletal disorders (3.5 per 100,000 workers), compared to all other industries. Preventive measures should focus on safety education, engineering control and workplace ergonomics. Enforcing workplace standards and incorporating an ongoing surveillance system will facilitate the control and reduction of occupational disease.     

Silica exposure and autoimmune diseases

There have long been case reports linking silica exposure to a variety of autoimmune diseases (systemic sclerosis, rheumatoid arthritis, lupus, chronic renal disease). Evidence of this association in larger epidemiologic studies has been increasing in the last decade. We summarize this evidence here, and present some plausible mechanisms which have been discussed in the literature. The link between silica exposure and autoimmune disease may have been missed in cohort mortality studies because autoimmune diseases are rarely underlying causes of death. Similarly, case-control studies of autoimmune diseases have often failed to consider occupational exposure to silica. Further research is needed in occupationally exposed populations to verify this association. The link between respirable silica exposure and autoimmune disease may have some bearing on the possible association between silicone breast implants and autoimmune disease, although the nature of the silica involved is quite different in the two Situations.     

Occupational rhinitis and occupational asthma: Association or progression?

Background

Occupational asthma is the most frequently reported occupational respiratory disease in registries, and is often co‐diagnosed with occupational rhinitis. We undertook a systematic review of the English‐language epidemiologic literature linking these two conditions, with emphasis on progression from occupational rhinitis to occupational asthma.

Methods

PubMed and Embase were queried in a series of structured searches designed to identify studies comparing occupational asthma and occupational rhinitis incidence or prevalence in occupationally exposed individuals.

Results

The searches yielded a total of 109 unique citations, 15 of which yielded inferential data on the occupational rhinitis‐asthma relationship. Nine of fifteen studies showed statistically significant associations between the occurrence of occupational rhinitis and occupational asthma among individual workers.

Conclusions

Limited data support the notion that occupational rhinitis precedes the development of occupational asthma, particularly when high‐molecular‐weight (HMW) agents are involved. The relationship between the two conditions could not be evaluated in many relevant studies due to a lack of cross‐tabulation of individual cases.

     

Geographic distribution of deaths due to sentinel health event (occupational) causes

This report describes the Compressed Mortality File available from the National Center for Health Statistics that can be used to easily and efficiently generate annual mortality rates for geographic areas as small as counties for any period from 1968 to 1985. Several ways of presenting geographic variation in mortality rates due to potentially work-related deaths and changes in these rates over time are discussed for the 15-year period from 1969 through 1983. Causes of death that are potentially work-related were identified using the sentinel health events (occupational) [SHE(O)] concept. Data are given for nine diagnostic groups of occupationally related disorders, and maps are presented for bladder cancer, acute myeloid leukemia, and pneumoconioses. Significant changes in age-adjusted mortality rates were noted for pneumoconioses and acute myeloid leukemia that could not be due to changes in the disease coding of death certificates. Racial differences in mortality rates due to pneumoconioses may be due to differences in employment patterns. The use of SHE(O) codes to search the Compressed Mortality File may be helpful in identifying areas for public health concern, even if only as a monitoring signal for subsequent time periods. This file also provides an easy way to generate reference population mortality rates for epidemiologic studies.     

Occupational disease in New York State: a comprehensive examination

In order to obtain information on the current magnitude of occupational disease in New York State, four data sources were reviewed: Workers' Compensation records, disease registries maintained by the state department of health, data from the Bureau of Labor Statistics (BLS), and data from the California's physician reporting system. A proportionate attributable risk approach is used to develop estimates of mortality due to occupational diseases. The distribution of occupational hazards was assessed using data from the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the New York State Department of Environmental Conservation (NYDEC). Finally, econometric estimates of the direct and indirect costs of occupational illness were developed. The best available data indicate that 5,000 to 7,000 deaths are caused each year in New York State by work-related illnesses, and at least 35,000 new cases of occupational illness develop each year in the State. It is also estimated that between 150,000 and 750,000 workers in New York State are employed in the 50 most hazardous industries. OSHA standards regulating exposure to selected chemicals were found to have been violated frequently. The annual costs of occupational disease in New York State are approximately $600,000,000; only a small fraction is covered by workers' compensation insurance. Of the 52,000 physicians in New York State, only 73 are board-certified in occupational medicine. Most of these are involved in administrative, teaching, and research aspects of occupational medicine. Of the 300 industrial hygenists in New York State, two-thirds are employed by major corporations. Recommendations are described to improve the recognition of occupational disease in New York State and to reduce the burden of this disease. A statewide network of occupational health clinical services is proposed and has been funded by the New York State Legislature. Other recommendations are also given.     

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。     

Acute occupational respiratory diseases in hospital discharge data

We investigated the feasibility of using hospital discharge diagnoses of ICD codes 506, 507, and 508, respiratory diseases from external sources, to identify occupational sentinel health events [SHE(O)]. Two hundred sixty-nine records were reviewed and 66 (25%) were incidents where the work-relatedness of the respiratory diseases was documented in the medical records. Twenty-six percent of the 269 records contained no exposure information. Sixty-four of the 66 occupational cases were from ICD codes 506.0-506.9, with the largest number classified as ICD codes 506.0 (bronchitis and pneumonitis due to fumes and vapors) and 506.3 (other acute and subacute respiratory conditions due to fumes and vapors). We conclude that surveillance of ICD codes in the 506 series, where 39% of the cases were secondary to occupational exposures, is a valuable component of a surveillance system for preventable occupational lung disease.     

河北省矽肺监测哨点接尘工人职业健康检查结果

目的了解矽肺监测哨点接尘工人的发病状况和影响因素,分析其危害因素对特定人群健康影响及发病的热点、规律和趋势,制定矽肺防治策略和措施。方法按照国家有关法律、法规、规范、标准的要求,对河北省矽肺监测哨点接尘工人进行职业健康检查,并对检查结果进行分析。结果职业健康检查涉及38家哨点企业共3394人,检出疑似职业病89人,检出率2．62％;职业禁忌证56人,检出率1．65％;疑似职业病检出涉及21家企业,占总调查企业的55．3％。结论该省大部分矽肺监测哨点企业职业病危害比较严重,接尘工人的健康问题不容忽视,应加强职业病防治工作。     

2014年顺义区部分涉苯企业涉苯作业工人 在岗职业健康检查分析

摘要:目的　分析顺义区部分涉苯企业涉苯作业工人在岗职业健康检查情况,为促进顺义区职业病防治提供建议。方法　对2014年顺义区涉苯企业54家的基本情况进行调查,对涉苯的在岗作业工人的进行职业健康检查,对结果进行统计分析。结果　不同规模涉苯企业在岗职业健康检查情况,小型企业体检率率最高,中型企业体检率最低（χ2＝44.39,P＜0.05）;对于复查率,大型企业复查率最高,小型企业复查率最低（χ2＝44.39,P＜0.05）。对不同行业类型企业,印刷行业体检率最高为84.55%,家具制造业体检率最低仅为59.18%,印刷业的疑似职业病报告人数最多,不同行业体检率（χ2＝92.271,P＜0.05）和复查率（χ2＝25.413,P＜0.05）比较有统计学差异。从经济类型来看,国有经济体检率最高为95.65%,外商经济的体检率最低为73.40%,各经济类型企业劳动者的体检率（χ2＝39.136,P＜0.05）和复查率（χ2＝18.438,P＜0.05）比较有统计学差异。结论　顺义区涉苯企业涉苯作业人员职业健康检查受检率和复查率还有待提高,应进一步加大职业卫生知识宣传,监管部门应该加大作业工人健康检查受检率及复查率监管力度,保障劳动者健康。     

A comprehensive list of asthmagens to inform health interventions in the Australian workplace

Objective: To develop a comprehensive list of asthmagens which may occur in occupational settings in Australia. Methods: Potential asthmagens considered for this list were identified through work health and safety classification databases in Australia and through lists developed by professional associations in other countries. Inclusion criteria were: there is evidence that the agent is asthmagenic; it is used in occupational settings; and it is available in Australia. Results: The final list contained 277 asthmagens in 27 groups that may be found in occupational circumstances in Australia. Three other agents that have been documented as asthmagens in Australia were included: almond dust, fluoride (in aluminium pot room fumes); and sawdust from the Australian Blackwood. Conclusions: This is the first comprehensive and inclusive list of Australian occupationally relevant asthmagens to have been compiled. Implications: This list is specific for Australian workplace exposure to asthmagens. It will help focus policy and preventative practices and reduce the burden of occupational asthma. It will also be useful in future studies to identify those who are exposed to the asthmagens and provide information to assist regulators to identify industries, occupations, specific activities and existing exposure standards that can be targeted to improve worker health and welfare.     

2006—2013年苏州市疾病预防控制中心职业病诊断分析

目的了解2006—2013年苏州市疾病预防控制中心职业病诊断现状、职业病发病数量、种类、分布及发展趋势。方法收集汇总2006—2013职业病网络报告系统的职业病病例及相关资料进行统计分析。结果 2006—2013年苏州地区5家诊断机构共诊断职业病1 615例,其中苏州市疾病预防控制中心诊断1 237例,占总病例的76.59%;除尘肺外的其他种类职业病384例,占89.71%。2006—2013年苏州市疾病预防控制中心共诊断尘肺853例,慢性职业中毒174例,急性职业中毒119例,物理因素所致疾病31例,职业性耳鼻喉疾病60例;经济类型分布：尘肺以集体企业为主,物理因素所致疾病以私营企业为主;急性中毒第1顺位为私营企业,慢性中毒第1顺位为港澳台企业,耳鼻喉疾病第1顺位为外资企业。行业类型分布：尘肺第1顺位为采矿业,急性中毒和慢性中毒的第1顺位均为电子信息类,中暑和噪声聋第1顺位均为制造业。急性职业中毒、慢性职业中毒、耳鼻喉疾病发病逐年上升,尘肺逐年下降。结论职业病诊断机构发展不均衡,职业病诊断机构亟待加强;产业结构的调整、转型升级对职业病的发病具有一定的影响。不同经济类型、不同行业存在不同的发病特征,职业病防治面临新的形势。     

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.     

Victoria M. Trasko: champion of state-based surveillance of occupational diseases in the United States, 1937 to 1971.

Victoria M. Trasko (1907-1979), a relatively unknown figure to many currently practicing occupational health specialists, was a pioneer in state-based surveillance of occupational diseases in the United States. To highlight her accomplishments during her career with the United States Public Health Service from 1937 to 1971, this report briefly reviews her publications on occupational disease surveillance. Her span of work includes guidelines for state industrial hygiene programs, numbers of workers in state occupational health programs, compilation of state and local laws related to industrial hygiene, proposals for standardized reporting of occupational disease, and analysis of trends in workers' compensation and mortality statistics for occupational diseases. She pilot tested the first state-based model system for occupational disease reporting in the United States. She documented the great difficulty experienced by states in getting physicians to report cases of occupational diseases, and pointed out that surveillance of other existing data sources was worthwhile, at least for some occupational diseases. She was the first to report on the distribution of silicosis cases in the United States by state, industry, and job title. She was the first to comment on mortality trends for the pneumoconioses and to document problems in comparability between different International Classification of Disease (ICD) periods.     

2019—2021年淄博市重点职业病监测与职业健康风险分析

目的 分析淄博市2019—2021年重点职业病监测和工作场所职业病危害因素监测结果,为制定和调整本市重点职业病防治策略提供技术参考。方法 通过相关监测信息系统收集淄博市2019—2021年重点职业病监测和工作场所职业病危害因素监测数据,用率、构成比和χ²检验进行描述性分析重点监测职业病危害作业劳动者体检情况、企业现场危害因素检测情况、职业病报告情况。结果 2019—2021年淄博市存在重点监测的职业病危害因素的企业24 384家,监测接害劳动者457 899人次,接受职业健康检查331 706人次,实检率为72.44%(331 706/457 899),其中疑似职业病检出率为0.03%(92/331 706),各职业病危害因素可能导致的疑似职业病检出率差异有统计学意义(χ²危害=271.400,P_危害<0.001),但年度变化趋势不显著(趋势χ²年度=0.000,P_年度=0.991);职业禁忌证检出率为2.20%(7 308/331 706),各职业病危害因素接触劳动者禁...