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.     

International occupational health

Working conditions for the majority of the world's workers do not meet the minimum standards and guidelines set by international agencies. Occupational health and safety laws cover only about 10 percent of the population in developing countries, omitting many major hazardous industries and occupations. With rare exception, most countries defer to the United Nations the responsibility for international occupational health. The UN's international agencies have had limited success in bringing occupational health to the industrializing countries. The International Labor Organization (ILO) conventions are intended to guide all countries in the promotion of workplace safety and in managing occupational health and safety programs. ILO conventions and recommendations on occupational safety and health are international agreements that have legal force only if they are ratified by ILO member states. The most important ILO Convention on Occupational Safety and Health has been ratified by only 37 of the 175 ILO member states. Only 23 countries have ratified the ILO Employment Injury Benefits Convention that lists occupational diseases for which compensation should be paid. The World Health Organization (WHO) is responsible for the technical aspects of occupational health and safety, the promotion of medical services and hygienic standards. Limited WHO and ILO funding severely impedes the development of international occupational health. The U.S. reliance on international agencies to promote health and safety in the industrializing countries is not nearly adequate. This is particularly true if occupational health continues to be regarded primarily as an academic exercise by the developed countries, and a budgetary triviality by the international agencies. Occupational health is not a goal achievable in isolation. It should be part of a major institutional development that touches and reforms every level of government in an industrializing country. Occupational health and safety should be brought to industrializing countries by a comprehensive consultative program sponsored by the United States and other countries that are willing to share the burden. Occupational health and safety program development is tied to the economic success of the industrializing country and its industries. Only after the development of a successful legal and economic system in an industrializing country is it possible to incorporate a successful program of occupational health and safety.     

The West Virginia Occupational Safety and Health Initiative: Practicum training for a new marketplace

CONTEXT: Occupational medicine practice has experienced a shift from larger corporate medical departments to organizations providing services for a variety of industries. Specific training needs will accompany this shift in practice patterns; these may differ from those developed in the traditional industrial or corporate medical department setting. METHODS: The West Virginia Occupational Health and Safety Initiative involves occupational medicine residents in consultation to a variety of small industries and businesses. It uses the expertise of occupational physicians, health and safety extension faculty, and faculty in engineering and industrial hygiene. Residents participate in multidisciplinary evaluations of worksites, and develop competencies in team-building, workplace health and safety evaluation, and occupational medical consulting. OUTCOME MEASURES: Specific competencies that address requirements for practicum training are used to measure the trainee's acquisition of knowledge and skills. Particular attention is paid to the acquisition of group problem-solving expertise, skills relevant to the current market in practice opportunities, and the specific career interests of the resident physician. Preliminary evaluation indicates the usefulness of training in evaluation of diverse industries and worksites. CONCLUSIONS: We offer this program as a training model that can prepare residents for the challenges of a changing marketplace for occupational health and safety services.     

我国职业卫生与职业病学的发展史

目的论述对职业卫生与职业病学做出过贡献的人和事,划分职业卫生与职业病发展时段,方便学术研讨。方法结合职业卫生与职业病学学科演变、职业卫生工作进展等资讯进行分析并予以确定。结果职业卫生与职业病学可分为3个期和3个阶段,3个期为萌芽(雏形)期、成形(冠名)期、发展(深化)期;3个阶段是工业卫生阶段、劳动卫生阶段、职业卫生阶段。结论职业卫生与职业病学是预防医学的一个重要分支学科,它学术性强,专业理论博杂,要想在职业卫生与职业病学工作中有所建树,必须精通专业理论知识和相关学科理论知识。职业卫生与职业病学工作保障了工人的身体健康,遏制了职业病危害,促进了国民经济的有序发展。学习和掌握职业卫生与职业病学知识,了解和熟悉职业卫生与职业病学发展史,对职业病防治工作的开展及学术研讨有明显的帮助。     

Advancing worker health and safety in the developing world

OBJECTIVES: Working conditions in the developing world seldom meet the minimum standards required by international agencies. This article addresses some of the major obstacles to occupational and environmental health and suggests methods by which they can be overcome. METHODS: International agencies such as the World Health Organization (WHO) and the International Labor Organization (ILO) offer a number of programs that address the problem. RESULTS: The results of international efforts to date have been disappointing. There is a need for renewed efforts on the part of international agencies and the developed countries. CONCLUSIONS: Occupational health and safety can be advanced in the developing world with modest funding of innovative programs.     

Occupational health in developing nations: the case of China

The need for a comprehensive view of occupational health problems in developing nations was suggested by a recent occupational health delegation to China. Such problems in most developing nations are superimposed on a background of scarce economic resources, rapid industrialization, and socioeconomic dislocation as well as a poor nutritional and general health status of the population. Occupational health problems are exacerbated in these countries by the presence of a high proportion of very small firms, inadequate attention to industrial hygiene and ergonomic principles for worker health and safety, and a lack of toxicologic and epidemiologic data. The peculiar case of China is noted, wherein only some of the characteristics of a developing nation are exhibited. The Chinese model for occupational health as observed in a spectrum of industries including textiles, paint, and steel is described. Recent political and economic developments are discussed along with their implications for Chinese health policy in general and for occupational health practice in particular.     

Environmental health services in primary care centers

Primary Health care centers supported by the Public Health Service through the Community Health Center and Migrant Health Centers programs are now required to provide environmental hazards directly related to clinical findings, but correcting community and occupational environmental problems may be pursued through appropriate agencies. State and local health departments will play key roles in the program in providing professional expertise in environmental health, assisting patients in taking corrective action, and assisting in the coordination with state, local, federal and voluntary agencies. Some primary care centers in areas of great need and limited resources will have their own environmental health professionals, but most will depend on local health departments for this specialty.     

Occupational health research in India

India being a developing nation is faced with traditional public health problems like communicable diseases, malnutrition, poor environmental sanitation and inadequate medical care. However, globalization and rapid industrial growth in the last few years has resulted in emergence of occupational health related issues. Agriculture (cultivators i.e. land owners + agriculture labourers) is the main occupation in India giving employment to about 58% of the people. The major occupational diseases/morbidity of concern in India are silicosis, musculo-skeletal injuries, coal workers' pneumoconiosis, chronic obstructive lung diseases, asbestosis, byssinosis, pesticide poisoning and noise induced hearing loss. There are many agencies like National Institute of Occupational Health, Industrial Toxicology Research Centre, Central Labour Institute, etc. are working on researchable issues like Asbestos and asbestos related diseases, Pesticide poisoning, Silica related diseases other than silicosis and Musculoskeletal disorders. Still much more is to be done for improving the occupational health research. The measures such as creation of advanced research facilities, human resources development, creation of environmental and occupational health cells and development of database and information system should be taken.     

The occupational physician and chemical disasters: old problem, new threats

Chemical disasters continue to occur, in spite of significant progress in process engineering, industrial hygiene practices, and improved enforcement of health and safety legislation. In addition to the ever-present risk of unintentional incidents, recent geopolitical events have raised the specter of chemical terrorism. Terrorists or even disgruntled employees may exploit lapses in chemical plant security and ready access to large quantities commodity chemicals, capable of causing great harm to the population if suddenly and unexpectedly released. Occupational physicians, who are uniquely equipped to understand the health hazards associated with industrial chemicals should be involved in prevention of planning for, and response to chemical disasters. Measures for improving preparedness include training and collaboration, not only with plant health and safety personnel but also with public safety and health care providers, through drills and assessment of needs and capacities. Occupational physicians should be aware that communications and other systems often fail in disasters, requiring multiple alternatives. Likewise, occupational health specialists should be prepared to deal with mass casualties, including psychological casualties which may be difficult to distinguish from those of organic etiology. Chemical disaster preparedness is an urgent and demanding responsibility for occupational physicians everywhere.     

An organized approach to the control of hazards to health at work

Shell U.K. has an approach which facilitates the implementation of its occupational hygiene programme in its many locations. The main elements of the system are Company Policy, Standards, Methods and Management. The Policy sets the scene and is rigorous in its aims. The new COSHH legislation has emphasized particular duties which have influenced the approach. The Company Occupational Health Guidelines [Guidelines on Health at Work for Shell in the U.K. Shell U.K. Ltd, London (1989)] set the standards for control of exposure, among other things, and the Company adopts appropriate methods to achieve them. Of particular note is the Company's COSHH Programme [Implementation of the Shell U.K. Policy on the Control of Substances Hazardous to Health. Shell U.K. Ltd, London (1989)] which applies to all hazards to health (including physical and biological agents) in the workplace. Its introduction has been given full corporate support and is in the process of implementation. Appropriate procedures have been introduced for assessments of risk and for work histories. Guidance has been given on competence, reflecting a philosphy based on a team approach using local resources to the full, supported by corporate resources as required. The awards of the British Examining and Registration Board in Occupational Hygiene (1987) are used as the professional standard. Because of difficulties in obtaining basic hazard data, an internal core hazard data system (CHADS) [Core Hazard Data System. Shell U.K Ltd, London (1989)] has been introduced. The whole programme is managed through Occupational Hygiene Focal Points (OHFP) which represent local activities but also participate in corporate strategy. Through them the multidisciplinary approach is promoted, working in conjunction with local and sector Medical Advisers. Work done by the central Occupational Hygiene Unit is recorded and the reports are used for time management and recovery of costs. In its entirety, the approach is being used successfully to implement a comprehensive occupational hygiene programme in a diversified and dispersed industrial organization.     

The local public health workforce in rural communities.

This work describes the public health workforce and training needs of rural local public health agencies (LPHAs) in comparison with suburban and metropolitan LPHA jurisdictions. A survey was sent to 1,100 LPHAs nationwide. The rural urban commuting area codes (RUCAs) defined LPHAs as rural or urban, and the Standard Occupational Classification system enumerated the workforce. Most occupational classifications had significantly fewer staff in rural LPHAs. Public health nurses ranked as the most needed staff and serve in various important capacities in rural LPHAs. In terms of training, job-specific or programmatic continuing education was identified as the most important training need. Developing leadership and public health workforce capacity within rural public health is an essential agenda item for rural America. Decision makers may need to consider different organizational structures while balancing the need for local input and control. Regionalization and collaborative approaches to difficult workforce issues may present potential solutions to workforce challenges.     

Occupational safety and health in the United kingdom: securing future workplace health and wellbeing

The industrial revolution that took place in the United Kingdom (UK) between 1760 and 1830 lead to profound social change, with rapid urbanisation associated with squalid living conditions and epidemics of infectious diseases. The next 150 yr or so saw the introduction of many specific acts of health and safety legislation. In 1974 new overarching primary legislation was introduced that would produce a step change in the evolution of health and safety enforcement. In 2004, a new strategy was launched designed to promote a vision embedding health and safety as a cornerstone of a civilised society and to achieve a record of workplace health and safety that leads the world. Good progress in controlling many safety hazards and improving occupational hygiene has been made. There has been a fall in numbers of a wide range of injuries and diseases or illnesses since 2000. The challenge will be to maintain these favourable trends and prepare for new and emerging diseases at a time when resources are diminishing. The importance of occupational health within the UK health and safety strategy has been recognised over the last decade. Occupational health is developing a new paradigm which combines classical health risk management with assessment of workability, rehabilitation back to work and promotion of health and wellbeing. There is an increasing recognition that being in supported employment is good for health and reduces health inequalities.     

湖州市加强城乡集居儿童保健管理的做法与体会

为了加强集居儿童卫生保健管理，提高集居儿童健康水平，湖州市托幼卫生相关职能部门密切协作，坚持保教结合的原则，在市托幼卫生保健工作指导小组统一部署下，坚持不懈地抓好托幼卫生保健的制度建设，通过经常性地检查和指导，促进其岗位责任的落实和管理水平的提高；同时注重托幼卫生保健人才的培养和培训工作，逐步建立了一支相对稳定的托幼卫生保健工作队伍。通过各级管理部门和广大托幼卫生工作者的共同努力，推进了全市集居儿童卫生保健工作的有序发展。     

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.     

The practice of occupational and environmental health in Belgium

Occupational medicine and occupational health regulations in Belgium are succinctly presented. Since 1970 a minimum level of appropriate training has been required for conferral of a certificate in occupational medicine. At some universities this training is integrated into a larger programme which meets the requirements of EEC Directive 89/594. The current Belgian legislation relating to the prevention of occupational diseases and injuries is detailed in the Règlement pour la Protection du Travail, first published in 1946 and constantly updated. The occupational physician is supposed to provide advice on the risks to which workers are exposed and the adaptation of working conditions in accordance with the state of health or the abilities of the worker. Employers are obliged by law to cover the risks of accident by subscribing to a private insurance policy which covers any related costs. They also contribute financially to the Fonds des Accidents du Travail (Occupational Accidents Fund) and the Fonds des Maladies Professionnelles (Occupational Diseases Fund). Occupational diseases are recognised and may be financially compensated by the Fonds des Maladies Professionnelles.     

Occupational health in Brazil

Brazil is a recently industrialised country with marked contrasts in social and economic development. The availability of public/private services in its different regions also varies. Health indicators follow these trends. Occupational health is a vast new field, as in other developing countries. Occupational medicine is a required subject in graduation courses for physicians. Specialisation courses for university graduated professionals have more than 700 hours of lectures and train occupational health physicians, safety engineers and nursing staff. At the technical level, there are courses with up to 1300 hours for the training of safety inspectors. Until 1986 about 19 000 occupational health physicians, 18 000 safety engineers and 51 000 safety inspectors had been officially registered. Although in its infancy, postgraduation has attracted professionals at university level, through residence programmes as well as masters and doctors degrees, whereby at least a hundred good-quality research studies have been produced so far. Occupational health activities are controlled by law. Undertakings with higher risks and larger number of employees are required to hire specialised technical staff. In 1995 the Ministry of Labour demanded programmes of medical control of occupational health (PCMSO) for every worker as well as a programme of prevention of environmental hazards (PPRA). This was considered as a positive measure for the improvement of working conditions and health at work. Physicians specialising in occupational medicine are the professionals more often hired by the enterprises. Reference centres (CRSTs) for workers' health are connected to the State or City Health Secretariat primary health care units. They exist in more populated areas and are accepted by workers as the best way to accomplish the diagnosis of occupational diseases. There is important participation by the trade unions in the management of these reference centres. For 30 years now employers organisations have also kept specialised services for safety and occupational health. Although they are better equipped they are less well used by the workers than the CRSTs. At the federal level, activities concerned with occupational health are connected to three ministries: Labour, Health and Social Security. The Ministry of Labour enacts legislation on hygiene, safety and occupational medicine, performs inspections through its regional units and runs a number of research projects. The Ministry of Health provides medical care for workers injured or affected by occupational diseases and also has surveillance programmes for certain occupational diseases. The Ministry of Social Security provides rehabilitation and compensation for registered workers. In spite of a decrease in the number of accidents at work during the past 25 years, working conditions have not improved. Changes in the laws of social security in the 1970s discouraged registration and reporting of occupational injuries and diseases. In consequence death rates due to accidents increased. With the implementation of the CRSTs, the recorded incidence of occupational diseases has risen, not only because of improved diagnosis, but also because of stronger pressure from the unions and better organisation of public services and enterprises. Received: 24 February 1997 / Accepted: 14 March 1997     

Occupational health in Singapore

Singapore, a newly industrializing country in Southeast Asia, has a resident population of 3 million and a work force of 1.75 million. Most workers are employed in the manufacturing, services, and commerce sectors. Agricultural and mining activities are negligible. In 1996 the infant mortality rate was 3.8 per 1,000 live births and the life expectancy at birth was 77 years. In 1996 the total industrial accident rate was 2.7 per million man-hours worked and the severity rate was 353 industrial man-days lost per million man-hours worked. The shipbuilding and construction industries had the most frequent and most severe accidents. In the same year, 1,521 cases of occupational disease were notified to, and confirmed by, the Ministry of Labor. The majority of cases involved noise-induced hearing loss. There is substantial underreporting of cases. New cases that are expected to appear will be work-related illnesses such as musculoskeletal or psychosocial disorders. The principal occupational health legislation in Singapore is the Factories Act. Although it selectively targets workers at highest risk of developing occupational illness, its main limitation is the exclusion of nonfactory workers, who comprise 63% of the working population. Labor regulations are enforced by the Ministry of Labor. Workmen's compensation paid in 1995 amounted to S $46.6 million (U.S. $1=S $1.75). Education and training in occupational health is provided by employer federations, employee unions, and various government agencies. Occupational health is taught to medical students during their undergraduate training. Postgraduate-diploma and Masters programs in occupational medicine are also available. About 600 doctors in Singapore have some form of postgraduate training in occupational health. Health care for workers is offered either through the private sector or through government clinics and hospitals. Although Singapore has made great strides in protecting and promoting the health of its workers, it must constantly strive to strengthen its commitment to occupational health and safety. New problems in the next century must be anticipated and solutions, implemented. Improved training and development of health professionals is needed such that they be better prepared to deliver optimal occupational health care. Finally, labor legislation must be appropriate and responsive to protect the health of all workers. Received: 12 February 1998 / Accepted: 25 February 1998     

某客车及工业用漆生产企业职业病危害因素控制效果评价

目的评价某生产企业客车及工业用漆新建项目职业病危害程度及防护效果,为卫生行政部门对该建设项目的职业卫生竣工验收提供科学的技术依据。方法采用检查表法、检测检验法,根据现场调查、职工职业健康检查情况,结合国家有关的职业卫生标准及其规范进行评价。结果经整改后,现场的职业病防护措施、管理措施、个人使用的职业病危害防护用品、职业健康监护、职业病危害因素检测等基本满足国家现行的法律法规和职业卫生标准。整改前粉尘CTWA最高值为4.13 mg/m3,整改后CTWA为0.11 mg/m3,达到标准要求。结论该建设项目职业病危害控制措施基本符合我国相关卫生法规和标准的要求,在职业卫生管理措施方面还需改进。     

Distance learning in occupational health

The burden of occupational illnesses and injuries in the developing world is now enormous. Local experts in occupational health and safety are needed to address the growing worker and environmental health problems brought about by global industrial expansion, but such expertise is lacking. The author describes a 15-week, online, instructor-led course, Principles of Environmental and Occupational Health, that was offered to international students over two semesters. She suggests the needs that must be determined and recommends collaborative development of a real-time, online curriculum to enhance the training of professionals in occupational and environmental health.