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.     

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.     

The National Occupational Research Agenda: a model of broad stakeholder input into priority setting.

OBJECTIVES: No single organization has the resources necessary to conduct occupational safety and health research to adequately serve the needs of workers in the United States. The National Institute for Occupational Safety and Health (NIOSH) undertook the task of setting research priorities in response to a broadly perceived need to systematically address those topics most pressing and most likely to yield gains to workers and to the nation. METHODS: NIOSH and its public and private partners used a consensus-building process to set priorities for the next decade for occupational safety and health research--the National Occupational Research Agenda. RESULTS: The process resulted in the identification of 21 research priorities grouped into 3 categories: disease and injury, work environment and workforce, and research tools and approaches. CONCLUSIONS: Although the field of occupational safety and health is often contentious and adversarial, these research priorities reflect a remarkable degree of concurrence among a broad range of stakeholders who provided input into a clearly defined and open process.     

Agricultural medicine core course: building capacity for health and safety professionals

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.     

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.     

Fatal occupational injuries--United States, 2005

Data from the annual Census of Fatal Occupational Injuries (CFOI), collected by the Bureau of Labor Statistics (BLS), provide information on fatal occupational injuries that occur in the United States. CDC's National Institute for Occupational Safety and Health (NIOSH) uses CFOI data to support research and evaluation activities related to the National Occupational Research Agenda (NORA), a partnership between the public and private sectors to encourage workplace safety and health research. Since 1992, when BLS first introduced CFOI, BLS has annually reported data on fatal occupational injuries from all 50 states and the District of Columbia. For 2005, BLS reported a total of 5,702 work-related fatal injuries and a rate of 4.0 deaths per 100,000 workers; compared with 1992, this represents an 8% decline in the number of deaths (from 6,217 in 1992) and a 23% decline in the fatality rate (from 5.2 in 1992). This report summarizes the 2005 data, which indicated that the highest percentages of fatal workplace injuries were attributed to highway incidents, followed by falls, being struck by an object, and homicides. Since 1992, the number of deaths resulting from highway incidents, falls, and being struck by an object has increased, and the number of homicides has decreased. To reduce the number of workplace deaths, transportation measures targeting workers (e.g., truck safety and highway work-zone safety) should be enhanced by state and local transportation agencies and coordinated with highway-safety measures for the general public.     

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.     

Occupational injury mortality: New Mexico 1998-2002

BACKGROUND: The current study characterizes patterns of occupational injury fatalities in New Mexico for the 5-year period 1998-2002. METHODS: The study applied methods developed by the Council of State and Territorial Epidemiologists/National Institute for Occupational Safety and Health (CSTE/NIOSH) Occupational Health Indicator Work Group and compared the relative strength and weakness of two different datasets (CFOI and NMVRHS) for occupational injury fatality surveillance. RESULTS: Annual occupational injury mortality rates ranged from 4.4 to 7.6 per 100,000 employed persons aged 16 and over compared to annual US rates of 4.0-4.6 per 100,000. Risk factors for higher mortality rates included age over 65 years, self-employment, non-US citizenship, being African-American or Hispanic, and occurrence in rural counties. The top industry for fatality rate was mining followed by transportation, public utilities, agriculture, and construction. CONCLUSIONS: Applying CSTE/NIOSH Occupational Health Indicator protocol and using both CFOI and NMVRHS data improved the characterization of occupational injury mortality and the setting of priorities for prevention intervention.     

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.     

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.     

Using the theory of planned behavior and a stage model of persuasion to evaluate a safety message for firefighters

A field study was conducted to evaluate the effectiveness of a National Institute for Occupational Safety and Health (NIOSH) health and safety message targeted at firefighters and to examine predictors of safety intentions among this group. This project examined: (a) the ability of the theory of planned behavior (TPB) to predict behavioral intentions for firefighters receiving a NIOSH occupational safety and health message; and (b) the use of a persuasion output matrix to assess message impact. A message about firefighting safety was nationally distributed to 36,000 fire chiefs, from which 781 were randomly selected to complete a survey assessing message impact and behavioral intentions. Results indicate message impact was weakest at the exposure, recall, and action stages of persuasion output. The TPB variables were found to significantly predict safety intentions.     

Expanding control banding for workplace silica exposures throughout the Americas

Abstract

Background: Silicosis, a lung disease caused by inhaling respirable crystalline silica dust, is an occupational illness affecting millions of workers worldwide. The National Institute for Occupational Safety and Health (NIOSH) has partnered with the World Health Organization, the International Labour Organization, and multiple agencies in the Americas to implement the program “The Elimination of Silicosis in the Americas”.

Objectives: One component of this program is control banding, a qualitative risk assessment and management strategy that allows non-experts to use task-based hazard data and potential exposure information to determine appropriate controls.

Results: From 2005 to the present, NIOSH occupational health researchers have worked with experts in Chile, Peru, Colombia, and Brazil to assess, implement, and provide tools to evaluate the use of control banding methodology.     

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.     

HIV safety guidelines and laboratory training. NIOSH.

At the Centers for Disease Control (CDC), educational activities concerning acquired immunodeficiency syndrome (AIDS) are directed to many target audiences; important among these are health care and public safety workers. Several CDC programs are designed to address the specific education and training needs of these groups. The National Institute for Occupational Safety and Health (NIOSH) has developed a set of occupational safety guidelines directed to fire service personnel, emergency medical technicians, paramedics, and law enforcement and correctional facility personnel. These guidelines provide information on modes of transmission of human immunodeficiency virus (HIV) in the workplace, the risk of transmission, the control of risk, and specific risk-control recommendations. NIOSH also has developed a model curriculum, based on the principles and practices discussed in the guidelines, for use in training workers. The Hospital Infections Program (HIP) at CDC's National Center for Infectious Diseases is responsible for assessing the risk of HIV infection for both health care workers and patients. As part of this effort, HIP has developed guidelines to prevent transmission of HIV and other bloodborne pathogens in health care settings, as well as statements regarding management of occupational exposure to HIV. The Public Health Practice Program Office provides laboratory training to health care workers who are performing HIV- and AIDS-related testing. This training is delivered through the National Laboratory Training Network and through courses given at CDC headquarters in Atlanta. The delivery of laboratory training is supported by the development of training materials and by performance evaluation programs.     

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.     

台湾《职业安全卫生法》介绍

台湾地区新近发布了《职业安全卫生法》,成立了劳动部职业安全卫生署,负责职业安全和卫生、职业灾害劳工保护和劳动检查等业务,这些做法紧紧围绕如何保障劳动者健康、创造良好的劳动环境与提升优质劳动的产业竞争力展开,对目前的职业卫生与安全管理工作具有重要的参考价值。现就有关内容做简要介绍。     

Occupational health in Australia

Australia is a developed country in the Asia-Pacific Region with a large land area but a small population. Its main economic activities are mining, agriculture and manufacturing, with its service and high-technology industries being the fastest growing sectors in recent years. The regulation and enforcement of Occupational Health and Safety policies are mainly administered by the Industrial Relations Departments of eight State and Territory jurisdictions in the country. A National Occupational Health and Safety Commission coordinates occupational health and safety at the Commonwealth level. In 1987 the six occupational health and safety priorities in Australia were listed as occupational back pain, management of chemicals used at work, occupational noise-induced hearing loss, occupational skin disorders, occupational cancer and mechanical equipment injury. Australia has probably the highest incidence of malignant mesothelioma in the world, although the use of asbestos has been largely phased out. There was an almost explosive “epidemic” of repetition strain injury in the 1980s. Approximately 500 work-related fatalities and 10,000 work-related injuries are notified for workers' compensation every year. In addition, it is estimated that there are several thousand cases of work-related diseases every year, many of which go unreported. Occupational physicians undergo 4 years of specialisation training. Occupational hygienists, nurses and ergonomists receive training supervised by their respective professional organisations. Received: 2 March 1998 / Accepted: 10 March 1998     

Nonfatal occupational injuries and illnesses among workers treated in hospital emergency departments--United States, 2003

CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on nonfatal occupational injuries and illnesses through the National Electronic Injury Surveillance System (NEISS), an emergency department (ED)-based surveillance system. This report summarizes data for 2003. The overall number and rate of occupational injuries and illnesses did not change substantially during the 5-year period since data were last reported in 1998. In 2003, age-, sex-, and diagnosis-related patterns of injury and illness among workers treated in EDs (ED-treated injuries/illnesses) were similar to those reported in 1998. To achieve substantial decreases in these injuries and illnesses, prevention efforts must focus on effective, targeted workplace-safety interventions for diverse occupations.     

Implications of OSHA's reliance on TLVs in developing the air contaminants standard

This paper evaluates the decision by the Occupational Safety and Health Administration (OSHA) to base its Air Contaminants Standard on the threshold limit values (TLVs) of the American Conference of Governmental Industrial Hygienists. Contrary to the claim made by OSHA in promulgating the standard, the TLV list was not the sole available basis for a generic standard covering toxic air contaminants. The National Institute for Occupational Safety and Health (NIOSH) presented data indicating that the TLVs were insufficiently protective for 98 substances. NIOSH Recommended Exposure Limits (RELs) were available for 59 of these substances. The ratio of PEL to REL ranged up to 1,000, with a median of 2.5 and a mean of 71.4. OSHA excluded 42 substances from the standard altogether despite the availability of NIOSH RELs, solely because no TLV had been established.