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Biomedical subjects

K Ringen

Publications and source records attributed to K Ringen.

At least 19 recordsLinked to original sources
PubMed1996

Intervention research in occupational safety and health: examples from construction.

Construction is one of the largest industries in the United States, with 13% of the gross national product and 5-6% of the labor force. It is also one of the most dangerous industries, accounting for 15% of occupational fatalities and 17% of all workers' compensation costs. In 1989, the Building and Construction Trades Department, AFL-CIO, completed an agreement with the National Institute for Occupational Safety and Health to develop a national labor-management initiative to improve occupational safety and health throughout the construction industry. The aim was to remedy a lack of research on construction occupational safety and health. The first years were spent on surveillance to characterize construction safety and health problems, development of awareness about safety and health issues among decisionmakers in the industry, and some limited interventions. A second phase was initiated in 1994, which focuses on intervention activities. Results from this joint program include a growth in annual federal construction safety and health research expenditure from $300,000 in 1989 to $12 million in 1995, a research network that now encompasses more than 30 institutions, a national conference that established an agenda to change construction safety and health, four regional conferences to develop coalitions and implementation strategies, and the development of a feasible goal to reduce fatality and injury rates by 80%. The program may already be having an impact. According to the Bureau of Labor Statistics, lost-time injury rates for construction for the three most recent years of reporting declined by 20%.

Absenteeism↗
PubMed1995

Safety and health in the construction industry.

Workers in the building, renovation, and demolition of roads and commercial structures in the U.S. suffer a disproportionate share of occupational fatalities and lost-time injuries. Nearly all of the injuries and deaths are preventable. The fatality rate from work-related ailments, such as cancers and silicosis, is believed to be excessive, but is not generally computed. The safety and health problems are tied largely to the construction industry's organization and how the work is performed. Many hazardous exposures result from inadequacies in access to information, measurement technology, and personal protective equipment. Potential solutions are in labor-management site safety and health planning and management, education and training of workers and supervisors, new technologies, federal regulation, workers' compensation law, medical monitoring, and occupational health delivery. Public health opportunities involve health care delivery systems, improved preventive medicine, disability determination and rehabilitation programs, and research, beginning with the standardization of data to monitor these problems.

Accidents, Occupational↗
PubMed1994

National Conference on Ergonomics, Safety, and Health in Construction summary report.

Decision makers from the construction industry, labor unions, government, and academia met in Washington, DC, July 18 to 22 to focus for the first time as a group on the work-related safety and health problems of construction workers. The National Conference on Ergonomics, Safety, and Health in Construction drew more than 750 participants, including experts in economics, engineering, ergonomics, industrial hygiene, insurance, public health, public policy, and occupational and rehabilitative medicine.

Accidents, Occupational↗
PubMed1993

Risk of hospitalization for specific non-work-related conditions among laborers and their families.

To better describe patterns of nonoccupational morbidity among construction laborers and their dependents, two health insurance plans organized by local unions of the Laborers' International Union of North America provided their medical claims data for 1989. The observed numbers of hospital admissions were compared with the numbers expected, based on the age-sex-specific hospital discharge rates from the 1989 National Hospital Discharge Survey. Standardized morbidity ratios thus obtained showed excesses for alcohol and drug dependence, complications related to pregnancy, and several other conditions. Medical claims data are a very useful resource in epidemiologic and medical care research, but their use poses numerous challenges, mainly related to the accuracy of diagnostic recording, problems in comparing different health insurance plans, and confounding factors due to health insurance largely being a condition of employment. Nevertheless, the use of these data can provide specific hypotheses for further study.

Adolescent↗
PubMed1993

Job tasks, potential exposures, and health risks of laborers employed in the construction industry.

Construction laborers have some of the highest death rates of any occupation in the United States. There has been very little systematic research focused exclusively on "laborers" as opposed to other workers in the construction industry. We reviewed the English language literature and various data bases describing the occupational tasks, exposures, and work-related health risks of construction laborers. The sources of information included 1) occupational mortality surveillance data collected by the states of California and Washington and the National Institute for Occupational Safety and Health (NIOSH); 2) National Occupational Exposure Survey; 3) national fatality data; 4) cancer registry data; and 5) case reports of specific causes of morbidity. While the literature reported that construction laborers have increased risk for mesothelioma, on-the-job trauma, acute lead poisoning, musculoskeletal injury, and dermatitis, the work relatedness of excess risks for all-cause mortality, cirrhosis, cerebrovascular disease, chronic obstructive pulmonary disease, ischemic heart disease, and leukemia is less clear. Furthermore, while laborers are known to be potentially exposed to asbestos, noise, and lead, and the NIOSH Job Exposure Matrix describes other potential hazardous exposures, little research has characterized other possible exposures and no research has been found that describes the exposures associated with specific job tasks. More advanced study designs are needed that include a better understanding of the job tasks and exposures to construction laborers, in order to evaluate specific exposure-disease relationships and to develop intervention programs aimed at reducing the rate of work-related diseases.

Facility Design and Construction↗
PubMed1990

Karl Evang: a giant in public health.

Karl Evang (1902-1981) was one of the leading figures in public health in the post-World War II era. His first contributions were in social epidemiology in the 1920s-30s, and his studies on sexually transmitted diseases, nutrition and health, and occupation and health, were seminal. He was instrumental in framing the constitutions of two key U.N. agencies, the Food and Agricultural Organization and the World Health Organization, and he helped shape the WHO definition of health. Following the war, as Norway's Director General of Health, he helped create one of the preeminent humanitarian democracies and its welfare state. He and his generation of public health workers were so effective because of ties to the dominant labor parties, the need for government intervention as a result of the Great Depression and the Second World War, and the humanistic reaction to the Nazi horrors. At the same time, their excessive emphasis on medical care, and the role of the physician in health policy, resulted in the great medical costs of today. Those who believe in activist government and the goal of equality in health status owe an enormous debt to Evang and his generation.

History, 20th Century↗
PubMed1989

The case for worker notification.

There is currently a heated debate about whether the U.S. Congress should enact the High Risk Occupational Disease Notification and Prevention Act. This Act would set up an orderly system for identifying, notifying, and assisting workers at high risk of occupational disease. Significant underpinning for this legislation comes from three pilot projects conducted by the National Institute for Occupational Safety and Health and the Workers' Institute for Safety and Health. These projects demonstrate that notification and intervention for occupational high-risk groups can be implemented feasibly within the existing structures of community health and labor management relations. These projects also suggest that, contrary to the views of opponents of current legislation, it is the absence of systematic programs that leads to massive litigation and high costs. At present, these costs are borne by workers and society.

Humans↗
PubMed1988

DNA hyperploidy as a marker for biological response to bladder carcinogen exposure.

A marker for biological response to bladder carcinogen exposure was evaluated in a cross-sectional study of 504 workers at high risk due to a range of exposures to various carcinogenic aromatic amines, primarily 2-naphthylamine. A quantitative fluorescence cytology method using the DNA-binding dye, acridine orange, was employed to measure DNA in exfoliated urothelial cells. DNA hyperploidy (greater than 5 C) was observed in 16 (21.6%) of 74 workers who had been exposed compared with 15 (3.5%) of 430 workers who had not (p less than 0.001). The prevalence of DNA hyperploidy increased in a dose-response manner from 3.5% to 60% with increasing duration of exposure. The association between DNA hyperploidy and exposure persisted when adjustment was made for age and cigarette smoking (p = 0.0001). The prevalence of the marker was greatest for exposed workers who smoked (23%), and lowest for those who had no exposure and who had not smoked (2%). This study indicates that DNA hyperploidy can serve as a marker for identifying workers who are at increased risk in occupational groups exposed to bladder carcinogens.

Adult↗
PubMed1987

Health policy: gaps in access, delivery, and utilization of the Pap smear in the United States.

Emergence of cervical cancer as a public health problem is largely a twentieth-century phenomenon; although primary prevention remains elusive, secondary prevention--through use of Pap smears--has markedly reduced mortality. Yet, major differences persist in both incidence and mortality between black and white women. The "routine" policies of identifying age groups, timing, and sites for Pap testing will have to yield to more targeted approaches. Both providers and individuals at risk have challenges and responsibilities.

Adult↗
PubMed1986

Risk factors for bladder cancer in a cohort exposed to aromatic amines.

Occupational and nonoccupational risk factors for bladder cancer were analyzed in a cohort of 1385 workers with known exposure to a potent bladder carcinogen, beta-naphthylamine. Bladder cancer was approximately seven times (95% confidence interval [CI] = 3.9, 12.4) more likely in exposed rather than nonexposed individuals, yet, otherwise, the groups were generally similar in other exogenous or hereditary risk factors. A total of 13 cases of bladder cancer were identified. After the first year of a screening program involving 380 members of the cohort, 9 of the 13 cases of bladder cancer and 36 persons with atypical bladder cytology, histology, or pathology were compared with 335 noncases for distributions of different variables. Occupational variables were significant in a multivariate model that controlled for age, cigarette smoking history, and source of drinking water. The estimated odds ratio for the association for bladder cancer and the duration of employment, when controlling of these other variables, is 4.3 (95% CI = 1.8, 10.3). In addition to the occupational factors, age was significant in the multivariate analysis. Other potential risk factors, such as consumption of coffee or artificial sweeteners, use of phenacetin, or decreased use of vitamin A were not found to be significantly different in cases and noncases.

1-Naphthylamine↗
PubMed1986

Optimal management of asymptomatic workers at high risk of bladder cancer.

Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are still in the preclinical disease stage. A large proportion of workers in these populations have been exposed to aromatic amines, but have not yet experienced the average latent period for bladder cancer. A need exists for definition of what constitutes optimal management for asymptomatic workers in these cohorts. Promising advances in the epidemiology, pathology, detection, and treatment of bladder cancer pressure for a reassessment of current practices and the application of the most current scientific knowledge. Some of these apparent advances, however, have not yet been rigorously evaluated. The time has come to evaluate these advances so that their application can occur while high risk cohorts are still amenable to and likely to benefit from intervention. This commentary calls for such an evaluation leading to a comprehensive approach to managing cohorts at high risk of bladder cancer.

Amines↗
PubMed1986

Interventions in high-risk occupational cohorts: a cross-sectional demonstration project.

In 1980, the Workers' Institute for Safety and Health began a demonstration project designed to develop a model program of community-based intervention in three cohorts with different workplace exposures and target cancer sites. Program components included identification, notification, medical surveillance, education, social support services (eg, psychosocial, legal, financial, etc), and evaluation. The three cohorts included the Augusta cohort, a group at risk for bladder cancer due to workplace exposure to beta-naphthylamine; the Port Allegany cohort, a group at high risk of cancer associated with a workplace exposure to asbestos; and the Pattern Makers cohort, a group shown to be at increased risk of colorectal cancer. Together, these three projects give a cross-sectional view of possible approaches to educational and medical intervention strategies in diverse situations.

Asbestosis↗
PubMed1985

Notification of a cohort of workers at risk of bladder cancer.

Surviving members of occupational cohorts studied in retrospective analyses of mortality usually are not notified individually of positive study results. However, concern has arisen that such results may contain risk information pertinent to study subjects. To evaluate the effects and implications of individually notifying survivors of such cohorts, we conducted a pilot notification study. Members of a cohort of 1,385 chemical workers who had handled carcinogenic amines were notified by mail that they were likely to be at increased risk of bladder cancer. Also a bladder cancer screening and follow-up program was established. The study demonstrated that notification is a complex action and that much care needs to be taken when communicating information on risk. Notification requires development of (1) criteria as to what constitutes a notifiable risk and (2) programs to meet the medical and social needs of the various parties involved in notification.

Carcinogens↗