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The intervention research process in occupational safety and health: an overview from the National Occupational Research Agenda Intervention Effectiveness Research team.

The goal of occupational safety and health intervention effectiveness research is to determine whether specific interventions work to prevent work-related injury and illness. But that is not the whole story. It is also important that the development and implementation of the intervention be evaluated. All three phases (development, implementation, and effectiveness) are central to a model of intervention research proposed by the National Occupational Research Agenda Intervention Effectiveness Research team. Areas for future research are also presented.

Data Collection↗

A description of an occupational reproductive health nurse consultant practice and women's occupational exposures during pregnancy.

It is estimated that each year 20 million workers in the United States are potentially exposed to a variety of reproductive hazards. In 1986, Wisconsin implemented an advanced practice public health nurse role to serve as the occupational reproductive health consultant to employees, employers, health care professionals, unions, and others. This article describes this advanced practice role in public health nursing and the women who sought reproductive health consultation. Data on the types of workplace exposures that these consultees had during pregnancy are used to illustrate the occupational history and its importance for pre-conceptional and early-pregnancy counseling. The sample for analysis was limited to the 118 women, aged 19-43 years, who received consultation services between 1990 and 1993 and whose pregnancies resulted in live births. Data were abstracted from the consultant's records of telephone and written consultations and linked to birth certificate records to provide information on smoking and alcohol use during pregnancy. The findings are summarized using descriptive statistics. Implications of the findings for public health nursing are discussed.

Adult↗

Use of specific inhalation challenge in the evaluation of workers at risk for occupational asthma: a survey of pulmonary, allergy, and occupational medicine residency training programs in the United States and Canada.

STUDY OBJECTIVES: To document the current practice of occupational asthma (OA) diagnosis and use of specific inhalation challenge (SIC). DESIGN, SETTING, AND PARTICIPANTS: A survey evaluating the current practice of SIC was mailed to 259 residency training programs in adult pulmonary diseases, allergy and immunology, and occupational medicine accredited in the United States and Canada during the year 2000. RESULTS: Forty-six percent (123 of 259 programs) participated. Ninety-two programs reported that patients with OA were seen during the previous year, 15 programs reported that SIC had been performed, and 10 programs reported that patients had been referred to other sites for SIC. A total of 259 patients underwent SIC. No unexpected adverse reactions were reported. Forty-one programs reported that they had been willing to undertake SIC but were unable to do so. The most common barriers cited were lack of availability of SIC within the evaluating institution, inability to locate a site for referral, concerns about reimbursement, and lack of an appropriate diagnostic reagent for use in SIC. Seventy-four programs indicated that SIC was useful, and 34 programs included training in the use of SIC was part of the residency curriculum. CONCLUSION: Although SIC is considered the "gold standard" for objective documentation of OA, the test is performed in only a few institutions in the United States and Canada. Many institutions indicate that SIC is not available, even when desired for patient management. Only a minority of participating residency training programs include SIC as a formal part of the training curriculum.

Asthma↗

[Occupational accidents and occupational disease: study of the hospital workers' knowledge about health risks of their work].

This study searches to gather the knowledge of the hospitalr health workers in relationship their own health in the development of their activities. The study was accomplished in a general hospital, of medium load, with medicine service occupational functioning. The way gone through is the presentation of the subject in study and the theoretical foundation as a way of basing the analysis of the datas, gathered through the questionnaire, to apprehend the worker's knowledge about the relationship work-health-disease. The result evidenced the workers' generic knowledge concerning the prevention of accidents and occupational diseases.

Accidents, Occupational↗

Occupational medicine: toward a worker/patient empowerment approach to occupational illness.

Clinicians practicing occupational medicine are increasingly confronted with patients who have complex illnesses with chronic nonspecific symptoms. Most clinicians use the traditional tools of biomedicine to diagnose and treat the illness, determine etiology, and assess disability. This article argues that the biomedical approach is inadequate to effectively evaluate and treat occupational illness. After reviewing several critiques of biomedicine, including biopsychosocial, feminist, class, and critical theory/postmodern perspectives, the author offers an alternative approach that builds on aspects of these perspectives as well as the "popular education" work of Paulo Freire. Constraints on, and possibilities for, the development of an alternative approach that attempts to build patients' capacities for transformative action are explored.

Attitude of Health Personnel↗

Occupational exposure to ethylene oxide; Occupational Safety and Health Administration. Advance notice of proposed rulemaking.

Notice is given that OSHA is undertaking, through rulemaking procedures under section 6(b) of the Occupational Safety and Health Act of 1970 (the Act), 29 U.S.C. 655(b), a reevaluation of the current occupational health standard regulating employee exposure to ethylene oxide (EtO), 29 CFR 1910.1000, Table Z-1. This notice summarizes the information currently available to OSHA concerning the production and use of EtO, estimates of employee exposure, and the potential health effects of employee exposure to EtO. The notice also invites interested parties to submit data, views and comments regarding the development of a new standard for EtO and the appropriate scope of coverage.

Ethylene Oxide↗

Occupational exposure to ethylene oxide--Occupational Safety and Health Administration. Proposed rule and notice of hearing.

By this notice, the Occupational Safety and Health Administration (OSHA) is proposing to amend its existing occupational standard that regulates employee exposure to ethylene oxide (EtO). The basis for this action is a determination by the Assistant Secretary, based on animal and human data, that exposure to EtO at OSHA's current permissible exposure limit (PEL) of 50 parts EtO per million parts of air (50 ppm) as an eight (8)-hour time-weighted average (TWA) is inadequate for employee health protection. OSHA proposes to reduce the PEL for EtO to a TWA of 1 ppm. An "action level" of 0.5 ppm as a TWA is included in the proposal as a mechanism for exempting an employer from the obligation to comply with certain requirements, such as employee exposure monitoring and medical surveillance, in instances where the employer can demonstrate that the employees exposures are at very low levels. The proposal would provide for among other requirements certain methods of exposure control, personal protective equipment, measurement of employee exposures, training, medical surveillance, signs and labels, regulated areas, emergency procedures and recordkeeping.

Ethylene Oxide↗

[Rules for prevention and certification of occupational diseases in workers occupationally exposed to antineoplastic drugs].

The risk of occupational exposure to antineoplastic drugs is related to cancerogenesis and reproductive dysfunction, including fertility disorders, congenital defects and toxic effects inter alia on the liver, kidneys, skin and bone marrow. The authors review current legal regulations of antineoplastic drug administration, the present state of the patients' care and guidelines for prophylactic examinations in this occupational group.

Antineoplastic Agents↗

Behavioral risk management. A partnership between occupational health nursing and occupational psychiatry.

1. The estimated prevalence of behavioral disorders among adults in the United States is 29.5%, affecting more than 52 million individuals each year. 2. Numerous or persistent problems in work performance increase the likelihood of either a psychiatric illness or unresolved psychosocial factors. Assessing work functions can help identify individuals early on with potential warning signs for employment problems. 3. Occupational health nurses can partner with occupational psychiatrists to clarify the complex scenarios that present to companies and recommend intervention. 4. Proactive intervention for employees, an effective team, and input and participation from the various stakeholders can produce positive outcomes for both the employee and the employer.

Adult↗

[Remote effects of occupational and non-occupational exposure to electromagnetic fields of power-line frequency. Epidemiological studies].

A retrospective cohort study of mortality in the personnel of power-supply plants in the European regions of Russia was carried out. The exposure of the personnel to electromagnetic fields of power-line frequency (PF) was taken into account. Statistically non-significant raise of mortality from leukemia was found, compared to low mortality rates due to all other causes including cancer of any type. Standardized mortality ratio (SMR) was equal to 2.03 (95% CI = 0.23-7.31). In the retrospective case-control study the haemoblastosis development risk under occupational PF EMF exposure was evaluated. The data of 571 "cases" and 1208 "controls" interview showed that odd ratio (OR) was 1.64 (95% CI = 0.8-3.1). In another retrospective case-control study the risk of the haemoblastosis development in children due to parents PF EMF occupational exposure was evaluated. The data of 208 "cases" and 319 "controls" interview showed that the odd ratio (OR) was 1.69 (95% CI = 0.7-3.3). A retrospective cohort study of mortality in a settlement situated near a high-voltage (500 kV) substation, which took into account PF EMF levels in residential areas, revealed low mortality rates, except leukemia mortality (SMR 1.3; 95% CI = 0.2-7.0). The obtained data do not allow excluding a possibility of PF EMF leukogenic effect.

Adolescent↗

[Secondary nephropathies in occupational health practice. I. Secondary nephropathies due to occupational exposure].

Kidneys are particularly susceptible to the effect of toxic agents that can cause renal damage and even renal failure. The aim of this study was to present current knowledge of the influence of occupational toxic agents on renal functions. The authors describe the major nephrotoxic factors, such as heavy metals (including lead, cadmium, and mercury), organic solvents, pesticides and silica. They discuss changes in the kidney structure and molecular mechanisms of nephrotoxicity and carcinogenesis induced by occupational exposure to major toxic agents and also indicate possibilities of detecting the predicted nephrotoxicity symptoms so that clinical, overt renal insufficiency could be prevented.

Cadmium Poisoning↗

[Anthropo-ecological aspects of occupational health and various biochemical approaches to the problem of its evaluation in workers in high risk occupations].

This paper presents the concept of occupational health of man, interpreted as the process of maintenance and development of regulatory properties of the body and his physical, psychic and social well-being, which provide high reliability of his professional activities, professional longevity and maximal lifetime. The paper discusses the main areas of biochemical investigations to evaluate occupational health of the flying personnel, which include identification of correlates between biochemical or immune changes and pathological or premorbid states, that reduce tolerance to environmental effects, as well as study of functional specificities related to the reserves and mechanisms of implementation of adaptive capabilities of the human body. It gives detailed biochemical data derived from pilots with neurotic problems and biochemical indicators of stress tolerance measured during exposure to +Gz acceleration, angular acceleration, hyperthermia, hypoxia, and exercise.

Adult↗

[Principles of decisional analysis applied to the screening for occupational diseases: the example of occupational fluorosis].

In this paper, two oral presentations are combined. The first described the broad aspects of decision analysis and the second mentioned those medical data which need to be gathered in order to apply the model to industrial fluorosis. For this purpose, biological and medical observations were collected, both from workers of the aluminium industry and from controls. The five successive steps for building up a decision tree are then demonstrated, the aim of which being to evaluate the fitness of a screening strategy. A computer programme has been developed which may be applied both to occupational or non occupational diseases. Referring to industrial fluorosis, the computerized decision tree showed that screening with preshift urinary fluor, clinical and radiological signs, plus bone fluor rate is required, as soon as the risk corresponds to a 7% prevalence of the disease.

Aluminum↗

Occupational exposure limits based on biological monitoring: the Japan Society for Occupational Health.

The Japan Society for Occupational Health started to recommend an occupational exposure limit based on biological monitoring (OEL-B) in 1993. Up to 1998, OEL-Bs for mercury, lead, hexane and 3,3'-dichloro-4,4'-diaminodiphenylmethane had been adopted and those for 17 chemical substances (arsenic, cadmium, chromium, nickel, acetone, methanol, benzene, toluene, xylene, styrene, tetrachloroethylene, trichloroethylene, N,N-dimethylacetoamide, N,N-dimethylformamide, carbon disulfide, carbon monoxide, and organophospate insecticides) are in preparation.

Environmental Monitoring↗