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PubMed2004

Occupational disease and workers' compensation: coverage, costs, and consequences.

Most of the costs of occupational disease are not covered by workers' compensation. First, the authors estimated the deaths and costs for all occupational disease in 1999, using epidemiological studies. Among the greatest contributors were job-related cancer, chronic respiratory disease, and circulatory disease. Second, the authors estimated the number of workers' compensation cases, costs, and deaths for 1999, using data from up to 16 states representing all regions of the country. Unlike the epidemiological studies that emphasized fatal diseases, the workers' compensation estimates emphasized nonfatal diseases and conditions like tendonitis and hernia. Comparisons of the epidemiological and workers' compensation estimates suggest that in 1999, workers' compensation missed roughly 46,000 to 93,000 deaths and 8 billion US dollars to 23 billion US dollars in medical costs. These deaths and costs represented substantial cost shifting from workers' compensation systems to individual workers, their families, private medical insurance, and taxpayers (through Medicare and Medicaid). Designing policies to reduce the cost shifting and its associated inefficiency will be challenging.

Adult↗

PubMed1984

Pesticide use, alternatives and workers' health in Cuba.

Cuba provides a unique example of a country that is actively implementing a program to reduce its dependence on pesticides. This paper addresses Cuba's current efforts to develop and implement alternatives to pesticides and legislation to limit exposure and protect workers in the interim. In 1980 Cuba embarked on a national program to utilize alternatives to chemical pest control. This three-part program includes expansion of knowledge of Cuban agro-ecology in order to implement cultural control practices; research and implementation on biological control of pests; and research on plant resistance and development of resistant crop varieties. To date, the program has enabled Cuba to reduce pesticide usage in sugar cane, citrus, tobacco, corn, and vegetable crops, among others. While alternatives to chemical pest control are being developed, the Cubans are paying special attention to regulating pesticide use and the safety of workers and members of the public exposed to toxic chemicals. In addition to the Resolution on Health and Safety (1967) and the Safety and Health Law (1978) which cover all workers, including Cuba's 250,000 agricultural workers, the Ministry of Public Health promulgated Resolution 335 in 1967. This resolution addresses requirements and administration of structural pest control, production, importation, transport and storage of pesticides, as well as requirements for worker contact with pesticides, pesticides for domestic use, aerial application of pesticides, and violations of the regulations. The paper concludes with a description of how the system works on the provincial level, as exemplified by Villa Clara, and the steps that have been taken to eliminate worker exposure to pesticides, to utilize pesticides which pose less of a hazard to workers, and to assure early detection of ill effects.

Agricultural Workers' Diseases↗

PubMed2004

Pesticide patch test series for the assessment of allergic contact dermatitis among banana plantation workers in panama.

BACKGROUND: Irritant contact dermatitis and allergic contact dermatitis (ACD) are frequent among agricultural workers and require targeted interventions. Patch testing is necessary for differential diagnosis, but patch testing with pesticides is uncommon. OBJECTIVE: This study explores the frequency of ACD and sensitization to pesticides among highly exposed banana plantation workers. METHODS: Frequently and recently used pesticides on banana plantations in Divala, Panama, were documented. A pesticide patch test tray specific for this population was prepared. A structured interview was administered to 366 participants, followed by a complete skin examination. The pesticide patch test series, as well as a standard patch test series, was applied to 37 workers with dermatoses likely to be pesticide related and to 23 control workers without dermatoses. RESULTS: The pesticide patch tests identified 15 cases (41%) of ACD (20 positive reactions) among the 37 workers diagnosed with pesticide dermatosis. Three controls had allergic reactions to pesticides (4 positive reactions). The pesticides were carbaryl (5 cases), benomyl (4 cases), ethoprophos (3), chlorothalonil (2), imazalil (2), glyphosate (2), thiabendazole (2), chlorpyrifos (1), oxyfluorfen (1), propiconazole (1), and tridemorph (1). Ethoprophos and tridemorph had not been previously identified as sensitizers. Thus, the prevalence of ACD was 0.03 (15 of 366). On the basis of observed prevalences of positive patch-test reactions among the subgroups with and without dermatoses, we estimated that > or = 16% of the entire population may be sensitized to pesticides. CONCLUSION: Sensitization to pesticides among banana plantation workers is a frequent occupational health problem. Pesticide patch test trays should be used in assessing skin diseases in highly exposed workers.

Adolescent↗

PubMed1995

Some aspects of occupational safety and health in green tea workers.

The objectives of this study were to evaluate the health and safety conditions of 36 male and 27 female green tea workers who were aged 40-69 years and had worked for at least 5 years in green tea production procedures. The Mean +/- SD of age was 57.1 +/- 5.8 years in males and 54.4 +/- 6.4 years in females. The mean working career was 26.1 +/- 9.5 years and 24.3 +/- 9.1 years, respectively. The most commonly subjective complaints developed while at work was pain in the lower back at a rate of 72.2% in males and 63.0% in females. Regarding persistent subjective complaints, female workers had significantly (P < 0.05) higher prevalence rate for breath shortness (25.9%) compared to that of male workers (5.6%). It was observed that the male workers whose occupational career was equal to or more than 28 years had significantly higher prevalence rates for stiffness in the neck and pain in the arms, compared to those of male workers whose occupational career was less than 28 years. The prevalence of nasal allergy was 11.1% either in the male or female workers. The total rate of accidents during working hours in the male workers was 22.2%, and that in the female subjects was 18.5%. The mean frequency weighted vibration magnitude produced by using tea-leaf plucker was in the range of 2.4-3.5 m/s2. The mean equivalent A-weighted noise level while using the same equipment was 100.6 +/- 5.0 dB(A). The need for occupational safety and health programs in these small farm settings are discussed.

Adult↗

PubMed2002

Healthy worker effect in cohort studies on chronic bronchitis.

OBJECTIVES: Despite the recognition of selection biases arising from the healthy worker effect in occupational mortality studies, the possibility of similar effects in occupational cohort studies on respiratory symptoms is not well known. Two mechanisms are responsible for the healthy worker effect in respiratory cohort studies. One is health-based selection of workers into employment (healthy him effect), and the other is health-based differential losses to follow-up (healthy worker survivor effect). The aim of the present paper was to estimate the magnitude of the healthy worker survivor effect in cohort studies of symptoms of chronic bronchitis. METHODS: A meta-analysis of occupational cohort studies of symptoms of chronic bronchitis was performed that included published articles identified in searches of the Medline bibliographic databases between 1980 and March 2001 and the reference lists of the located articles. RESULTS: Eight cohort studies were identified using an a priori selection criterion. The pooled odds ratio of the prevalence of chronic bronchitis for subjects leaving the cohorts was 1.23 when these subjects were compared with those who remained under study (95% confidence interval 1.04-1A4). CONCLUSIONS: The prevalence of respiratory symptoms among exposed workers may he underestimated if the healthy worker survivor effect is not taken into account

Bronchitis, Chronic↗

PubMed1999

Health services research in workers' compensation medical care: policy issues and research opportunities.

OBJECTIVE: To describe some of the unique aspects of medical care offered under workers' compensation insurance systems and discuss the major policy considerations relevant to health services researchers undertaking investigations in this area. BACKGROUND AND FINDINGS: State-based workers' compensation (WC) insurance systems requiring employers to pay for medical care and wage replacement for workplace injuries and illnesses were first developed between 1910 and 1920 in the United States. Employers are generally required to purchase state-regulated workers' compensation insurance that includes first-dollar payment for all medical and rehabilitative services and payment of lost wages to workers with work-related illness or injury. Injured workers have variable but usually limited latitude in choosing their health care provider. Employers and workers' compensation insurers have incentives for controlling both the cost of medical care and lost wages. CONCLUSION: The major policy issues in WC medical care--the effect of patient choice of provider and delivery system structure, the ensuring of high-quality care, the effect of integrating benefits, and investigation of the interrelationships between work, health, and productivity--can be informed by current studies in health services research and by targeted future studies of workers' compensation populations. These studies must consider the extent of patient choice of physician, the regulatory environment, the unique role of the workplace as a risk and modifying factor, and the complex interaction between health and disability insurance benefits.

Health Benefit Plans, Employee↗

PubMed1999

Contested claims in carpal tunnel surgery: outcome study of worker's compensation factors.

UNLABELLED: We retrospectively analyzed the importance of factors relating to worker's compensation for 273 wrists in 211 consecutive patients who underwent primary carpal tunnel release. Patients were divided into three groups: non-work related, worker's compensation-uncontested, and worker's compensation-contested. Contested claims were those in which the worker's compensation carrier denied authorization for surgery, and in which such authorization was given following intervention by a plaintiff's attorney. RESULTS: there were no statistically significant differences in postoperative return of grip strength and in postoperative return to work intervals in comparing groups I and II. However, the contested worker's compensation patients were much less likely (and much slower) to return to light duty and to return to full duty work. Return of grip strength was slower and less complete in this group as well. Within worker's compensation, a contested claim portends a poorer prognosis. Uncontested worker's compensation claimants have nearly as good a prognosis as non-compensation patients.

Adult↗

PubMed2003

[Causes of death of COGEMA active workers, 1980-1995].

BACKGROUND: Populations exposed to risks at work show a deficit in deaths in comparison with the national population, the "healthy worker effect". This effect has been observed among former nuclear workers. The aim of our cross-sectional study was to evaluate the mortality in a metallurgy worker population, and to study the impact of the choice of the reference population on the estimation of the Standardized Mortality Ratio (SMR). METHODS: The studied population was the COGEMA Metallurgy Department workers, aged 25 years to 64, during the period 1980-1995 in two regions of France (North--La Hague; South--Cadarache, Marcoule, Miramas and Pierrelatte). In order to account for geographical variability and the difference in mortality between the working population and the non-working population, we used several reference populations: national population, regional population, "working" national population (farmers not present in COGEMA and non-workers excluded), and "working" regional population. RESULTS: All SMRs were increased when we used a "working" regional reference compared with the national reference population. Among men, eight pathologies presented a significant deficit with a national reference, whereas only two pathologies showed a deficit with the "working" regional reference. CONCLUSION: The use of a reference population close to the study population enabled us to reduce the Healthy Worker Effect among metallurgy workers at COGEMA plants.

Adult↗

PubMedDate not supplied

Workers' compensation: a background for Social Security professionals.

This article provides a brief history and background of workers' compensation programs for occupationally injured and ill workers in the United States. It presents the basic principle involved in workers' compensation and briefly discusses the disability benefits to which workers are generally entitled. It also discusses why there are settlements in this disability program and the availability of information about the amounts paid in workers' compensation cases for obtaining an offset for Social Security Disability Insurance benefits paid to the worker. Finally, the article explains the rationale behind the public policy on coordination of Disability Insurance and workers' compensation in the new paradigm of disability and return to work.

Eligibility Determination↗

PubMed1991

[Immunologic and respiratory findings in workers on a pig farm].

The prevalence of respiratory symptoms and ventilatory capacity in relation to immunological status were studied in 32 swine workers and in 39 controls. A large number of swine workers reacted to antigen of swine hair (34%) and to swine confinement antigen (28%) but also to other antigens such as animal food (78%), and corn flour (37%). Control workers showed comparable prevalence in their reaction to these antigens (17%, 25%, 51%, 25%). Increased IgE serum level was determined in three swine workers (9.4%) and in one control worker (2.6%). Swine workers with positive skin tests demonstrated significantly larger acute reductions in FEF50 and FEF25 than those with negative skin tests (P less than 0.01). The ventilatory capacity data measured before shift in swine workers with positive skin tests were significantly lower than the predicted normal values. Swine confinement antigen caused a dose-related contraction of guinea pig smooth muscle in vitro. Our data indicate that non-immunological reactions may be partly responsible for the acute and/or chronic changes in respiratory function.

Adult↗

PubMed1988

Workers' compensation: 1980-84 benchmark revisions.

The first workers' compensation program was introduced 80 years ago. Its purpose was to compensate occupationally injured workers and their families for lost wages and medical expenses from job-related injury, regardless of fault. Today, each of the State and Federal programs that provides coverage to more than 86 percent of the work force uses a combination of private insurance, State or Federal funds, and self-insurance to meet its benefit obligations. The workers' compensation program is of continuing interest to the Social Security Administration (SSA) for several reasons. Since 1965, Social Security Disability Insurance benefits have been subject to reduction if such benefits, when combined with those provided under workers' compensation laws, exceed 80 percent of the worker's earnings. Because the two programs have gaps in protection as well as duplication in coverage, a periodic review of the workers' compensation program is necessary. In addition, SSA administers Part B of the Black Lung program--established to provide income-maintenance protection to coal miners disabled by pneumoconiosis--to about 1 million beneficiaries whose claims were filed before July 1973. This article provides revised benchmark data on the workers' compensation programs and presents a review of program operations during the early 1980's.

Costs and Cost Analysis↗

PubMedDate not supplied

A controlled field trial of physiological responses to organophosphate residues in farm workers.

Blood acetylcholinesterase (ACHE) and pseudocholinesterase (PCHE) activity and urinary dialkyl phosphate (DAP) excretion were measured in a group of 15 male agriculture field workers during a five-day thinning operation in a Northern California peach orchard. Eight men were randomly assigned to work in a Guthion-treated plot, and seven men to work in an adjoining plot free from organophosphate residues. Foliage samples were taken to measure dislodgeable and total Guthion residues. The daily mean percent change in the ACHE and in the PCHE activity was less than -10.0 percent of baseline values for each group of men. Mean ACHE activity of workers in the Guthion treated plot was different from that of workers in the control plot on the fifth exposure day. The mean PCHE activity of workers in the Guthion treated plot was not different from that of workers in the control plot. Daily group-mean urinary metabolite excretion levels for workers exposed to Guthion residues were highly correlated with their daily group-mean percent change in ACHE activity. No urinary metabolites were detected in workers in the control plot. Decay in Guthion residues was markedly slower in this trial than in a comparable study conducted one year previously, emphasizing the difficulty in setting re-entry intervals based on time elapsed from pesticide application. Suggestions were made to extend the time interval of future studies on the human health effects of organophosphate residue exposure, and to further refine urinary metabolite surveillance methods toward the goal of establishing a threshold level of metabolites which would correspond to meaningful exposure to these pesticides residues.

Acetylcholinesterase↗

PubMedDate not supplied

[Respiratory function in poultry workers].

A group of 343 workers (252 male and 91 female) employed in poultry farms was studied for the prevalence of acute and chronic respiratory symptoms and lung function changes. There were significantly higher prevalences of most of the chronic respiratory symptoms in poultry workers than in controls (p < 0.01 or < 0.05). Poultry male smokers had significantly higher prevalences of chronic cough, chronic phlegm and chronic bronchitis than poultry male nonsmokers (p < 0.01). Poultry workers employed for more than 10 years had also significantly higher prevalences of these symptoms than those with shorter employment (except female smokers). There was also a high prevalence of acute symptoms in poultry workers which develop during work shift. The measured FVC, FEV1 and FEF25 in poultry workers were significantly lower than predicted normal values. Changes were particularly pronounced in workers employed for more than 10 years. We showed additionally that a water-soluble poultry extract causes a dose-related contraction of nonsensitized guinea pig tracheal smooth muscle when studied in vitro. Our data suggest that the work in poultry farms may in some workers cause the development of acute and chronic respiratory impairment.

Acute Disease↗

PubMedDate not supplied

Acceptance of auxiliary health worker in rural Iran.

A pilot project to train and deploy low-level rural health auxiliaries is being carried out in southern Iran. This first group of 16 village health workers (VHW) went to work in the initial 16 project villages early in 1974. The group consisted of 11 men and 5 women ranging in age from 15 to 45. These workers are taught to treat simple medical conditions, to practice preventive health measures, and to conduct health education and visit programs. Six months after initial deployment to the villages, a sample survey of 226 villagers was carried out to determine what characteristics of the VHW and of the consumers were associated with greater acceptance of the VHW's work and his or her role in the village. The results indicated that both male and female health workers are accepted in an equivalent role, and that workers returning to their own villages are no more or no less likely to have difficulties in gaining acceptance than are those returning to a different village. It was found that experience with a VHW of a particular sex could significantly alter attitudes toward the preferred for the VHW. The age of the worker was the only variable closely associated with the villagers' confidence in the worker--the older the VHW, the higher the villagers tended to rate his or her knowledge. In Iran, as in many developing countries, the rural village tends to be a closed, male-dominated group. The experience of the VHWs in Iran makes it apparent that the health worker, regardless of sex, age, or village of origin, can gain the confidence and respect of the villagers.

Adolescent↗

PubMed1998

Occupational hazards, living conditions, and physical assault of sugar cane workers in KwaZulu-Natal, South Africa.

OBJECTIVES: To characterise the occupational hazards and living conditions of sugar cane workers in KwaZulu-Natal. DESIGN: Based on information provided by shop stewards, a survey instrument (questionnaire) was constructed for administration to union members. SETTING: Seven sugar cane farms and estates owned by one large corporation in late 1993. SUBJECTS: Members of the South African Farm and Allied Workers Union (SAFAWU). RESULTS: Of the 632 participants, 50% were permanent workers, 22.3% were seasonal workers and 27.7% were casual workers. Mean daily pay ranged from R5 to R35 per worker. The majority of participants reported substandard housing both during the growing season and during the off-season. Percentages reporting health problems in the last 12 months believed by the respondent to be caused or made worse by work included 79% with eye problems, 78% with upper respiratory problems, 88% with lower respiratory problems, 93% with musculoskeletal problems, and 81% with an acute traumatic injury. More than half the participants reported fainting, collapsing or illness from working on hot or sunny days. Fourteen per cent reported being struck with the fist or hand, or being pushed, shoved or kicked by a farm owner, member of the owner's family, manager or supervisor; 9% reported being struck with an object, whipped, or attacked or threatened with a knife or gun by one of these same individuals. CONCLUSIONS: Sugar cane workers employed by a large corporation in KwaZulu-Natal appear to face severe threats to their physical and psychological well-being including: (i) inadequate pay to meet basic living needs; (ii) substandard living conditions; (iii) significant occupational hazards resulting in high reported levels of occupational illness and injury; and (iv) physical and psychological abuse and intimidation by farm owners and their agents.

Accidents, Occupational↗

PubMed1998

Seroepidemiologic study on tick-borne encephalitis among forestry workers and farmers from the Lublin region (eastern Poland).

The paper presents the results of seroepidemiologic studies concerning tick-borne encephalitis (TBE) in 1,583 persons (1,261 forestry workers and 233 farmers) from the Lublin region (eastern Poland) occupationally exposed to ticks and in 130 healthy blood donors (a control group). The mean percentage of seropositive reactions in forestry workers amounted to 19.8% and in farmers 32.0%. Based on 5-year research (1994-1998) conducted in 5 districts of the Lublin region, the existence of endemic foci of TBE was detected in the district of Bia a Podlaska, on the areas of Radzyń Podlaski and Parczew, where the percentage of seropositive reactions in forestry workers exceeded 50%. Statistical analysis showed that the frequency of seropositive reactions in forestry workers and farmers was significantly greater compared to control group (p < 0.001 and p < 0.05, respectively). It indicates that these groups are occupationally exposed to TBE virus. In the years 1994-98, a total of nine clinical cases of TBE (acute neuroinfection) in forestry workers and fourteen clinical cases in farmers were confirmed serologically. The effectiveness of specific immunization against TBE was proved on the basis of 100% seroconversion in 56 earlier seronegative forestry workers. The obtained results proved that forestry workers and farmers in Poland are under increased risk of infection with TBE virus.

Adult↗

PubMed1996

Longitudinal study of respiratory findings in rubber workers.

A cross-sectional assessment of respiratory function and symptoms was performed in 1985 on 409 male rubber workers and 172 unexposed control workers. A follow-up study in 311 of the original rubber workers was performed 6 years later. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves. At the time of the initial study, significantly higher prevalences of all chronic respiratory symptoms, except for asthma, were found among the rubber workers compared to controls. Smokers had a significantly higher prevalence of most of the chronic respiratory symptoms compared with nonsmokers. A high prevalence of acute symptoms during the workshift was recorded among the rubber workers at both surveys. Rubber workers demonstrated significantly lower ventilatory capacity measurements compared to predicted. Ventilatory capacity measurements diminished significantly across the workshift, particularly FEF50 and FEF25. Metaproterenol inhaled at the end of the workshift significantly improved lung function in a small group of sensitive rubber workers. Annual lung function loss among both smokers and nonsmokers was in excess of predicted. Our data suggest that exposure to noxious agents in the rubber industry are associated with the development of acute and chronic respiratory impairment.

Adolescent↗

PubMed1996

Respiratory symptoms and pulmonary function in mill workers exposed to wood dust.

This study surveyed wood dust exposure levels and pulmonary hazards among wood mill workers. Dust concentrations as measured by six-stage cascade impactors were high in work areas of grinding and screening. Total dust concentrations for these dusty activities ranged from 4.4 to 22.4 mg/m3, and the respirable proportions were between 2.4% and 50.2%. The dust level in the sawing work was 2.9 mg/m3. Although symptoms of cough and phlegm were higher in smoking workers than in nonsmoking workers, the prevalence of respiratory symptoms in the exposed workers was not significantly higher than in the controls. However, the incidence of symptoms such as chronic phlegm and chronic bronchitis in the nonsmoking high-exposure workers was significantly higher than in nonsmoking controls. The mean values of MMF, PEFR, and FEF25% were significantly lower in the exposed workers than in controls for both smokers and nonsmokers. The pulmonary function deficits, with the exception of FEV1.0/FVC, also showed a significant trend with increasing levels of wood dusts exposure classified by job titles for both smokers and nonsmokers. After adjustment for age, sex, height, and smoking status, all parameters of pulmonary function were significantly lower in exposed workers than in controls and showed a declining trend with increasing exposure levels classified by job titles. These results indicate that high level of wood dust exposure in the wood mill industries may lead to pulmonary hazards. Engineering control and industrial hygiene are mandatory for dusty activities.

Adult↗