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PubMed1993

Health, employment, and financial outcomes in workers with occupational asthma.

OBJECTIVE: To study the health, employment, and financial outcome of occupational asthma. DESIGN: A follow study of workers with confirmed occupational asthma. SETTING: A specialist occupational lung disease clinic. SUBJECTS: All workers had a diagnosis of occupational asthma made at least one year earlier. Diagnosis was confirmed by serial peak expiratory flow measurement, specific bronchial provocation testing, or specific immunology. MAIN OUTCOME MEASURES: Respiratory symptoms, medication, pulmonary function, employment state, and financial position. RESULTS: 112 of a total of 140 eligible workers were followed up. 32% of patients remained exposed to the causative agent. These workers had more symptoms at follow up than those removed and a greater number were taking inhaled steroids. Continued exposure was also associated with a fall in % predicted forced expiratory volume in one second (FEV1) of 3% compared with that at presentation. Their median loss of annual income due to occupational asthma was 35%. Those removed from exposure were worse off financially (median loss 54% of annual income), had fewer respiratory symptoms than the group who remained exposed, and their % predicted FEV1 had improved by 4.6%. Statutory compensation and that obtained by common law suits did not match the loss of earnings due to the development of occupational asthma. Of the workers removed from exposure, those who no longer complained of breathlessness had been diagnosed significantly earlier after the onset of their first symptom (48 v 66 months, p = 0.001) and had a significantly higher FEV1 at presentation (90% v 73% predicted, p = 0.008) compared with those who were still breathless. They had developed symptoms earlier after first exposure (48 v 66 months, p > 0.05) and had been removed from exposure sooner (eight v 12 months, p > 0.05). CONCLUSION: Removal from exposure after diagnosis of occupational asthma is beneficial in terms of symptoms and lung function, but is associated with a loss of income. Early diagnosis is important for symptomatic improvement after removal from exposure. Inadequate compensation may contribute to the workers' decision to remain exposed after diagnosis.

Adolescent↗
PubMed2003

Early prognostic factors for duration on temporary total benefits in the first year among workers with compensated occupational soft tissue injuries.

AIMS: To develop a model of prognosis for time receiving workers' compensation wage replacement benefits in the first year. METHODS: A prospective cohort of 907 injured workers off work because of soft tissue injuries was followed for one year through structured telephone interviews and administrative data sources. Workers were recruited at workers' compensation claim registration. Only those still off work at four weeks post-registration were included in the analysis. Data from several domains (demographics, clinical factors, workplace factors, recovery expectations) were collected at approximately two weeks and a subset again at four weeks. Outcome was duration on total temporary wage replacement benefits. Variable selection was carried out in two steps using content experts and backward elimination with the Cox model. RESULTS: Body region specific functional status, change in pain, workplace offers of arrangements for return to work, and recovery expectations were independently predictive of time on benefits. Change in pain and workplace offers interacted, so the largest mutual association occurred for those whose pain was getting worse-that is, reduction in median duration from 112.5 to 32.5 days. Across observed values, widely different recovery profiles of groups of workers resulted; for example, at four months, only one third of the highest risk group had gone off benefits while over 95% of the lowest risk group had done so. CONCLUSIONS: Focus on a relatively small set of prognostic factors should enable occupational health practitioners to triage injured workers within the first month and concentrate on those requiring additional assistance to return to work.

Accidents, Occupational↗
PubMedDate not supplied

Predictors of onset of wheezing in grain elevator workers.

A longitudinal study of Canadian grain elevator workers over a 12-year period was conducted. Data on respiratory symptoms and pulmonary function tests were collected once every three years as part of the Grain Dust Medical Surveillance Program started by Labour Canada in 1978; each three-year interval was called a 'cycle'. Of workers who had two or more observations, 1848 subjects (67.2%) were free of respiratory symptoms (wheeze, dyspnea, cough or sputum) at the baseline (cycle II). Predictors of first episode of wheezing were examined in these symptoms-free grain workers. Baseline mean age +/- SD of the grain workers was 34.0 +/- 11.4 years and mean duration of work in the industry was 9.9 +/- 8.7 years. Of the 1848 symptoms-free grain workers at cycle II, 203 (11.0%) subsequently reported wheezing during the study. Cox's proportional hazards model for analysis of survival data was used to determine significant predictors of first episode of wheezing. Significant predictors for first episode of wheezing were current smoking (relative risk [RR] 2.33; 95% CI 1.63 to 3.33; P<0.0001) and baseline forced expiratory volume in 1 s to forced vital capacity ratio [RR 0.02; 95% CI 0.003 to 0.20; P<0.0001). Baseline pulmonary function measurements and smoking habits appear to be important predictors of future development of asthma-like symptoms in grain elevator workers.

Adult↗
PubMedDate not supplied

Participatory mapping of occupational hazards and disease among asbestos-exposed workers from a foundry and insulation complex in Canada.

A study of former asbestos-exposed foundry and insulation workers was carried out in Sarnia, Ontario, home to Canada's petrochemical industry, using participatory mapping to document past exposures and subsequent diseases. Before it closed, government inspectors had monitored the use of asbestos at the facility, documenting levels that were thousands of times above the current legal limit. The study was undertaken by the Occupational Health Clinics for Ontario Workers (OHCOW) and Canadian Auto Workers (CAW) to provide evidence for worker compensation claims. Using facilitated hazard mapping, former Holmes workers graphically reconstructed their workplaces and detailed their exposures. Using facilitated body mapping, workers recorded and displayed their health problems. The study uncovered a grim pattern of occupational diseases. Following the release of the results, coupled with clinically confirmed diagnoses and corroborating evidence of exposure, hundreds of former Holmes employees and their families received compensation for occupational diseases that had previously gone unrecognized.

Asbestosis↗
PubMed2004

Occupational asthma in newly employed workers in intensive swine confinement facilities.

Respiratory symptoms, reductions in pulmonary function and increased bronchial responsiveness have been described in exposed workers and in naïve volunteers exposed to intensive swine production facilities. Typically, this occurs in persons who have been employed for a long duration or in previously unexposed, naïve volunteers. The current authors describe four cases, all female, who developed acute onset of wheezing and cough suggestive of asthma within weeks of commencing full-time employment in intensive swine production facilities. None of the workers were aware of any previous asthma, allergies or hay fever. All four employees reported improvement of symptoms on cessation of work in the facilities and consequent withdrawal from exposure. However, when seen at the respiratory clinic, cases 1 and 3 continued to be either mildly symptomatic or were taking medications with continued borderline airways responsiveness, as measured by methacholine challenge test up to 4 and 5 months, respectively, following work cessation. Case 2 continued to have symptoms for > or =3 months after work cessation. Only case 1, however, was seen at repeated visits in the respiratory clinic. One worker participated in a work re-entry trial and experienced profound coughing and chest tightness within an hour of entry, after which, the trial had to be terminated. Provocative concentration causing a 20% fall in forced expiratory volume in one second (PC20) measured 5 h later was lower than pre-trial PC20. No acute exposure event was recorded in the workers prior to the onset of symptoms. To the current authors' knowledge, this is the first report of occupational asthma occurring in newly employed full-time intensive swine production workers after a short-term exposure and should raise awareness that previously unexposed workers may be at risk of developing what would appear to be long-term asthma after relatively short-term exposure.

Adult↗
PubMed2002

Workers' compensation claims related to natural rubber latex gloves among Oregon healthcare employees from 1987-1998.

BACKGROUND: Occupational reaction to natural rubber latex (NRL) glove use by healthcare employees has been an area of increasing concern. Unfortunately, there is little data demonstrating the prevalence and severity of actual reactivity to NRL. METHOD: Occupational reaction to NRL was estimated using workers' compensation claims filed by healthcare employees in Oregon for the period of 1987-1998. For the first ten years, these claims were estimated by source and conditions consistent with NRL glove reactions, while in the last two years a specific code developed in 1997 for NRL glove reactions was also employed. RESULTS: The claim rate was on average 0.58 per 10,000 healthcare workers annually, which constituted 0.29% of all workers' compensation claims. The most common condition experienced was dermatitis (80%) and most common body part affected was the hands (55.4%). The majority of claimants, 45 (69.2%), reported taking less than a month off work, suggesting most reactions were minor in nature, although one fatality was reported. The average NRL claim cost was $8,309.48. Overall the average cost per insured healthcare worker was approximately $0.50 per year. The occupational groups with the highest number of claims were nurses (30.8% of claimants) and nursing aides and orderlies (24.6% of claimants). CONCLUSIONS: In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.25% of the total was potentially related to NRL gloves. The rare incidence of respiratory and ocular claims is inconsistent with the hypothesis that asthmatic or conjunctival reactions to NRL gloves are common.

Adult↗
PubMed1999

HIV-infected workers deported from the Gulf States: impact on Southern Pakistan.

HIV prevalence is still very low in Pakistan, but its south Asian location and subgroups with recognized lifestyle risk factors suggest that Pakistan will experience expanded diffusion of HIV. We report the frequency of HIV infections identified by the AIDS Control Programme on the Sindh province of Pakistan. Most HIV-positive cases currently reported to the Sindh AIDS Control Programme are found among Pakistani workers deported from the Gulf States and among foreigners. The 58 returned workers with HIV represent 61 to 86% of reported cases in any given year during the 1996-1998 period. Five wives of returning workers have been identified with HIV. Expatriate workers in the Gulf States are tested for HIV routinely, unlike other subgroups in Pakistan. Considering the risk of HIV/AIDS due to regular introduction of HIV from returned workers, and the limited awareness surrounding sexual health and HIV/STD transmission issues in Pakistan, intervention programmes targeted at overseas workers need to be implemented to control the expansion of the HIV epidemic in Pakistan.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Work-related pain and injury and barriers to workers' compensation among Las Vegas hotel room cleaners.

OBJECTIVES: We examined the prevalence of work-related pain and injury and explored barriers to and experiences of reporting among workers. METHODS: We surveyed 941 unionized hotel room cleaners about work-related pain, injury, disability, and reporting. RESULTS: During the past 12 months, 75% of workers in our study experienced work-related pain, and 31% reported it to management; 20% filed claims for workers' compensation as a result of work-related injury, and 35% of their claims were denied. Barriers to reporting injury included "It would be too much trouble" (43%), "I was afraid" (26%), and "I didn't know how" (18%). An estimated 69% of medical costs were shifted from employers to workers. CONCLUSIONS: The reasons for underreporting and the extent of claim denial warrant further investigation. Implications for worker health and the precise quantification of shifting costs to workers also should be addressed.

Accidents, Occupational↗
PubMed1979

The effect of outreach workers' educational efforts on disadvantaged preschool children's use of preventive services.

A special program of outreach services was implemented to assist a poverty population to appropriately use health services in the Kaiser-Permanente Medical Care Program. A study was conducted to determine the effect of outreach workers' intervention on the use of preventive services by this population. Intially, families were divided into two groups, one with and one without outreach workers. Outreach workers (neighborhood health coordinators) were trained in prevention and health education. They were then assigned to specific subgroups of the poverty population to teach the importance of preventive services and to motivate persons to use these services. This paper focuses on the effect of outreach workers' services on the use of selected preventive care services (immunizations and tine test) by preschool children from poverty families. Preschool children in families with coordinator services had higher use rates for preventive care. The sub-group for which outreach workers were specially trained to focus on preventive procedures for the pre-school group had markedly higher use rates for preventive care. The findings suggest that special intervention programs, using indigenous and nonprofessional outreach workers, can increase preventive service utilization by poverty groups.

Child, Preschool↗
PubMed1999

Respiratory diseases among agricultural industry workers in India: a cross-sectional epidemiological study.

Epidemiological survey for respiratory diseases among agricultural industry workers, such as bakeries, poultry farms, granaries and a sugar refinery was carried out using a medical questionnaire on various respiratory symptoms such as cough, breathlessness, rhinitis. The questionnaire was filled up by two doctoral students during personal visits to these work environments. The survey revealed that 40-59% of workers in different occupational work environments suffered from one or more respiratory ailments. As much as 36-40% of the workers reported work-related symptoms which is close to similar data from Western countries. A higher incidence of respiratory disorders was recorded in workers with longer duration of employment. Older workers suffered more than the young ones. Family history of atopy was found to have least effect on the incidence of cough, breathlessness and rhinitis in the workers. Smoking was found to have definite impact on the incidence of cough and breathlessness

Adolescent↗
PubMed2001

Using decision science to gain insight into ethical issues: an example involving thresholds in workers' compensation.

Systematically analyzing and comparing the ethical dimensions of policy-decision alternatives is remarkably difficult. The ethical implications of a set of decision alternatives, as well as the ranking of that set, are subject to any number of quantitative and qualitative variables, not the least of which is differing individual interpretation. In spite of this, decision science offers a consistent, transparent framework from which to analyze the ethical components and implications of policy decisions. Workers' Compensation insurance programs are state-governed systems of insurance in which workers, in exchange for giving up the right to sue their employer and their coemployees, receive some compensation if they are injured on the job, without regard as to who was at fault. Importantly, Workers' Compensation does not compensate workers for all losses. Thus, injured workers often sue those who provide goods and services to their employer's production system. Different states set different thresholds relating to who can be brought into such a lawsuit and under what conditions a sued means-of-production entity can, in turn, bring the injured party's employer into the suit as a third-party defendant. Forensic engineers are often involved in such lawsuits to evaluate whether or not a given component of a production system is or is not defective. Using Workers' Compensation as an example, this paper explores the methodology and the difficulty of quantifying the ethical implications of policy decisions by examining the concept of thresholding a policy variable. Thresholding will be defined and the ethical effect on the various parties of varying a policy threshold will be discussed.

Decision Making↗
PubMed2001

Fulfilling the bargain: how the science of ergonomics can inform the laws of workers' compensation.

In the last decade, cumulative trauma disorders have become a significant percentage of reported workplace injuries and litigated workers' compensation claims. Arising from the accumulated impact of daily work activities on the body, these injuries do not fall neatly within either the "accident" or "disease" categories which comprise workers' compensation laws. As a result, courts and legislatures have struggled to properly evaluate workers' compensation claims for these injuries. This Note looks at the legal treatment of cumulative trauma injuries in light of the "original bargain" of workers' compensation, where workers give up a tort remedy against their employers in exchange for guaranteed, but limited, compensation for work-related injuries. In doing so, this Note undertakes a comprehensive comparison of litigated cumulative trauma cases in the tort and workers' compensation systems. Ultimately, this Note argues that judges must use the original bargain as an interpretive less when deciding cumulative trauma cases, and points to ergonomics--the science of the workplace--as a significant new tool for determining whether such injuries are work-related.

Cumulative Trauma Disorders↗
PubMed1990

Haiti. Educating factory workers.

There are approximately 50,000 workers employed in the light assembly industry in Haiti. About 70% are women, the majority of whom are aged between 25 and 34 years, and are either single or in a nonpermanent relationship with the father of their children. Many live and work in appalling conditions, surviving on very low wages to support several children and an extended family. The acquired immunodeficiency syndrome (AIDS) is now a visible problem in many factories. In October 1988, the Center for the Promotion of Women Workers (Centre de Promotion des Femmes Ouvriers/CPFO) launched a pilot AIDS education program for factory women. The Center, based in a large industrial zone near the airport, runs a health clinic and courses in literacy, communications skills, health promotion and family planning. The new AIDS program allowed CPFO staff to gain entry into factories for the 1st time. Other courses were held outside working hours and outside factory premises. Staff contacted manages by telephone to arrange a meeting to discuss AIDS and to ask permission to hold educational "round tables" with workers. Of 18 managers in the factories approached over a 12-month period, only 2 refused entry to CPFO staff. Almost all managers reported they had registered between 2 and 5 deaths from AIDS among their employees over the past couple of years. A total of 85 educational sessions, each lasting about 2 hours, were held within 28 different factories, community or labor organizations reaching 3063 workers (male and female). In each session, the presentation was carried out by 2 CPFO trained monitors and included a slide show, flip charts, and the video "Met ko," originally produced for Haitian immigrants in New York. The most important aspect of the program was the training of 38 volunteer factory-based health promoters. These promoters attended the round table sessions, where they facilitated discussion and distributed condoms and were subsequently available for counseling co-workers. Initially, the Center intended to recruit only literate women as promoters, but several nonliterate women were selected for training by labor organizations 18 hours of tuition and discussion of AIDS/human immunodeficiency virus were held over 2 1/2 weeks, including sessions on group dynamics and organizational skills. To improve communications skills, sessions included role play exercises which were videotaped and played back to trainees. Training in communication skills also helps promoters participate in activities aimed at supporting a broader range of workers' rights.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Occupational health problems among migrant and seasonal farm workers.

Migrant and seasonal farm workers are one of the most underserved and understudied populations in the United States. The total US population of such farm workers has been estimated at 5 million, of whom about 20% live or work in California. Farm workers perform strenuous tasks and are exposed to a wide variety of occupational risks and hazards. Low socioeconomic status and poor access to health care also contribute to existing health problems in this population. Potential farm work-related health problems include accidents, pesticide-related illnesses, musculoskeletal and soft-tissue disorders, dermatitis, noninfectious respiratory conditions, reproductive health problems, health problems of children of farm workers, climate-caused illnesses, communicable diseases, bladder and kidney disorders, and eye and ear problems. Few epidemiologic studies exist of these occupational health problems. No comprehensive epidemiologic studies have assessed the magnitude of occupational health problems among migrant and seasonal farm workers and their dependents. Although the migratory nature of this population makes long-term studies difficult, the development of standardized data collection instruments for health consequences and scientific assessment of farm work exposures and working conditions are vital to characterize and reduce the occupational health risks in farm workers.

Accidents, Occupational↗
PubMed2004

An older worker's decision to "push or protect self" following a work-related injury.

UNLABELLED: This study highlights the return-to-work experience of older workers on worker's compensation as there is a dearth of research in this area. METHOD: Qualitative research methods delineated the experience of four older workers who had sustained work-related musculoskeletal injuries. RESULTS: "Push or Protect Self" emerged as the core category with three themes, including the level of employer support and degree of flexibility in work; continued health problems; and financial distress. These themes influenced each worker's decision to either "push self" to meet their pre-injury work demands, or "protect self" and accept a job post-injury that was less physically demanding, but was at a lower pay level. The four workers sustained financial difficulties subsequent to being off work, and reported continued health problems related to their injuries after being discharged from the worker's compensation system. CONCLUSION: Degree of employer support in providing flexibility in work demands varied, where low support and inflexibility in job tasks contributed to difficulty in returning to work or in sustaining the work demands of the job.

Cross-Sectional Studies↗
PubMed1988

Workers' compensation: coverage, benefits, and costs, 1985.

The 84.3 million workers protected by workers' compensation laws in 1985 represented 87 percent of all wage and salary workers in that year. Both the amount of benefits paid to workers and the cost of the program to employers rose substantially from 1984 to 1985. Benefit payments totaled $22.5 billion-14.1 percent higher than in 1984 and the largest annual increase since 1978-79. About two-thirds of the payments in 1985 were money payments ($15.1 billion) and the remainder ($7.4 billion) went for medical care for disabled workers. Private insurance companies made nearly three-fifths of these payments and State funds and self-insured employers each paid about one-fifth of the total benefit amount in 1985. For the first time since 1978, the annual growth in employer costs exceeded the growth in workers' benefits, resulting in a slight decrease in the loss ratio for 1984-85. Employer costs were up nearly 17 percent from the previous year, reaching an estimated $29.3 billion. Covered payrolls increased by 7 percent in that same period. Total benefit payments as a percent of payroll also increased noticeably in 1985.

Costs and Cost Analysis↗
PubMed1994

Workers' compensation law: an overview.

1. The workers' compensation system provides benefits to workers who are injured or made ill in the course of employment or their dependents regardless of fault. 2. The current workers' compensation laws benefit both the employer and the employee; however, workers' compensation is an exclusive remedy which bars recovery through a negligence lawsuit. 3. Workers' compensation regulations interact with other federal statutes such as the Americans With Disabilities Act and the Family Medical Leave Act. 4. Workers' compensation covers occupational injuries and occupational diseases, which may include cumulative trauma and mental stress claims. Nurses may be instrumental in evaluating and planning for an injured employee's return to work and occasionally in detecting fraudulent claims.

Persons with Disabilities↗
PubMedDate not supplied

Working on reform. How workers' compensation medical care is affected by health care reform.

The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?

Health Care Costs↗