Arthur L. Frank

Injuries related to shiftwork

OBJECTIVE The purpose of this study was to review the relationship of shiftwork to industrial injuries, and possible methods of injury control. METHOD The primary method was a systematic review of the published literature. The Cochrane Collaboration protocol was used to conduct the literature search. SELECTION CRITERIA Studies were included if they addressed the issue of industrial injuries related to shiftwork. RESULTS No controlled interventions were found. All studies were observational, and most were retrospective. The studies were not comparable with one another since they refer to different industrial settings. CONCLUSIONS Findings from the literature indicate that shiftwork should be avoided, but that if necessary, certain patterns and rest breaks appear to be associated with fewer injuries. More and better-focused research is needed in this field of study.

The Global Spread of Asbestos

BACKGROUND Asbestos continues to be used in large quantities around the world and to be an important commodity in global trade. OBJECTIVE To assess and quantify current global patterns of asbestos production, export and use; to examine global patterns of asbestos-related disease; and to examine barriers to an asbestos ban. METHOD Review of the biomedical literature describing patterns of asbestos exposure and disease; review of documents from national governments, UN agencies, and NGOs on asbestos production and use. FINDINGS Despite widespread knowledge of the hazards of asbestos and bans on any use of asbestos in more than 50 countries, an estimated 2 million tons of asbestos continue to be used around the world each year. Although this amount is significantly less than peak annual consumption of nearly 5 million tons two decades ago, significant amounts of asbestos are still used in India, China, Russia, and some developing countries. This use of asbestos is responsible for disease today and will cause still more asbestos-related disease in the years ahead. Real and artificially manufactured controversies regarding asbestos such as arguments about the relative hazards of different asbestos fiber types and fiber sizes have impeded bans on asbestos. CONCLUSIONS All forms of asbestos pose grave dangers to human health. All are proven human carcinogens. There is no continued justification for the use of asbestos. Its production and use should be banned worldwide.

American College of Occupational and Environmental Medicine (ACOEM): A Professional Association in Service to Industry

Abstract The American College of Occupational and Environmental Medicine (ACOEM) is a professional association that represents the interests of its companyemployed physician members. Fifty years ago the ACOEM began to assert itself in the legislative arena as an advocate of limited regulation and enforcement of occupational health and safety standards and laws, and environmental protection. Today the ACOEM provides a legitimizing professional association for company doctors, and continues to provide a vehicle to advance the agendas of their corporate sponsors. Company doctors in ACOEM recently blocked attempts to have the organization take a stand on global warming. Company doctors employed by the petrochemical industry even blocked the ACOEM from taking a position on particulate air pollution. Industry money and influence pervade every aspect of occupational and environmental medicine. The controlling influence of industry over the ACOEM physicians should cease. The conflict of interests inherent in the practice of occupational and environmental medicine is not resolved by the ineffectual efforts of the ACOEM to establish a pretentious code of conduct. The conflicted interests within the ACOEM have become too deeply embedded to be resolved by merely a self-governing code of conduct. The specialty practice of occupational and environmental medicine has the opportunity and obligation to join the public health movement. If it does, the ACOEM will have no further purpose as it exists, and specialists in occupational and environmental medicine will meet with and be represented by public health associations. This paper chronicles the history of occupational medicine and industry physicians as influenced and even controlled by corporate leaders.

APPROACH TO THE PATIENT WITH AN OCCUPATIONAL OR ENVIRONMENTAL ILLNESS

This article reviews the importance of the occupational and environmental history, and the approach to a patient with a disease suspected to be of occupational or environmental origin. There is a detailed review of obtaining special aspects of the medical history related to work and environmental exposures as well as illustrative case studies. Sources of additional information are also cited.

Health Care Access and Health Care Workforce for Immigrant Workers in the Agriculture, Forestry, and Fisheries Sector in the Southeastern US

BACKGROUND The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in the US is comprised primarily of Latino immigrants. Health care access for these workers is limited and increases health disparities. METHODS This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers. CONTENTS Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers. C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US.

Environmental and Agricultural Literacy Education

Educational offerings that utilize environmental and agricultural themes can reinforce basic education for students in kindergarten through twelfth grade (K-12) while also teaching about the environment and agricultural methods and products. A curriculum guide about the environment and food and fiber production was created for K-12 teachers. These materials were evaluated for their effectiveness in increasing student knowledge using elementary classes in several states. It was noted through pre/post tests that younger students, in general, made greater gains. Within five thematic areas, the greatest overall improvement was shown in themes related to the environment. Environmental topics covered, all in the context of agricultural themes, included the need to preserve shared natural resources including land, water, and air as well as the managing of the ecosystem and the use of non-renewable energy resources. Clearly such classroom guides have utility in teaching young students about environmental issues and their relationship to other important topics. This guide and its corresponding Website enhance both opportunities to transmit new knowledge as well as assess performance and impact on behavior.

Health Effects Associated With Organic Dust Exposure During the Handling of Municipal Solid Waste

Municipal solid waste is a collection of discarded liquid and solid materials that serves as a breeding ground for bacteria and fungi. Individuals involved in the collection, transport, transfer and management of this waste may be exposed to elevated concentrations of biological aerosols. Based on the nature of the work environment and the knowledge of bioaerosol related health effects in other occupations, the handling of municipal solid waste can be expected to result in adverse health outcomes. Only limited research has been performed to date evaluating the relationship between organic dust exposure and adverse health effects in these workers. The majority of this work has been conducted in Europe, with little performed in the United States. Although not extensive, the existing body of research suggests that there is an association between the performance of job tasks involving the handling of municipal solid waste and various respiratory, dermatologic and gastrointestinal health effects. While increased incidences of specific adverse health outcomes have been documented in this group of workers, the limited nature of exposure assessment in this body of research does not allow for strong evidence based conclusions to be drawn regarding exposure levels and associated health effects. Based on this review it is concluded that the detailed characterisation of organic dust exposure experienced by municipal solid waste workers is necessary in order to both improve understanding of resultant health effects and develop strategies to improve occupational health.

Occupational lung diseases: from old and novel exposures to effective preventive strategies

Occupational exposure is an important, global cause of respiratory disease. Unlike many other non-communicable lung diseases, the proximal causes of many occupational lung diseases are well understood and they should be amenable to control with use of established and effective approaches. Therefore, the risks arising from exposure to silica and asbestos are well known, as are the means of their prevention. Although the incidence of occupational lung disease has decreased in many countries, in parts of the world undergoing rapid economic transition and population growth-often with large informal and unregulated workforces-occupational exposures continue to impose a heavy burden of disease. The incidence of interstitial and malignant lung diseases remains unacceptably high because control measures are not implemented or exposures arise in novel ways. With the advent of innovative technologies, new threats are continually introduced to the workplace (eg, indium compounds and vicinal diketones). In developed countries, work-related asthma is the commonest occupational lung disease of short latency. Although generic control measures to reduce the risk of developing or exacerbating asthma are well recognised, there is still uncertainty, for example, with regards to the management of workers who develop asthma but remain in the same job. In this Review, we provide recommendations for research, surveillance, and other action for reducing the burden of occupational lung diseases.

Kaolinosis in a cotton mill worker

A 62-year-old white male employed for 43 years in the polishing room of a cotton textile mill was admitted to a tertiary care center with progressive dyspnea and productive cough that had not responded to therapy for tuberculosis. In spite of aggressive antibiotic therapy and respiratory support, the patient died as a consequence of respiratory failure. Small rounded and irregular opacities had been noted on the chest radiograph. Review of job-site spirometry demonstrated a worsening restrictive pattern over a 4-year period prior to his death. Additional occupational history revealed long-term exposure to kaolin in the polishing room, and pathologic examination of lung tissue confirmed extensive fibrosis and substantial quantities of kaolin. Kaolinosis is a disease typically found among individuals involved in mining or processing this material rather than in user industries. This case illustrates the importance of obtaining a complete occupational history in reaching a diagnosis. The clinicopathologic aspects of kaolinosis are also reviewed.

Collegium Ramazzini: Comments on the 2014 Helsinki consensus report on asbestos.

The Collegium Ramazzini is an international scientific society that examines critical issues in occupational and environmental medicine with a view towards action to prevent disease and promote health. The Collegium derives its name from Bernardino Ramazzini, the father of occupational medicine, a professor of medicine of the Universities of Modena and Padua in the late 1600s and the early 1700s. The Collegium is comprised of 180 physicians and scientists from 35 countries, each of whom is elected to membership. The Collegium is independent of commercial interests. TheCollegiumRamazzini recognizes thework of the 2014 expert committee convened by the Finnish Institute of Occupational Health (FIOH) to update the 1997 and 2000 Helsinki criteria onAsbestos, Asbestosis, andCancer in light of newadvances in research.Thepublishedconsensus report of the Helsinki Committee [Wolff et al., 2015] and its more extensive on-line version (Helsinki Criteria Update 2014 Asbestos, Asbestosis, and Cancer) provide a valuable synthesis of many aspects of current knowledge of the hazards of asbestos. The Collegium Ramazzini is, however, very concerned about the sections of the 2014 Helsinki consensus report that discuss criteria for pathological diagnosis of the diseases caused by asbestos. The sections of the Helsinki report dealing with pathology diagnosis are based on a selective reading of the medical literature. They rely overly much on certain published articles [Srebro et al., 1995; Butnor et al., 2003; Roggli et al., 2010] while omitting reference to other important and highly relevant information. They are heavily influenced by the outdated and incorrect concept that analysis of lung tissue for asbestos fibers and asbestos bodies can provide data to contradict exposures that are documented in a reliable occupational history. Further, without any explanation the most accepted College of American Pathologists (CAP)-NIOSH 1982 asbestos definition which underwent extensive review and endorsement by NIOSH is now replaced in the 2014 Helsinki criteria by the more restrictive CAP/Pulmonary Pathology Society (PPS) modification which differs especially in the early histological stages of asbestosis and in the higher numbers of asbestos bodies needed to make the pathological diagnosis of asbestosis [Hammar and Abraham, 2015]. Applying the 2014 Helsinki report recommendations on pathology diagnosis will lead to: