Kelly B. Kyes

Psychological effects of hazardous materials exposures.

Objective To study psychological outcomes after hazardous materials incidents. Methods Individuals exposed to hazardous materials were contacted to complete a telephone questionnaire within 8 to 40 days of the incident. The Brief Symptoms Inventory was used for psychological assessment. General severity index, depression, anxiety, hostility, and somatization were analyzed. Positive findings were defined as two standard deviations above a normative mean. Results A total of 202 (60%) of the 339 subjects in 87 incidents were surveyed. For 159 adults with valid Brief Symptoms Inventory scores, all dimensions were within normal ranges of elevation, with 1% to 5% of the subject pool having elevation, except for somatization. Twenty-four (14%) of 160 subjects had elevated somatization scores. Based on logistic regression analysis, prior medical therapy for a psychological condition and transport to a health care facility were predictors of elevated somatization scores. Conclusions Somatization was the most frequently elevated score after exposure to hazardous materials incidents. Further research is needed to determine whether specific risk factors are useful in identifying individuals for intervention after hazardous materials incidents.

Use of a questionnaire to improve occupational and environmental history taking in primary care physicians

New patient charts were reviewed before and after the introduction of a self-administered questionnaire, designed to elicit occupational and environmental (OE) information from patients. The Occupational Health Risk Assessment questionnaire (OHRA) was expected to prompt primary care physicians to make further inquiries into OE health issues. Chart reviews determined the amount and type of information detailed in the primary care physicians’ notes. Twenty-three percent of completed OHRAs indicated a job-related health problem. Despite a high prevalence of self-reported work-related symptoms and exposures, the mean number of notations regarding OE exposures was less than one item per patient chart. A comparison of mean OE notations per chart before versus after introduction of the OHRA indicated a decline in notations after introduction of the OHRA (1.03 vs 0.72, P = 0.02). We detail the type of OE issues that patients presented to a primary care practice and the resulting information contained in primary care providers’ notes. Suggestions are made to improve a self-administered patient questionnaire to better diagnose, prioritize, and formulate treatment plans related to OE issues.

Reliability and validity of medical outcome and patient satisfaction measures among injured workers in Washington state: A pretest

Several existing measures of medical outcomes and some newly constructed measures of patient satisfaction were tested for reliability and validity on a sample of 100 subjects who had suffered work-related injuries and illnesses in Washington State. Included in the measures of medical outcome were the SF-36 and the upper body mobility subscale of the Health Assessment Questionnaire. The newly constructed measures of patient satisfaction assessed areas such as satisfaction with the attending physician and with access to referrals. Also administered were assessments of job satisfaction, both prior to and since the injury, and a measure of chance health locus of control. The patient satisfaction and medical outcomes measures demonstrated good reliability and validity for use with this population. However, neither the measures of job satisfaction nor chance health locus of control were related to either patient satisfaction with medical care nor to medical outcomes.

Risk factors for adverse health effects following hazardous materials incidents

Toidentify risk factors for persistent morbidity, we conducted a prospectivestudy of individuals involved in hazardous materials incidents reported to theWashington Poison Center. Between December 1997 and October 1999, 202 subjectsin 87 incidents were surveyed by telephone. Medical symptoms persisting for aminimum of 8 days after the incident were reported in 51 (25%) subjects, and18 (9%) left work or school for more than 2 days because of the exposure.Medical intervention was reported in 46 (58%) of 79 subjects for whom medicalrecords were available, and objective abnormalities were found in 57 (72%).Multiple logistic regression analysis indicated that subjects with dermalexposures, three or more alcoholic drinks per week, and previous use ofpsychiatric medications were more likely to report persistent symptoms.Divorced, widowed, or separated subjects, asthmatic subjects, and those havinginitial dermal symptoms were more likely to miss work or school for more than2 days. Of patients evaluated at a health care facility, subjects withpreexisting hypertension were more likely to receive medical treatment or haveobjective medical findings, whereas those with inhalation exposures and thosedecontaminated at the scene were less likely to be treated or haveabnormalities. In our study, both incident and individual factors werepredictive of adverse health effects, and these findings should be consideredin planning the care of patients involved in hazardous materialsincidents.

Hazardous materials events: an industrial comparison.

Identifying industries at high risk for hazardous materials releases can facilitate prevention and preparation for such events. A retrospective review by Standard Industrial Classification (SIC) codes was conducted on non-petroleum hazardous materials emergency events from 1993 to 1995 and collected by the Washington State Department of Health in a program supported by the Agency for Toxic Substances and Disease Registry. Annual US Census data were used to determine the number of facilities and employees by SIC code in the state of Washington. SIC codes with the most total events and events per 10,000 employees were ranked and characterized by type of releases. In 3 years, 1269 events were recorded, with 294 involving human victims. Industries with the highest average annual number of events per 10,000 employees were agricultural chemical manufacturing (142); petroleum refining (122); industrial and miscellaneous chemical manufacturing (56); electric light and power (54); and pulp, paper, and paperboard mills (39). Industries with high rates of hazardous materials emergency events should continue to develop methods of preventing these releases.