Health insurance and workers' compensation: the delivery of medical and rehabilitation services for construction workers.

The construction industry has one of the highest proportions of workers without health insurance. The authors review the two types of insurance systems that are generally used to cover the cost of health care for construction workers in the U.S.: health and welfare funds and workers' compensation. Recent developments in health care delivery in the U.S. are discussed, as are the more comprehensive occupational medicine services offered in France, Germany, The Netherlands, and Sweden.

Injury coding and hospital discharge data.

Data are currently inadequate to develop, implement, and evaluate injury prevention and control programs in the United States. Information about cause of injury, which is available for fatal injuries, is rarely available for severe nonfatal injuries. Although hospital discharge data systems contain much of the important information needed for injury prevention and control programs, they rarely are coded with information about the external cause of injury (E codes). E-coded hospital discharge data systems are potentially one of the most effective and feasible means available to collect data needed to prevent and control injuries. We recommend that E codes be required elements in hospital discharge data systems, that separate fields for E codes be created, and that E-code definitions and guidelines be developed.

Medical appraisal during health hazard evaluations involving workers exposed to lead.

To evaluate the medical aspects of the Health Hazard Evaluation (HHE) program of the National Institute for Occupational Safety and Health (NIOSH), 170 lead-related HHE reports published through 1984 were examined. The percentages of HHEs conducting basic medical examination procedures justified by elevated environmental exposure to lead at worksites were as follows: blood or urine lead level testing, 57%; medical history taking, 55%; physical examinations, 23%; CBCs, 18%; and urinalysis, 7%. The HHE program has primarily focused on whether or not environmental worksite hazards are present at the time of the evaluation and not on ascertaining whether there is evidence of adverse health effects attributable to past worksite exposures. The program has not focused on minimizing adverse health effects when they exist or on providing a series of building blocks for health effects research. More clearly defined HHE program goals and a logic for deciding when and how medical examinations should be performed during HHEs need to be developed.

Clinical healing two to six years after poststreptococcal glomerulonephritis in Trinidad.

To determine the incidence of chronic nephritis after poststreptococcal acute glomerulonephritis in Trinidad, 760 patients (41 adult) were examined two to six years after recovery from the illness, 344 being studied twice (four and six years). Only 1.8 per cent had persistent urine abnormalities on their last follow-up examination, and another 8.0 per cent had abnormalities that were transient or occurred only after the patient had assumed the lordotic position. In 1.4 per cent hypertension was present, whereas only one had azotemia. Both persistent urine abnormalities and hypertension increased in prevalence with age at onset of prior poststreptococcal glomerulonephritis but did not vary between sexes, races or epidemic versus endemic forms. Half the urine abnormalities present four years after recovery were absent two years later. Thus, poststreptococcal acute glomerulonephritis appears to have a low incidence of chronicity in Trinidad, with continuing resolution for more than four years.

Estimated changes in human exposure to suspended sulfate attributable to equipping light-duty motor vehicles with oxidation catalysts.

The potential environmental impact of equipping vehicles with oxidation catalysts is estimated. Three independent techniques are used to appraise community exposures. Incremental increases in suspended sulfates and sulfuric acid aerosols are evaluated in terms of the number of vehicles equipped with oxidation catalysts.