Advancing the framework for considering the effects of climate change on worker safety and health.

In 2009, a preliminary framework for how climate change could affect worker safety and health was described. That framework was based on a literature search from 1988-2008 that supported seven categories of climate-related occupational hazards: (1) increased ambient temperature; (2) air pollution; (3) ultraviolet radiation exposure; (4) extreme weather; (5) vector-borne diseases and expanded habitats; (6) industrial transitions and emerging industries; and (7) changes in the built environment. This article reviews the published literature from 2008-2014 in each of the seven categories. Additionally, three new topics related to occupational safety and health are considered: mental health effects, economic burden, and potential worker safety and health impacts associated with the nascent field of climate intervention (geoengineering). Beyond updating the literature, this article also identifies key priorities for action to better characterize and understand how occupational safety and health may be associated with climate change events and ensure that worker health and safety issues are anticipated, recognized, evaluated, and mitigated. These key priorities include research, surveillance, risk assessment, risk management, and policy development. Strong evidence indicates that climate change will continue to present occupational safety and health hazards, and this framework may be a useful tool for preventing adverse effects to workers.

Impact of organizational policies and practices on workplace injuries in a hospital setting.

OBJECTIVE: This study aimed to assess relationships between perceptions of organizational practices and policies (OPP), social support, and injury rates among workers in hospital units. METHODS: A total of 1230 hospital workers provided survey data on OPP, job flexibility, and social support. Demographic data and unit injury rates were collected from the hospitals' administrative databases. RESULTS: Injury rates were lower in units where workers reported higher OPP scores and high social support. These relationships were mainly observed among registered nurses. Registered nurses perceived coworker support and OPP as less satisfactory than patient care associates (PCAs). Nevertheless, because of the low number of PCAs at each unit, results for the PCAs are preliminary and should be further researched in future studies with larger sample sizes. CONCLUSIONS: Employers aiming to reduce injuries in hospitals could focus on good OPP and supportive work environment.

A framework for the concurrent consideration of occupational hazards and obesity.

Occupational hazards and obesity can lead to extensive morbidity and mortality and put great financial burden on society. Historically, occupational hazards and obesity have been addressed as separate unrelated issues, but both are public health problems and there may be public health benefits from considering them together. This paper provides a framework for the concurrent consideration of occupational hazards and obesity. The framework consists of the following elements: (i) investigate the relationship between occupational hazards and obesity, (ii) explore the impact of occupational morbidity and mortality and obesity on workplace absence, disability, productivity and healthcare costs, (iii) assess the utility of the workplace as a venue for obesity prevention programs, (iv) promote a comprehensive approach to worker health and (v) identify and address the ethical, legal and social issues. Utilizing this framework may advance the efforts to address the major societal health problems of occupational hazards and obesity.

Rapid declines in FEV1 and subsequent respiratory symptoms, illnesses, and mortality in coal miners in the United States.

Coal mine dust exposure is associated with accelerated loss of lung function. We assessed long-term health outcomes in two groups of underground coal miners who during previous mine surveys had shown either high rates of FEV1 decline (cases, n = 310) or relatively stable lung function (referents, n = 324). Cases and referents were matched initially for age, height, smoking status, and FEV1. We determined vital status for 561 miners, and obtained a follow-up questionnaire for 121 cases and 143 referents. Responses on the follow-up questionnaire were compared with those on the last previous mine health survey questionnaire. Cases showed a greater incidence of symptoms than did referents for cough, phlegm production, Grades II and III dyspnea, and wheezing, and greater incidences than referents of chronic bronchitis and self- reported asthma and emphysema. More cases than referents (15% versus 4%) left mining before retirement because of chest illnesses. After controls were applied for age and smoking, cases had twice the risk of dying of cardiovascular and nonmalignant respiratory diseases and a 3.2-fold greater risk of dying of chronic obstructive pulmonary disease than did referents. Rapid declines in FEV1 experienced by some coal miners are associated with subsequent increases in respiratory symptoms, illnesses, and mortality from cardiovascular and nonmalignant respiratory diseases.

Clinically important FEV1 declines among coal miners: an exploration of previously unrecognised determinants.

OBJECTIVES: The relation between occupational exposure to dust and loss of ventilatory lung function is now well established. However, many exposures during work and other activities might also have important roles in determining clinically important losses of lung function. In this study, we attempted to explore additional plausible determinants of exposures and other potential risk factors for clinically important decline in forced expiratory volume in 1 second (FEV1) during work in dusty trades. METHODS: The study was performed in 264 underground coal miners whose lung function had been followed up for an average of 11 years. With an extensive follow up questionnaire, miners were asked about their occupational and non-occupational exposures, smoking, personal and family medical history, and living conditions during childhood. RESULTS: Several variables of the mine environment (as well as previously recognised effects of mining work and region) were found to be associated with excess decline in FEV1, including work in roof bolting, exposure to explosive blasting, and to control dust spraying water that had been stored in holding tanks. Use of respiratory protection seemed to reduce the risk of decline in FEV1. Other factors that were found to be associated with declines in pulmonary function included smoking, body mass, weight gain, childhood pneumonia, and childhood exposure in the home to passive tobacco smoke and possibly smoke due to wood and coal fuels. Miners with excessive decline in FEV1 were less likely to be working in mining jobs at follow up. CONCLUSIONS: These findings suggest the existence of additional risk factors for decline in lung function in dusty trades, and may be useful in developing additional approaches to the prevention of chronic respiratory disease.

The National Occupational Research Agenda: a model of broad stakeholder input into priority setting.

OBJECTIVES: No single organization has the resources necessary to conduct occupational safety and health research to adequately serve the needs of workers in the United States. The National Institute for Occupational Safety and Health (NIOSH) undertook the task of setting research priorities in response to a broadly perceived need to systematically address those topics most pressing and most likely to yield gains to workers and to the nation. METHODS: NIOSH and its public and private partners used a consensus-building process to set priorities for the next decade for occupational safety and health research--the National Occupational Research Agenda. RESULTS: The process resulted in the identification of 21 research priorities grouped into 3 categories: disease and injury, work environment and workforce, and research tools and approaches. CONCLUSIONS: Although the field of occupational safety and health is often contentious and adversarial, these research priorities reflect a remarkable degree of concurrence among a broad range of stakeholders who provided input into a clearly defined and open process.

Asbestosis and silicosis.

Interstitial fibrosis resulting from workplace exposure to asbestos and crystalline silica persists throughout the world despite knowledge of the causes and effective means for prevention. Asbestosis and silicosis occurrence is predictable among people overexposed to dusts in various industries and occupations such as mining, construction, manufacturing, and building maintenance. Asbestosis and silicosis are incurable and may be progressive even after dust exposure has ceased, therefore early recognition and supportive interventions are important. Although current disease is a result of past exposures, effective control of current workplace exposures is the only way to prevent continued occurrence of these potentially debilitating diseases. Physicians can contribute to this effort through accurate diagnosis and disease reporting.

Chronic occupational respiratory disease.

The authors discuss various methodologic issues pertinent to the epidemiologic study of chronic occupational lung disease. Examples to illustrate problems inherent in chronic occupational lung disease epidemiology and approaches to surmounting them are presented from the extensive literature on coal miners' lung diseases.

Comparison of spirometric reference values for Caucasian and African American blue-collar workers.

Interpretation of lung-function test results, specifically the forced vital capacity and forced expiratory volume in one second, generally involves the comparison of these parameters with reference values based on an individual's age, height, sex, and race. Such comparisons are often used to make important decisions concerning an individual, such as job placement or disability rating. Several studies have shown that predicted values for African Americans are approximately 15% less than those for Caucasians, most likely because of the use of standing height to estimate the size of the thorax. When an adjustment for race is applied to reference values based on a Caucasian population, a single value (15%) is usually applied to all individuals. When using a group of blue-collar workers (766 Caucasian and 633 African-American subjects) without any race adjustment, 10.2% of the Caucasians and 37.4% of the African-American subjects were below the lower limit of normal. When a single adjustment factor was used, 11.5% of the African-American subjects were below the lower limit of normal. Between-subject variability within an ethnic group was far greater than variability between groups. Our results suggest that although a difference between Caucasian and African-American test results for forced vital capacity and forced expiratory volume in one second exists, an application of a single adjustment factor universally applied to all individuals, regardless of their age, sex, and height, is not optimal, and alternative approaches are needed.

Airway responsiveness and job selection: a study in coal miners and non-mining controls.

BACKGROUND: It has been suggested that health related job selection is a major cause of the healthy worker effect, and may result in inaccurate estimates of health risks of exposures in the working environment. Improved understanding of self selection, including the role of airway hyperresponsiveness, should improve accuracy in estimating occupational risks. METHODS: We evaluated symptoms of the respiratory tract, lung function, occupational and smoking histories, and airway responsiveness from a cross sectional survey of 478 underground bituminous coal miners and non-mining controls. Workers with abnormal spirometry were excluded from methacholine testing. RESULTS: Methacholine responsiveness (> or = 15% decline in forced expiratory volume in one second) was associated in both miners and controls with reduced ventilatory lung function and an increased risk of respiratory symptoms. Miners with the longest duration of work at the coal face had a low prevalence of methacholine responsiveness, compared with miners who had never worked at the coal face (12% v 39%, P < 0.01). Throughout their mining careers, miners who responded to methacholine were consistently less likely to have worked in dusty jobs than miners who did not respond to methacholine. CONCLUSIONS: These results provide evidence that workers who are employed in dusty jobs are less likely than their unexposed coworkers to show increased non-specific airway responsiveness, presumably as a result of health related job selection. Surveys of workers in which responsiveness data are unavailable may underestimate the effects of dust exposure on respiratory health.

Respiratory disease risks in the construction industry.

This chapter focuses on the primary identified respiratory hazards in construction, including respiratory tract cancers, pulmonary and pleural fibrosis, airway diseases, inhalation injuries, and respiratory infection. An extensive table identifies the exposure limits specified by NIOSH, OSHA, and ACGIH for more than 30 substances.

Respiratory and irritant health effects of ambient volatile organic compounds. The Kanawha County Health Study.

Kanawha County, West Virginia, is one of the largest chemical manufacturing centers in the United States. In 1988, a survey of respiratory and irritant symptoms was administered to all third grade to fifth grade children attending 74 elementary schools in Kanawha County, and concentrations of 15 volatile organic compounds were measured at each school. Exposures were characterized by school location, by the sum of the concentrations of five petroleum-related compounds, and by the sum of the concentrations of 10 compounds more specific to industrial processes. Children enrolled in schools within the valley had higher rates of doctor-diagnosed asthma (odds ratio (OR) = 1.27, 95% confidence interval (CI) 1.09-1.48) and a higher score on a composite indicator of five chronic lower respiratory symptoms (OR = 1.13, 95% CI 1.02-1.26) than children who were enrolled in schools outside of the valley. The incidence of chronic respiratory symptoms was also positively associated with the concentrations of volatile organic compounds. The estimated change in the odds ratio for chronic lower respiratory symptoms associated with a 2-micrograms/m3 change in process-related compounds was 1.08 (95% CI 1.02-1.14). No consistent pattern was found between acute irritant symptoms in the 2 weeks preceding questionnaire administration and either proximity to industry or exposure to volatile organic compounds. The authors conclude that exposure to volatile organic compounds, including emissions from chemical manufacturing plants, is associated with increased rates of chronic respiratory symptoms characteristic of reactive airways.

Medical screening using periodic spirometry for detection of chronic lung disease.

Approximately half of a worker population may benefit from the addition of a longitudinal comparison of their spirometry results, over only using annual comparisons with a cross-sectional LLN. The ATS recommendation of 15% for year-to-year changes appears to be essentially equivalent to a longitudinal LLN method based on the SEE. Therefore, a practical method for longitudinal interpretations is to establish a baseline value for a worker's FEV1 through several initial spirometric examinations. The FEV1 longitudinal LLN is calculated by taking 85% of this baseline value minus the expected decline over the time period based on the individual's age (e.g., for individuals older than 35 years at their initial examination, one approach is to use 30 mL/year times the number of years of follow-up). However, before any final classification is rendered, the data should be reviewed for stability. This analysis demonstrates that longitudinal spirometry adds sensitivity to spirometry screening efforts. The spirometry examinations should probably be performed annually in order to detect survey biases and determine the stability of the FEV1 measurements. If spirometry results indicate that someone has crossed either the longitudinal or the cross-sectional LLN, intervention activities should be initiated for that individual. As new data and studies become available, these suggested procedures will need to be revised-particularly estimates for the expected annual decline in FEV1.

Chest radiography in dust-exposed miners: promise and problems, potential and imperfections.

Since the early 1900s, it was recognized that many dust-exposed workers developed abnormal radiographs during life. Chest radiography remains the primary means of determining the presence and extent of dust-induced pneumoconiosis, although it is ineffective for detecting airways obstructions from mine dust exposure. This chapter reviews the uses and limitations of chest radiography in the study, surveillance, screening, clinical diagnosis, and disability determinations of occupational lung diseases in dust-exposed workers.

A report on a workshop on the National Institute for Occupational Safety and Health B reader certification program.

In September 1990, a 2-day workshop was held in Chicago to discuss the current status of the NIOSH B reader certification program and to suggest modifications and improvements. This is a summary report of the proceedings of that conference.

The NIOSH B reader certification program. An update report.

Physicians trained in the use of the International Labour Office system for classification of radiographs of pneumoconioses who pass a competence test administered by the National Institute for Occupational Safety and Health are designated as B readers. The current certification and recertification examinations for qualification under the NIOSH B reader program are described. Details of the rationale and format of each examination are given, and information on candidates' scores provided for the years 1987-1990.