Proportion of dermatitis attributed to work exposures in the working population, United States, 2011 behavioral risk factor surveillance system.

BACKGROUND: The US employer-based surveillance system for work-related health conditions underestimates the prevalence of work-related dermatitis. OBJECTIVE: The authors sought to utilize information from workers to improve the accuracy of prevalence estimates for work-related dermatitis. METHODS: Three state health departments included questions in the 2011 Behavioral Risk Factor Surveillance System survey designed to ascertain the prevalence of dermatitis in the working population, as well as healthcare experiences, personal perceptions of work-relatedness, and job changes associated with dermatitis. RESULTS: The percentage of working respondents who reported receiving a clinician's opinion that their dermatitis was work-related was between 3.8% and 10.2%. When patients' perceptions were considered, the work-related dermatitis prevalence estimate increased to between 12.9% and 17.6%. CONCLUSIONS: Including patients' perceptions of work-relatedness produced a larger prevalence estimate for work-related dermatitis than the previously published estimate of 5.6%, which included only those cases of dermatitis attributed to work by healthcare professionals.

Are employment shifts into non-manufacturing industries partially responsible for the decline in occupational injury rates?

BACKGROUND: Bureau of Labor Statistics figures have shown declines in injury and illness rates over the past 25 years. It is unclear what factors are contributing to that decline. METHODS: Connecticut injury and illness data was industry-adjusted to account for the shifts in employment by industry sector for the 25-year period from 1976 to 2000. Additional adjustment was made for manufacturing sub-sectors, since declines in manufacturing employment accounted for the largest proportion of the shift in injuries over that period. RESULTS: Approximately 18% of the decline in injury and illness rates was associated with a shift in employment from more hazardous to less hazardous industries. Shifts in manufacturing sub-sectors accounted for an additional 5.7% of the decline. CONCLUSION: A significant proportion of the decline in injury and illness rates appears to be due to demographic shifts in industry composition.

The mortality burden of chronic liver disease may be substantially underestimated in the United States.

PURPOSE: The United States National Center for Health Statistics (NCHS) uses death certificate data to estimate the burden of serious disease. This study aimed to determine the accuracy of the NCHS method for estimating the burden of chronic liver disease (CLD). METHOD: The authors identified death certificates of New Haven County residents who died from October 1999-September 2000 that were assigned one of 115 ICD-10 codes that might indicate CLD. They reviewed medical charts, medical examiner records and a certifier questionnaire to determine whether CLD was the cause of death. RESULT: Using the authors' determination of CLD status as the gold standard, the specificity of the NCHS classification was high (86%), but the sensitivity was low (36%). The authors found that adding selected ICD-10 codes to those considered by the NCHS to be CLD (certain CLD malignancies and viral hepatitis) could improve sensitivity. Ensuring that deaths attributed by certifiers to "End Stage Liver Disease" were coded as CLD could also improve completeness. These modifications could increase sensitivity substantially with little effect on specificity. CONCLUSION: The NCHS method may understate the CLD burden substantially which could have a detrimental effect on planning for and evaluating prevention and treatment. Modifications could improve completeness.

Quantifying the burden of chronic viral hepatitis-related cirrhosis hospitalizations in New Haven County, Connecticut.

Chronic viral hepatitis can cause cirrhosis. Viral hepatitis-related cirrhosis may be causing an increasing health burden since exposure to hepatitis B virus and hepatitis C virus in the United States increased starting in the 1960s. Using hospital discharge data, we estimated the number of adult New Haven County residents hospitalized for cirrhosis and examined the proportion caused by chronic viral hepatitis. Data on etiology were obtained from hospital discharge records, death certificate information, and New Haven County Liver Study records. From 1 October 1999 to 30 September 2000, 269 adult New Haven County residents were hospitalized for cirrhosis in a New Haven County hospital, for an incidence of 43.2 per 100,000 population. The burden of viral hepatitis-related cirrhosis was 15.9 per 100,000. Hepatitis C virus was the most common viral etiology. Given the long period between initial infection and clinical decompensation, screening and treatment programs aimed at reducing viral hepatitis-related morbidity should reduce hospitalization rates.

Occupational disease in Connecticut: 2002.

Data on chronic work-related conditions were compiled for Connecticut for 2002 from physician reports to the Occupational Disease Surveillance System (ODSS), the Workers' Compensation (WC) Commission, and the Bureau of Labor Statistics (BLS)/ ConnOSHA survey. Physicians reported 2,082 cases of occupational disease in Connecticut in 2002, approximately half of the estimate of 4,388 cases using the BLS/ ConnOSHA methodology. Cases in the ODSS included 921 (44%) reports of musculoskeletal disorders (MSD), 476 adult lead poisonings (based on lab reporting), 338 skin disorders, and 283 respiratory and lung conditions. There were increased reports in both the ODSS and WC systems over 2001 figures. Emerging conditions included vibration-related MSD, a mold-related respiratory outbreak, and Lyme Disease/tick bites among outdoor workers. Only 86 physicians from 29 clinics reported cases indicating widespread under-reporting of occupational disorders among community physicians despite Connecticut statutes mandating reporting of work-related disease.

Identification of patients with hepatitis C virus infection in New Haven County primary care practices.

BACKGROUND: Primary care providers (PCPs) must identify persons at risk for hepatitis C virus (HCV) infection, test them correctly, refer to subspecialists, and use published guidelines. The objectives of this study were to describe HCV practices of New Haven County PCPs. STUDY: All 652 PCPs in New Haven County, Connecticut, were surveyed to determine practices related to hepatitis C, including risk factor ascertainment, testing routines, use of published guidelines, and referral practices. RESULTS: Of 181 eligible respondents, 143 (79%) were internal medicine physicians and 38 (21%) were family practitioners. Eighty-four PCPs (46%) routinely asked about a history of blood transfusion, and 112 (62%) routinely asked about a history of injection drug use (IDU). Most PCPs would test current or past IDU (91% versus 83%, respectively), persons transfused prior to 1992 (79%), health care workers with a history of a needle stick accident (88%), and a child born to an HCV-infected mother (76%). PCPs frequently referred patients with hepatitis C to gastroenterologists. Most PCPs (76%) were familiar with available hepatitis C testing guidelines. CONCLUSIONS: Most PCPs test for HCV infection appropriately, but many do not elicit risk factor histories that could identify such persons. More effective training with emphasis on eliciting a history of pertinent risk factors is needed.