NIOSH Proposes New Digital Classification for Pneumoconiosis

Monitoring the health of individuals involved in dusty work is intended to provide assurance to the worker that ongoing exposure controls are adequate. Recognition of minor health abnormalities serves as an early warning to both workers and managers when there is need for more effective measures to prevent work-related impairment and disability. Since 1970, NIOSH and other organizations have successfully applied traditional film screen chest radiography, interpreted using the ILO International Classification of Radiographs of Pneumoconiosis, toward these objectives. 

Imaging of interstitial lung diseases such as the pneumoconiosis represents one of the most difficult challenges in diagnostic radiology, and comprehensive attention to technological, methodological, and human factors is required to assure that the image quality and interpretation are satisfactory for achieving early disease detection. 

This NIOSH Guideline is based upon accepted contemporary professional recommendations, and provides technical and operational guidance for radiographic facilities and physician readers who obtain digital chest radiographs for the evaluation of pneumoconiosis. The intent is to assure that the recognition of pneumoconiosis using digitally-acquired chest radiographs is at least as safe and effective as traditional film screen radiography. The Guideline should not be considered a mandate for medical practice; however participating practitioners and facilities who deviate from the specifications should have a sound medical rationale for alternative approaches.

The ILO system has been used extensively in the diagnosis of asbestos related disease.

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Workers Compensation and Nanotechnology - The New Frontier

NIOSH research has revealed that breathing nanoparticles may result in damaging health effects.

"Nanotechnology has the potential to revolutionize countless products, create computers smaller and faster than once could be imagined, and fight diseases such as cancer. According to the Project on Emerging Nanotechnology, by the summer of 2009 there were 1,015 consumer products using nanotechnology. That represents nearly a 19-fold increase over the 54 products listed in 2005. Nanotechnology involves the manipulation of matter at a near-atomic scale. Nanoparticles measure from 1 to 100 nanometers in size, with 1 billion nanometers forming a meter. For comparison, a billion inches would nearly circle the Earth 2 times."

• A 2004 survey estimatedthat nearly 25,000 U.S. workers were employed at businesses that exclusively produced nanotechnology products.
• Nanoparticles can enter the body through many routes including inhalation, swallowing, ingestion, and absorption through the skin.
• Nanotechnology may present health risks but it can also be used to protect workers. New respirator designs, for instance, use nanotechnology to create more effective filters to block harmful substances.

Authors of Inhalation Versus Aspiration of Single-Walled Carbon Nanotubes in C57BL/6 Mice: Inflammation, Fibrosis, Oxidative Stress, and Mutagenesis—Anna Shvedova, Elena Kisin, Ashley Murray, Victor Johnson, Olga Gorelik, Sivaram Arepalli, Ann Hubbs, Robert Mercer, Phouthone Keohavong, Nancy Sussman, J. Jin, J. Yin, Samuel Stone, The-hsun Chen, Gregory Deye, Andrew Maynard, Vince Castranova, Paul Baron, and Valerian Kagan; Health Effects Laboratory Division; NIOSH—received the 2009 Alice Hamilton Award in the Biological Sciences category.

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For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

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Opportunities, Challenges in Use of Workers’ Comp Data Are Examined in NIOSH Workshop Proceedings Report

Opportunities for maximizing the use of workers’ compensation data for occupational safety and health surveillance and research - and challenges that researchers face in exploring those opportunities - are examined in a report of proceedings now available both electronically and in paper copy from the National Institute for Occupational Safety and Health (NIOSH).

"Use of Workers’ Compensation Data for Prevention of Occupational Injuries and Illnesses: Proceedings from September 2009 Workshop," DHHS (NIOSH) Publication No. 2010-152, is posted at http://www.cdc.gov/niosh/docs/2010-152/pdfs/2010-152.pdf . The 2009 workshop was co-sponsored by NIOSH, the Bureau of Labor Statistics, the National Council for Compensation Insurance, and the Washington State Department of Labor and Industries’ Safety and Health Assessment and Research for Prevention Program.

"As researchers and practitioners seek innovative means to improve the surveillance of occupational injuries and illnesses, workers’ compensation data offer a potentially useful answer - but the limitations and uncertainties of those data must be addressed," said NIOSH Director John Howard, M.D. "We are pleased to offer these proceedings as a unique resource for assessing current uses of workers’ compensation information for health surveillance, suggesting new uses, and engaging the uncertainties that we face in doing so."

Although workers’ compensation programs record cases of occupational injury and illness that have already occurred, they generate data that may also serve useful purposes for preventing future injuries and illnesses. Those data may provide insights into the severity of cases, recent trends, and emerging concerns that other data sources may not.

However, several factors pose difficulties for using workers’ compensation records as a surveillance and research resource. Because different states have different rules on compensability and because data are not always coded according to a standard system, it may be difficult to harmonize and interpret data nationally. Where larger data sets exist, they generally are proprietary, and access is restricted beyond the purposes for which they were originally established.

The proceedings include more than 30 prepared presentations and a summary from the workshop. Nearly 80 participants from federal and state agencies, labor, academia, and the insurance industry made presentations and engaged in discussions.

Asbestos Deaths Predicted to Continue for Decades

The National Institute for Occupational Safety and Health (NIOSH) has released a draft Intelligence Report concerning asbestos and mesothelioma in an effort to create a "road-map for research."

"Asbestos has been a highly visible issue in public health for over three decades. During the mid- to late-20th century, many advances were made in the scientific understanding of worker health effects from exposure to asbestos fibers and other elongate mineral particles (EMPs). It is now well documented that fibers of asbestos minerals, when inhaled, can cause serious diseases in exposed workers. However, many questions and areas of confusion and scientific uncertainty remain. For instance, due to the mineralogical complexity of the asbestos minerals, the scientific literature contains various inconsistencies in the definition and application of the term asbestos for health protection guidance and regulatory purposes."

"The purpose of the Roadmap is to outline a research agenda that will guide the development of specific research programs and projects that will provide a broader and clearer understanding of the important determinants of toxicity for asbestos and other EMPs. NIOSH recognizes that results from such research may impact environmental as well as occupational health policies and practices. Many of the issues that are important in the workplace are also important to communities and to the general population.Therefore, NIOSH envisions that the planning and conduct of the research will be a collaborative effort involving active participation of multiple federal agencies, including the Agency for Toxic Substances and Disease Registry (ATSDR), the Consumer Product Safety Commission (CPSC), the Environmental Protection Agency (EPA), the Mine Safety and Health Administration (MSHA), the National Institute of Environmental Health Sciences (NIEHS), the National Institute of Standards and Technology (NIST), the National Toxicology Program (NTP), the Occupational Safety and Health Administration (OSHA), and the United States Geological Survey (USGS), as well as labor, industry, academia, health and safety practitioners, and other interested parties, including international groups. This collaboration will help to focus the scope of the research, to fund and conduct research, and to develop and disseminate informational materials describing research results and their implications for establishing new occupational and public health policies."

Asbestos Deaths Predicted to Continue for Decades

"NIOSH has annually tracked U.S. asbestosis deaths since 1968 and malignant  mesothelioma deaths since 1999 using death certificate data in the National Occupational  Respiratory Mortality System (NORMS). NORMS data, representing all deaths among  U.S. residents, show that asbestosis deaths increased almost 20-fold from the late 1960s  to the late 1990s (Figure 6) [NIOSH 2007b]. Asbestosis mortality trends are expected to substantially trail trends in asbestos exposures (see Section 2.4.2) for two primary  reasons: (1) the latency period between asbestos exposure and asbestosis onset is 2 typically long, commonly one or two decades or more; and (2) asbestosis is a chronic disease, so affected individuals can live for many years with the disease before succumbing. In fact, asbestosis deaths have apparently plateaued (at nearly 1,500 per year) since 2000 (Figure 3) [NIOSH 2007b]. Ultimately, it is anticipated that the annual  number of asbestosis deaths in the United States will decrease substantially as a result of  documented reductions in exposure. However, asbestos usage has not been completely  eliminated, and asbestos-containing materials remain in place in structural materials and  machinery, so the potential for exposure remains. Thus, asbestosis deaths in the United  States are anticipated to continue to occur for several decades."

Mesothelioma Strongly Linked to Occupational Exposures

"Malignant mesothelioma, an aggressive disease that is nearly always fatal, is known to be  caused by exposure to asbestos and some other mineral fibers [IOM 2006]. The occurrence of mesothelioma has been strongly linked with occupational exposures to asbestos [Bang et al. 2006]. There had been no discrete International Classification of Disease (ICD) code for mesothelioma until its most recent 10th revision. Thus, only seven years of NORMS data are available with a specific ICD code for mesothelioma (Figure 4); during this period, there was a 9% increase in annual mesothelioma deaths, from 2,484 in 1999 to 2,704 in 2005 [NIOSH 2007b]. A later peak for mesothelioma deaths than for asbestosis deaths would be entirely expected, given the longer latency for mesothelioma [Järvholm et al. 1999]. One analysis of malignant mesothelioma incidence based on the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program data found that an earlier steep increase in incidence had moderated and 1 that mesothelioma incidence may have actually peaked sometime in the 1990s in SEER-2 covered areas [Weill et al. 2004]. In contrast to NORMS data, which represents a census 3 of all deaths in the entire United States, the analyzed SEER data were from areas in 4 which a total of only about 15% of the U.S. population resides."

NIOSH  has invited Public Comment Until April 16, 2010 5:00pm EDT

Click here to read more about asbestos and workers compensation.

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Ethnic Disparities in Workers' Compensation

Researchers from the National Institute for Occupational Safety and Health (NIOSH) have partnered up with researches from other agencies and organizations address the needs, challenges, and opportunities for improving workplace safety and health for underserved worker populations in a special February 2010 issue of the American Journal of Industrial Medicine, “Occupational Health Disparities.” 


NIOSH reports, " Low-wage, low-skilled, and immigrant workers face disproportionately high risks for work-related injuries and illnesses in comparison with the U.S. workforce in general.  They also encounter significant barriers in accessing training and education programs, health care systems, and legal protections that are critical for mitigating those risks."


“This special issue of the American Journal of Industrial Medicine adds to our knowledge by examining occupational health disparities and inequities immigrant and other workers face, and measuring the extent of the problem,” U.S. Secretary of Labor Hilda Solis states in a Foreword to the issue. “In addition to helping address the need for better data, this research promises to create new knowledge that can be used to improve the lives of our nation’s workers."

• Occupational health surveillance must be enhanced and improved to describe the nature and extent of disparities in occupational illnesses and injuries (including fatalities), identify priorities for research and intervention, and evaluate trends. This is a priority of NIOSH and its partners under the National Occupational Research Agenda (NORA). Serious shortcomings in current surveillance systems include an undercounting of what research suggests to be the true incidence of work-related injuries, illnesses, and deaths, and a lack of information in key datasets that would allow users to identify incidence and trends in cases by race, ethnicity, and place of birth.
  
• A case study under NIOSH’s state-based Sentinel Event Notification System for Occupational Risk (SENSOR) demonstrated the value of occupational health surveillance for protecting migrant farmworkers from risk of job-related illness. SENSOR’s pesticide-poisoning surveillance staff identified a birth-defects cluster among migrant farmworkers exposed to pesticides. Subsequent state legislation in North Carolina provided funding to strengthen surveillance, improve the quality of state inspections for compliance with pesticide regulations, increase and improve worker pesticide safety training, and broaden the coverage of state anti-retaliation rules to include agricultural workers.
  
• Questionnaires for worker health studies that ask questions in different languages are essential for identifying work-related injuries and illnesses, and trends in those cases, among the ethnically diverse U.S. workforce. Developing such questionnaires is complex, and literal translation often is not appropriate or accurate. More research should be focused on development of useful bilingual and multilingual research tools.

To read more about NIOSH and workers' compensation click here.

Occupational Hazards in the Home Healthcare Industry

NIOSH has focussed on the dangers of working in the home healthcare industry. Home healthcare works face unique risks on the job to their own health. During 2007 alone 27,400 recorded injuries occurred among the more than 890,800 home healthcare workers. 


The US agency reported, "Home healthcare workers are frequently exposed to a variety of potentially serious or even life-threatening hazards. These dangers include overexertion; stress; guns and other weapons; illegal drugs; verbal abuse and other forms of violence in the home or community; bloodborne pathogens; needlesticks; latex sensitivity; temperature extremes; unhygienic conditions, including lack of water, unclean or hostile animals, and animal waste. Long commutes from worksite to worksite also expose the home healthcare worker to trans- portation-related risks."


The report concludes, "The Bureau of Labor Statistics has projected home healthcare work to be the fastest growing occupation through 2016. Home healthcare workers, including home healthcare aides, nurses, physical therapists, occu- pational therapists, speech therapists, therapy aides, social workers, and hospice care workers, face unique hazards delivering services in patients’ homes and in various di- verse communities. Persons other than the patient who are residing or visiting in the patient’s home may be a risk to the worker. Home healthcare workers are susceptible to injuries. These may result from overexertion due to transferring patients into and out of bed or to assisting with patient walking or standing. Home healthcare workers may be exposed to bloodborne pathogens, needlesticks, infectious agents, latex, stress, violence occurring in the home or street, verbal abuse, weapons, illegal drugs, and they may encounter animals, temperature extremes, unsanitary conditions in the homes, lack of water, severe weather, or a response to a chemical spill or act of terrorism. The large amount of driving from home to home ex- poses the home healthcare worker to risks of vehicular injury or fatality."


Click here to read the complete NIOSH report.


Click here to read more bout NIOSH and workers' compensation.

Workplace Safety, the Aging Workforce & The Logical Step

Safety in the workplace is now a growing concern as US aging workforce expands. It has been frequently reported that the expansion of this dimension of the labor sector has generated an increase in serious accidents and illness at work.


Over the past decade the work force has demographically changed. The number of those who are working past age 55 has grown. This increase mirrors an increase in accidents at work. It well known that those age 55 and older have a higher propensity for illness and disease resulting in complex of medical conditions.


The workers' compensation claims for this age group have become more serious and eventually evolve into Social Security Disability Claims. Besides the administrative complexity of navigating a fragile and dysfunction workers' compensation, these workers are require more emergent medical care for exigent conditions.


The National Institute for Occupational Safety and Health (NIOSH) has recognized this issue and is attempting to put SAFETY back into the equation.


"A report of conference presentations and discussions among participants from the National Academies of Science, universities and research institutions, and representatives of professional associations, industry and labor, recommends attention to workplace environments to maintain “work ability” as workers age, along with legislative fixes and research to fill in knowledge gaps for keeping workers healthy and productive."


As Social Security studies these issues, and more reliable data becomes available through NIOSH's efforts, a redesign of the approach to mandate safety, and deliver medical benefits universally and in a more efficient fashion, appears to be the next logical step.


Click here to read more about safety and workers' compensation.

NIOSH Schedules Conference on Safety of Nanoparticles

NIOSH announced a conference in July 2010 to discuss the safety concerns that have been raised concerning workers and nanotechnology.

“NIOSH research has shown that some nanoparticles, including certain types of carbon nanotubes and metal oxides, can be toxic to the heart and lung in mice and rats in laboratory experiments. Other research has demonstrated various other adverse effects of nanoparticles. Through its Approaches to Safe Nanotechnology, NIOSH recommends that specific precautions be taken to protect workers who might be exposed to any level of nanoparticles or nanoparticle-containing materials. A big question left unanswered is, can nanoparticles cause the same types of disease in humans?”

Concern intensified on this issue following the publication of the September issue of the “European Respiratory Journal, the first medical case series of workers with serious disease that the study authors associate with exposure to nano-sized particles has been published.”

NIOSH Proposes Special Cohort to Include Linden NJ Workers

The National Institute for Occupational Safety and Health (NIOSH), Department of Health and Human Services (HHS) published a notice of a decision to designate a class of employees for the Standard Oil Development Company in Linden, New Jersey, as an addition to the Special Exposure Cohort (SEC) under the Energy Employees Occupational Illness Compensation Program Act of 2000. On June 18, 2009, the Secretary of HHS designated the following class of employees as an addition to the SEC:

All AWE employees of the Standard Oil Development Company in Linden, New Jersey, during the period from August 13, 1942 through December 31, 1945, while working for a number of work days aggregating at least 250 work days, either solely under this employment or in combination with work days within the parameters established for one or more other classes of employees in the SEC.

This designation will become effective on July 18, 2009, unless Congress provides otherwise prior to the effective date.

Federal Register: June 30, 2009 (Volume 74, Number 124 Page 31279-31280

California Workers Compensation Fund Alerts Employers and Employees as to Flu

The California Workers' Compensation Fund has taken the initiative of alerting employers and employees as to preventative measures that should be taken to prevent the spread of Swine Flu. 

"To protect California workers and businesses, State Fund advises employers to educate their employees about swine flu facts, symptoms, and preventative measures and to prepare their business operations should a pandemic outbreak significantly reduce their workforce or disrupt their business operation. "

As of today there are 403 reported cases and one death according to the CDC. Numbers are expected to rise as testing has now been shifted from the CDC to the States. California has 49 reported cases.

The novel influenza outbreak (H1N1) has given rise to concern on the impact what a pandemic would cause. The Department of Homeland Security has posted information that workers' compensation programs would probably become involved in responding to the emergency. NIOSH has issued an alert concerning the impact upon psychological and social workers comparing a potential pandemic to the 911 tragedy.