Occupational Disease in New York State: An Update.

An assessment of occupational disease in New York State was undertaken that partially replicated and expanded earlier work from 1987. Utilizing an expanded conception of occupational disease, the assessment used a variety of data sources and methods to provide estimates of mortality and morbidity of occupational disease; workers exposed to specific workplace hazards; disparities in occupational disease among racial/ethnic groups and gender; costs and distribution of costs of occupational disease; and accessible occupational medical resources. Examples of the pathways work may impact health in some of the major health issues of current import including stress-related health conditions; substance use; and overweight/obesity were included. The report contains recommendations for addressing the problem of occupational disease in New York State and advocates for the convening of a statewide group to develop an occupational disease prevention agenda.

The Perils of Integrating Wellness and Safety and Health and the Possibility of a Worker-Oriented Alternative.

Integration of workplace wellness with safety and health has gained momentum on the initiative of the state allied with a segment of large employers and some health and safety professionals. Integration has a dual potential: to fundamentally reshape occupational health in ways that profoundly benefit workers, or to serve neoliberal corporate goals. A focus on the workplace and the ways work and health interact broaden the definition of a work-related injury or illness and emphasize and challenge the employer decisions that create hazards and determine risk. However, the implementation of integration is taking place in a context of corporate dominance and the aggressive pursuit of a neoliberal agenda. Consequently, in practice, integration efforts have emphasized individual worker responsibility for health and fail to actually integrate wellness with safety and health in a meaningful way. Can an alternative be envisioned and pursued that realizes the promise of integration for workers?

Predictors for return to work for those with occupational respiratory disease: clinical and structural factors.

BACKGROUND: Few occupational researchers have examined "return to work" among patients with work-related respiratory diseases. In addition, prior studies have emphasized individual patient characteristics rather than a more multi-dimensional approach that includes both clinical and structural factors. METHODS: A retrospective chart review identified patients with occupational respiratory diseases in the Occupational Health Clinical Center, Syracuse, NY between 1991 and 2009. We assessed predictors of work status using an exploratory, sequential mixed methods research design, multinomial (n = 188) and Cox regressions (n = 130). RESULTS: The findings suggest that patients with an increased number of diagnoses, non-union members, and those who took more than a year before clinical presentation had significantly poorer work status outcomes, after adjusting for age, education level, and relevant diagnoses. CONCLUSIONS: Efforts to prevent slow return to work after developing occupational respiratory disease should recognize the importance of timely access to occupational health services, disease severity, union membership, and smoking status.

Saúde Ocupacional na região central do estado de Nova York: um ambulatório de doenças ocupacionais com financiamento público 25 anos depois / Occupational Health in central New York: a publicly funded occupational health clinical center after 25 years

Para tratar o problema do sub-reconhecimento de agravos relacionados ao trabalho, em 1987, o estado de Nova York utilizou financiamentos públicos para criar uma rede de ambulatórios de saúde ocupacional, que continua sendo o único projeto de seu tipo nos Estados Unidos. Sua missão é o diagnóstico, o tratamento e a prevenção de doenças ocupacionais. O financiamento público foi necessário para sustentá-la e permitir que funcionasse de forma independente e universalmente acessível. Este artigo relata as experiências dos Ambulatórios de Saúde Ocupacional (Occupational Health Clinical Centers - OHCC) ao longo dos últimos 25 anos. Cada serviço é parte da rede e atende grande parte da região central do estado de Nova York. Durante este período, os ambulatórios construíram uma experiente equipe multidisciplinar e um programa multifacetado, que inclui atividades clínicas, ações de capacitação e educação, assessoria técnica e pesquisa. Alcançaram considerável sucesso em estabelecer-se como um recurso para os trabalhadores acidentados na região e como defensores, do ponto de vista clínico, de trabalhadores acidentados nos seus locais de trabalho e junto ao sistema de compensação. Como os OHCCs se movem em direção à nova fase, desafios consideráveis permanecem, especialmente na identificação e no acesso de trabalhadores submetidos a situações de alto risco com pouco alcance aos serviços de saúde.

To address the problem of the under-recognition of occupational disease, New York State used public funds to create a network of occupational health clinical centers (OHCN) in 1987. New York State's OHCN remains the only project of its kind in the United States. The mission of the network centers was the diagnosis, treatment and prevention of occupational illness. Public funding was necessary to sustain the network and to allow it to function independently and to be universally accessible. This paper reports on the experiences of the Occupational Health Clinical Centers (OHCC) over the last 25 years. The OHCC is part of the OHCN serving a large portion of central New York State. Over this time period the OHCC has built an experienced multidisciplinary team and a multi faceted program including clinical activities, training and education, technical assistance, and research. The OHCC has achieved considerable success in establishing itself as a resource for injured workers in the region, and as an advocate for injured workers medically, in their workplaces, and in the Workers' Compensation system. As the OHCC moves into its next phase, considerable challenges remain, particularly in identifying and reaching high risk and under-served workers.

Workers' Compensation reform requires an agenda and a strategy.

In a response to Joseph LaDou's article in this issue, Michael Lax focuses on the broader issues. If we are agreed that we need significant change in Workers' Compensation, what should the nature of those changes be? Of equal importance to knowing what we want is the development of a strategy for how to get there. Without an effective strategy, we will be consigned to discussing the issues again and again, developing attractive alternatives that live only on paper or at conferences.

More than meets the eye: social, economic, and emotional impacts of work-related injury and illness.

The impact of an occupational illness or injury on an injured worker can be severe. This study assessed several dimensions of the impact on a group of 50 injured workers, all patients at an Occupational Health Center. The dimensions assessed included aspects of access to health care, support from treating physicians in obtaining Workers' Compensation benefits, financial impacts, the role of attorneys and "Independent Medical Examiners," and the impact on mental health. Many reported that their treating physician did not want to become involved in Workers' Compensation, despite indicating a belief that the health condition was work-related. The financial impacts of a work-related diagnosis were particularly striking, with respondents reporting that they were burdened both with costs directly related to the medical care of their condition, and with coping with ongoing general expenses on a reduced income. Many respondents reported depleting savings, borrowing money, taking out retirement funds, and declaring bankruptcy in efforts to cope. Emotionally, respondents almost universally reported their diagnosis and related issues were associated with depression, anxiety, and loss of identity and self-worth. This study demonstrates how a work-related injury or illness can extend far beyond the physical impact for injured workers. Existing systems fail to adequately compensate or rehabilitate injured workers, leaving them to their own devices to deal with their losses, medical or otherwise.

"Guidotti fails to convince" on two issues.

This is a response to Tee Guidotti's defense of the American College of Occupational and Environmental Medicine (ACOEM) as an ally for workers struggling for safer and healthier work. Guidotti fails to convince on two central issues: a blindness to the powerful impact of corporate power on professional thought and behavior; and a lack of evidence that ACOEM has ever been inclined to collaborate with workers. In addition, Guidotti relies upon his own review of ACOEM's historical archive to support his argument. Unfortunately, access to this archive is limited to those deemed reliable by Guidotti, giving the appearance of an attempt to control both information and interpretation, and calling Guidotti's own "objectivity" into question.

Wounding the messenger: the new economy makes occupational health indicators too good to be true.

The U.S. Bureau of Labor Statistics and workers' compensation insurers reported dramatic drops in rates of occupational injuries and illnesses during the 1990s. The authors argue that far-reaching changes in the 1980s and 1990s, including the rise of precarious employment, falling wages and opportunities, and the creation of a super-vulnerable population of immigrant workers, probably helped create this apparent trend by preventing employees from reporting some injuries and illnesses. Changes in the health care system, including loss of access to health care for growing numbers of workers and increased obstacles to the use of workers' compensation, compounded these effects by preventing the diagnosis and documentation of some occupational injuries and illnesses. Researchers should examine these forces more closely to better understand trends in occupational health.

Medical evaluation of work-related illness: evaluations by a treating occupational medicine specialist and by independent medical examiners compared.

Treating physicians' and independent medical examiners' (IMEs') opinions were compared to identify differences of opinion and to develop a basis for understanding the differences. Twenty-three patients of an occupational health center (OHC) who had been examined by an IME were studied. OHC and IME opinions regarding diagnosis, work-relatedness, treatment recommendations, and disability assessment were categorized by degree of agreement. There was agreement on all four issues for only one patient. Opinions were most divergent with regard to disability assessment and least divergent with regard to diagnosis. Disagreement was unidirectional: the IMEs made fewer diagnoses, deemed fewer illnesses work-related, made fewer treatment recommendations, and assessed lower levels of disability than the OHC examiners. The results suggest that differences in opinion between the OHC and IMEs are due to differences in perspective, rather than skill or training.

Occupational medicine: toward a worker/patient empowerment approach to occupational illness.

Clinicians practicing occupational medicine are increasingly confronted with patients who have complex illnesses with chronic nonspecific symptoms. Most clinicians use the traditional tools of biomedicine to diagnose and treat the illness, determine etiology, and assess disability. This article argues that the biomedical approach is inadequate to effectively evaluate and treat occupational illness. After reviewing several critiques of biomedicine, including biopsychosocial, feminist, class, and critical theory/postmodern perspectives, the author offers an alternative approach that builds on aspects of these perspectives as well as the "popular education" work of Paulo Freire. Constraints on, and possibilities for, the development of an alternative approach that attempts to build patients' capacities for transformative action are explored.

Recognizing Occupational Disease: Taking an Effective Occupational History

This article describes ways in which family physicians can improve the detection of occupational disease in their patients. It is intended for physicians to raise their level of suspicion for occupational disease, build skills for efficiently obtaining an occupational history and develop routine access to occupational medicine resources. Document is intended for personal, non-commericial use only.