Cost effectiveness of surveillance for isocyanate asthma : finding an occupational health policy framework

Wild et al present an original cost effectiveness analysis for medical surveillance for isocyanate asthma in this issue of OEM.1 The general case for surveillance for isocyanate asthma is a compelling one. Most occupational physicians, practitioners, and researchers might rightly expect that if a cost effectiveness (CE) case cannot be made for this agent, it would be hard to make a case for most others. The causal link between isocyanate exposure and asthma is well established, and more is known about the pathophysiology, natural history, long term consequences, and benefits of medical surveillance in this instance than for most other occupational exposures.A mathematical simulation model was developed based on a carefully specified set of clinical parameters, drawing from empirical studies where possible (for example, in estimating sensitisation rates ranging from 0.7% to 5.3% per year), and well qualified expert opinion otherwise (for example, in estimating the chance of removal from exposure if a patient is diagnosed versus undiagnosed). Their “state transition” model compared passive case finding to surveillance (the heart of the CE analysis question as proposed) for a theoretical population of 100 000 otherwise healthy and exposed workers, predicting their progression over 10 years across three mutually exclusive “states”: healthy and exposed; symptomatic; and disabled. This alone is an impressive and valuable piece of research, integrating a substantial body of empirical research to show that surveillance is estimated to result in 700 fewer cases of disability over 10 years compared to passive case finding. While such a modelling exercise necessarily requires numerous assumptions and simplifications, each was well articulated and defensible.

Integrating workplace exposure databases for occupational medicine services and epidemiologic studies at a former nuclear weapons facility

We outline methods for integrating epidemiologic and industrial hygiene data systems for the purpose of exposure estimation, exposure surveillance, worker notification, and occupational medicine practice. We present examples of these methods from our work at the Rocky Flats Plant?a former nuclear weapons facility that fabricated plutonium triggers for nuclear weapons and is now being decontaminated and decommissioned. The weapons production processes exposed workers to plutonium, gamma photons, neutrons, beryllium, asbestos, and several hazardous chemical agents, including chlorinated hydrocarbons and heavy metals. We developed a job exposure matrix (JEM) for estimating exposures to 10 chemical agents in 20 buildings for 120 different job categories over a production history spanning 34 years. With the JEM, we estimated lifetime chemical exposures for about 12,000 of the 16,000 former production workers. We show how the JEM database is used to estimate cumulative exposures over different time periods for epidemiological studies and to provide notification and determine eligibility for a medical screening program developed for former workers. We designed an industrial hygiene data system for maintaining exposure data for current cleanup workers. We describe how this system can be used for exposure surveillance and linked with the JEM and databases on radiation doses to develop lifetime exposure histories and to determine appropriate medical monitoring tests for current cleanup workers. We also present time-line-based graphical methods for reviewing and correcting exposure estimates and reporting them to individual workers.

Occupational light-vehicle use and OHS legislative frameworks : an Australian example

Occupational light vehicle (OLV) use and associated exposures and hazards in the Australian context are described. Available insurance data indicate that the OLV injury burden, which is greater than that of other work–road users, is growing asOLV use changes incidental, to workers', primary occupations and work patterns. Legislation that affects OLV users is reviewed and the shifting of the burden of responsibility for injured or killed OLV users between workers' compensation, motor accident insurance and public health systems is described. Changes to OHS regulatory frameworks are proposed to better address OLV-relevant policy and practice. These issues are relevant for many international jurisdictions.

Primary prevention of latex related sensitisation and occupational asthma : a systematic review

Eight primary prevention intervention studies on natural rubber latex (NRL) published since 1990 were identified and reviewed. This is the largest evidence base of primary prevention studies for any occupational asthmagen. Review of this small and largely observational evidence base supports the following evidence statement: Substitution of powdered latex gloves with low protein powder‐free NRL gloves or latex‐free gloves greatly reduces NRL aeroallergens, NRL sensitisation, and NRL‐asthma in healthcare workers. Evidence in support of this statement is ranked SIGN level 2+, referring to well conducted case‐control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal. Substitution of powdered latex gloves with low protein powder‐free NRL gloves or latex‐free gloves promises benefits to both workers' health and cost and human resource savings for employers. This message should be broadly disseminated beyond the hospital sector to include other healthcare settings (such as aged care facilities) as well as food service and other industries where latex gloves might be used.