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EPID 600 - Introduction to Public Health Practice - Fall 2017


Industrial Hygiene & Carcinogenesis
Drs. Compton, Vance and Buttery

Issues

Review the historical data provided in the first session of this course to examine how long worker's health has been a concern of health professionals.

First review Slide presentations from Dr Compton.
The Occupational Health Program
Then review these article on a specific occupational health issue; Fire fighting Deaths and the NEJM Commentary, Then this recent NIOSH release on prevention of cardiovascular disease among firefighters and this commentary,, Also this article about heat stroke which affects firefighters as well as many other occupations..
Then as an example of a work related infection review this article about a cat bite to a veterinary assistant.
Also look at these recommendations from the NEJM for generalists acting as 'health coaches'..
Additional Readings: Many On-The-Job Clinics Offer Primary Care, from the KFF. Also this just released material from the IOM.

Also investigate the following Web Sites to look at information that would be useful in counseling workers about options if disabled as well as general Occupational Medicine reference information.

Bureau of Labor Statistics. Note Workplace injuries and workplace demographics. Look at the available databases, particularly the featured data products
Americans with Disabilities.. Look at the ADA enforcement activities.
Association of Occupational and Environmental Clinics. look at "principles and guidance", click on 4th link at left

The following web sites also provide important information  related to occupational health & industrial hygiene

CDC Foundation. Look at the various tabs that tell you about the Foundation Functions. Also look at the Foundation's Business Pulse and look at the various links
NIOSH (there are excellent fellowship opportunities at this site)
Pocket Guide to Chemical Hazards Read the Introduction
Health Hazard Evaluations Click on HHE Program Information, link in 2nd paragraph.
OSHA  (Occupational Safety & Health Administration) Scan page for types of information available. Note that Dr. Vance was Asst.. Sec. during the Reagan Administration.
ACGIH (American Conference of Governmental and Industrial Hygienists) Review the history

Also of importance, although not occupational, is general exposure of the population to environmental chemicals. See this page from CDC on frequently asked questions,In particular, go to the section on "what do these findings in people's bodies mean? Are the levels dangerous?" For years Congress required use of the 'AMES' test to define dangerous chemicals, but the act was removed about 5 years ago. Scan this short piece about Dr. Ames

References to assist with the week's discussions
Global UN Hazard references Modification of the Hazard Communication Standard (HCS) to conform with the United Nations' (UN) Globally Harmonized System of Classification and Labeling of Chemicals (GHS) Be sure to click on the 1st link

Diesel References

Then review the Slides (Read in edit view rather than screen- view so you can see the notes)  Examine the Links to web sites and be prepared to discuss current occupational health issues.

The following short pieces should stimulate some thoughts about Asbestos as a carcinogen. 
What types of cancer does it cause? How much exposure is needed to obtain an effect?

1) This first article was one of the first cohort studies in the US. (available at TWL online journal webpage)


This set of articles raised concerns following WW!! and became an issue in the 1950s

Although a number of epidemiologists cautioned that more data was need following the media 'feeding frenzy' it was not until a further review 20_years later when some of the news media harassment died down. You might well want to go online and read the original articles in full, or at least the summaries.

2) The look at the table from Selikoff's original study and consider what this tells you about the comparative dangers of asbestos exposure and smoking. If you could only control one of these hazards which would you focus on?

3) Then review the short summary  and the indicators for Health Effects Monitoring using the preceding as an example of an issues needing such monitoring.

4) Finally try and get a feel for what parts per million, billion and trillion mean when this kind of data is quoted

5) a) From the NEJM, March 3, 2011. Combating Environmental Causes of Cancer b) What do all these chemicals mean?

13th report on Carcinogens (Oct 2014).