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Biomedical subjects

N Maizlish

Publications and source records attributed to N Maizlish.

At least 19 recordsLinked to original sources
PubMed1999

Design of a state-based workers' compensation information system.

BACKGROUND: California policy makers have long been hampered by a lack of credible information for use in making legislative or administrative changes to address serious problems in the workers' compensation system. In 1993, the legislature directed the California Division of Workers' Compensation to develop a Workers' Compensation Information System (WCIS). METHODS: An advisory committee developed key questions and identified data sources regarding injury/illness incidence, costs, promptness of benefit delivery, adequacy of benefits, satisfaction with services, and other outcomes. RESULTS: Key data elements were identified, mostly from existing mandated reporting forms for employers and physicians, and from standardized medical billings. Data collection will be carried out using: 1) rapid electronic data interchange (EDI) for a minimum number of data elements; 2) electronic collection of data on medical services for a sample of claims; and 3) surveys to address adequacy of benefits, satisfaction with services, return to work, and other outcomes. A state-based repository will analyze data and provide de-identified public use data files. CONCLUSIONS: The proposed WCIS will provide information to improve the performance and to increase the accountability of all the participants in California's Workers' Compensation system. More importantly, it will provide information which will allow improved quality in the provision of mandated benefits to injured workers.

Benchmarking↗
PubMed1997

Designing prevention-oriented software for workplace health and safety.

Rapid changes in technology and health services organization are propelling information-driven decision making in all aspects of business. The potential of electronic data processing to reduce costs and increase efficiency has been heralded, but disease and injury prevention have received scant attention. Prevention-oriented software for surveillance and disability management must generate population- and case-level measures of magnitude and severity of occupational injury and illness. A public domain program, called WIZARD, was developed as a model. With 12 data elements, it generates, from injury and employment files, injury- and return-to-work rates, avoidable costs, attributable cases using several reference rates, and case lists from screening criteria. In conjunction with an explicit case definition, screening criteria for case follow-up, and guidelines for medical, disability, and health and safety management, software can play a significant role in prevention.

Accidents, Occupational↗
PubMed1995

Neurobehavioral evaluation of Venezuelan workers exposed to organic solvent mixtures.

To assess the applicability of the World Health Organization (WHO) Neurobehavioral Core Test Battery (NCTB), we evaluated 53 male and 29 female Venezuelan workers exposed to mixtures of organic solvents in an adhesive factory, and 56 male and 11 female workers unexposed to any type of neurotoxic chemical. The average age of unexposed workers was 30 years and 33 years for those exposed, average schooling for both groups was 8 years, and the mean duration of exposure was 7 years. The NCTB, which assesses central nervous system functions, is composed of seven tests that measure simple motor function, short-term memory, eye-hand coordination, affective behavior, and psychomotor perception and speed. The battery includes: profile of mood states (POMS); Simple Reaction Time for attention and response speed; Digit Span for auditory memory; Santa Ana manual dexterity; Digit-Symbol for perceptual motor speed; the Benton visual retention for visual perception and memory; and Pursuit Aiming II for motor steadiness. In each of 13 subtests, the exposed group had a poorer performance than the nonexposed group. The range of differences in mean performance was between 5% and 89%, particularly in POMS (tension-anxiety, anger-hostility, depression-rejection, fatigue-inertia, confusion-bewilderment), Simple Reaction Time, Digit-Symbol, and Santa Ana Pegboard (p < .05). In multivariate regression analyses, controlling for the effects of age, sex, and education, significantly poorer performance in the exposed was found for tension-anxiety, hostility, depression, and confusion moods in the POMS, and in digit-symbol and simple reaction time (p < .05). These alterations were also dose-related using years of exposure in analyses of covariance. Compared to the nonexposed, the exposed subjects demonstrated an increased frequency of subjective symptoms of fatigue, difficulties with memory, confusion, paresthesias in upper and lower extremities, and sleep disturbances. We conclude that the methodology is applicable to the population studied. The tests of the NCTB were accepted by the subjects and were administered satisfactorily, except for occasional difficulties in verbal comprehension in subtests of POMS, which is the only test that requires more demanding verbal skills. The magnitude of the behavioral deficits is consistent with the probable high level of exposure and with the range of deficits previously reported in workers with long-term solvent exposures.

Adhesives↗
PubMed1995

Surveillance and prevention of work-related carpal tunnel syndrome: an application of the Sentinel Events Notification System for Occupational Risks.

In response to limitations in state-based, occupational disease surveillance, the California Department of Health Services developed a model for provider- and case-based surveillance of work-related carpal tunnel syndrome. The objectives were to enhance case reporting, identify risk factors and high-risk work sites, and link preventive interventions to work sites and the broader community. Using elements from surveillance of communicable diseases and sentinel health events, a model was integrated into the pre-existing reporting system in one California county. Between 1989 and 1991, 54 Santa Clara County health care providers reported 382 suspected cases, of which 365 from 195 work sites met reporting guidelines. Risk factors were profiled from interviews of 135 prioritized cases and 38 employers. Of 24 work sites prioritized for a free, voluntary, nonenforcement inspection, 18 refused and 6 completed an on-site visit. Sentinel Event Notification System for Occupational Risks (SENSOR) captured many cases not reported to the pre-existing reporting system. Case interviews indicated a profile of symptoms and signs, treatment, and exposure to uncontrolled occupational risk factors, including a lack of training on ergonomics hazards. Employer health insurance, rather than workers' compensation, was the apparent source of payment for most medical bills. Employers lacked knowledge and motivation to reduce ergonomic risks. Governmentally mandated occupational ergonomics standards are urgently needed.

Adolescent↗
PubMed1995

The surveillance of work-related pesticide illness: an application of the Sentinel Event Notification System for Occupational Risks (SENSOR)

OBJECTIVES: In response to limitations in state-based occupational disease surveillance, the California Department of Health Services developed a model for surveillance of acute, work-related pesticide illness. The objectives were to enhance case reporting and link case reports to preventive interventions. METHODS: Elements from surveillance of communicable diseases and sentinel health events were used to integrate a model into the preexisting system in one agricultural country. RESULTS: Between 1988 and 1991, 45 Fresno County health care providers reported 230 suspected cases, of which 217 from 80 work sites met reporting guidelines. Risk factors were profiled from interviews of 81 prioritized case patients and 36 employers. Fifteen work sites were visited and 117 recommendations were made, of which 6% were identified in enforcement inspections. Pest management experts consulted with growers on reducing future pesticide use. CONCLUSIONS: Risk factors for pesticide illness were prevalent. Agricultural inspectors did not detect routine and serious hazards. Integrated pest management should be expanded and linked to occupational health. Agricultural enforcement personnel should be oriented and trained in occupational safety and health.

Adolescent↗
PubMed1993

California adults with elevated blood lead levels, 1987 through 1990.

OBJECTIVES: Follow-up of California blood lead registry reports, 95% of which are of occupationally exposed adults, can guide interventions at specific high-risk work sites and measure the impact of targeted, industry-specific interventions. METHODS: A protocol was implemented to follow up the most severe case reports (> or = 2.90 mumol/L) and establish a statistical database for descriptive analysis. RESULTS: From 1987 through 1990, the California Department of Health Services received 17,951 reports for 4069 civilian, noninstitutionalized adults employed by at least 328 companies. Of 232 incident case subjects with severe lead toxicity (> or = 2.90 mumol/L), 182 were successfully traced and interviewed. Index case subjects were mostly male (95%) and disproportionately Hispanic (46%); 35% lived with children aged 7 or younger, and 10% had been hospitalized. Ninety-four percent involved overexposures at work sites that lacked medical removal (50%), ventilation (36%), appropriate respirators (62%), training (64%), clothing changes (45%), or showering (60%). CONCLUSIONS: Well-known risk factors for occupational lead poisoning clustered at the work sites of index case subjects. Despite standards of the Occupational Safety and Health Administration, lead overexposure in California adults remains a significant public and occupational health concern.

Adult↗
PubMed1992

Lead exposure in the construction industry: results from the California Occupational Lead Registry, 1987 through 1989.

The construction industry is exempt from the medical monitoring portions of the US Federal Occupational Safety and Health Administration General Industry Lead Standard. Of 28 construction workers reported to the California Occupational Lead Registry through March 1989, 11 (39%) had blood lead levels of 2.90 mumol/L (60 micrograms/dL) or greater, the level at which immediate removal from lead exposure is mandated in nonconstruction industries. Many workers had not been warned of possible lead exposure. The exemption of the construction industry from the General Industry Lead Standard should be reconsidered.

California↗
PubMed1990

Elevated blood lead in California adults, 1987: results of a statewide surveillance program based on laboratory reports.

California medical laboratories that test for blood lead are required to report results exceeding 1.21 mumols/L (25 micrograms/dl). Between April and December 1987, the California Department of Health Services received 3,077 blood lead reports from 34 laboratories for 1,293 civilian, non-institutionalized adults. Approximately 1 percent of all reports exceeded 3.87 mumols/L (80 micrograms/dl), 7 percent exceeded 2.42 mumols/L (50 micrograms/dl), and 21 percent exceeded 1.93 mumols/L (40 micrograms/dl). Individuals tested were overwhelmingly male (94 percent), disproportionately Hispanic surnamed (44 percent), and most often residents of Los Angeles County (81 percent). Workers in lead smelting, battery manufacturing, and brass foundries accounted for nearly 80 percent of reports. Construction, radiator repair, pottery and ceramics manufacturing, and gun firing ranges accounted for the remainder. All adults with reports of greater than or equal to 2.90 mumols/L who were contacted reported on occupational exposure. Approximately half were not in routine medical monitoring programs. Despite OSHA standards, elevated blood lead with the potential for serious acute and chronic lead poisoning in California adults remains a significant public health and major occupational health concern.

Adolescent↗
PubMed1990

Risk of neuropsychiatric disability among painters in the United States.

Scandinavian studies have suggested that working with solvents is associated with chronic neuropsychiatric disease. In the United States the Social Security Administration's records of white male recipients of disability compensation were used in a case-referent study on this topic. The cases were defined as men with any one of several neuropsychiatric diseases, and the referents as men with other disabling conditions. The men were considered exposed if they had worked as a painter prior to disability and unexposed if they had worked as a bricklayer. A job-exposure matrix verified the painters' potential exposure to solvents and the bricklayers' lack of potential exposure. The painters had a significant excess of neuropsychiatric disability [adjusted odds ratio (OR) 1.42, 95% confidence interval (95% CI) 1.04-1.94]. Construction painters had an excess of neuropsychiatric disability [OR 1.47 (95% CI 1.07-2.02)] in contrast to spray painters [OR 0.77 (95% CI 0.38-1.54)]. The limitations of the data are discussed, including potential diagnosis bias and exposure misclassification.

Adult↗
PubMed1990

Occupational illness and poison control centers. Referral patterns and service needs.

In a study of occupational illness reported to a regional poison control center and to gauge the center's outreach and services, we did follow-up interviews of 301 case contacts over a 6-month period. We ascertained referral routes, reasons for contacting the poison control center, and awareness of the center's function. For 122 cases a nonphysician was the initial poison control center contact. Of the nonphysician contacts, 41 had already consulted a health care provider and been referred to the poison control center for assistance. Of the 70 persons with exposure, only 21 had been aware before their exposures that poison control center services might include occupational chemical illness consultation. Physicians and nonphysicians expressed similar reasons for contacting the poison control center, with 118 of 301 identifying the need for an exposure hazard risk assessment. These data suggest that although those contacting a poison control center because of occupational illness include a variety of cases, they have many similar service needs.

Humans↗
PubMed1989

Occupational illness: case detection by poison control surveillance.

STUDY OBJECTIVE: To evaluate the usefulness of poison control center detection in occupational illness surveillance. DESIGN: Case series of all occupationally related exposures referred for poison control center consultation over 6 months. Follow-up structured interviews were done of exposed persons and health care providers. Cases were traced under established occupational illness reporting programs. SETTING: A regional poison control center. PATIENTS: Consecutive sample of 461 symptomatic occupational exposure cases. After exclusions and losses to follow-up, interview of 301 patients and the treating physician, physician's assistant, or nurse practitioner for the 223 of the patients under direct medical care. MEASUREMENTS AND MAIN RESULTS: One hundred and fifty-five persons (61%; CI, 55% to 67%) had systemic or respiratory illness; 109 (36%; CI, 31% to 41%) had eye or skin conditions. Work practices were associated with exposures more often than technical failure; 118 persons (39%; CI, 33% to 45%) reported lack of respirators or other appropriate personal protective equipment. For 223 persons who received direct medical care, only five treating health care providers (2%; CI, 0.2% to 4%) reported occupational specialization, although occupational care was a regular practice activity for 128 of the health care providers (57%; CI, 51% to 63%). Sixty-seven cases (22%; CI, 17% to 27%) were detected by the Doctor's First Report surveillance program; 97 cases (32%; CI, 27% to 37%) comprised the maximal detection estimated for Occupational Safety and Health Administration surveillance. CONCLUSIONS: Poison control center detection provides a useful surveillance measure for occupational illness. The proportion of case detection failures by established surveillance programs suggests that the incidence of occupational illness in the United States, which is calculated from these incomplete programs, may be three to five times greater than previously estimated.

Adult↗
PubMed1988

Mortality among California highway workers.

Standardized proportional mortality ratios (PMR) were computed for a population of highway workers. Hazards of highway maintenance work include exposure to solvents, herbicides, asphalt and welding fumes, diesel and auto exhaust, asbestos, abrasive dusts, hazardous material spills, and moving motor vehicles. Underlying cause of death was obtained for 1,570 workers who separated from the California Department of Transportation between 1970 and 1983, and who died in California between 1970 and 1983 (inclusive). Among 1,260 white males, the major findings were statistically significant excesses of cancers of digestive organs (PMR = 128), skin (PMR = 218), lymphopoietic cancer (PMR = 157), benign neoplasms (PMR = 343), motor vehicle accidents (PMR = 141), and suicide (PMR = 154). Black males (N = 66) experienced nonsignificant excesses of cancer of the digestive organs (PMR = 191) and arteriosclerotic heart disease (PMR = 143). Among 168 white females, deaths from lung cancer (PMR = 189) and suicide (PMR = 215) were elevated. White male retirees, a subgroup with 5 or more years of service, experienced excess mortality due to cancers of the colon (PMR = 245), skin (PMR = 738), brain (PMR = 556), and lymphosarcomas and reticulosarcomas (PMR = 514). Deaths from external causes (PMR = 135) and cirrhosis of the liver (PMR = 229) were elevated among white males with a last job in landscape maintenance. White males whose last job was highway maintenance experienced a deficit in mortality from circulatory diseases (PMR = 83) and excess mortality from emphysema (PMR = 250) and motor vehicle accidents (PMR = 196). Further epidemiologic and industrial hygiene studies are needed to confirm the apparent excess mortality and to quantify occupational and nonoccupational exposures. However, reduction of recognized hazards among highway maintenance workers is a prudent precautionary measure.

Accidents, Occupational↗
PubMed1988

Occupational cancer in metalworking and transportation equipment industries.

Hazardous chemical exposures may be a more important public health problem in chemical-using industries, such as the metalworking and transportation equipment industries, than in chemical manufacturing plants. Recent studies have identified excess mortality from cancer among groups of workers in model and patternmaking, plating and die-cast, foundry, machining, electronics operations and vehicle assembly plants. The chemical agents or levels of exposure associated with these findings have not previously been thought to pose a cancer risk. Therefore, estimates of the fraction of cancers associated with workplace exposure may understate the importance of exposure in this setting.

Female↗
PubMed1988

Mortality among bearing plant workers exposed to metalworking fluids and abrasives.

Epidemiologic studies have reported associations between gastrointestinal cancer mortality and exposure to cutting fluids and abrasives in metal machining and precision grinding operations. Two previous studies found excess stomach cancer among workers exposed to water-based cutting fluids in bearing plants. This study reports similar findings in a third and larger population. Cause of death and work histories were determined for 1,766 bearing plant workers who died between Jan 1, 1950 and June 30, 1982. Mortality odds ratios (SMOR) and proportional mortality ratios (PMR) revealed significant excesses of gastrointestinal malignancies. The proportional mortality excess for stomach cancer among white men was greatest among those with more than 10 years' exposure in the major grinding group (PMR = 13/3.8 = 3.39; P less than .001). The SMOR by logistic regression for stomach cancer among white men was 2.3 (P = .02) for 25 years' grinding experience. For cancer of the pancreas among white men, there were significant associations with both machining and grinding jobs in straight oil (SMOR = 9.9 and 3.2, respectively, for 25 years duration). These findings could not be explained by confounding due to the ethnic background of the decedents. This study confirms previous evidence that grinding operations using water-based cutting fluids increase the risk for stomach cancer and provides moderate evidence that exposures to straight oil-cutting fluids increase the risk for cancer of the pancreas. There were indications, meriting further investigation, that non-malignant liver disease is associated with cutting fluid exposures and that lung cancer is associated with oil smoke from operations such as forging or heat treating.

Aluminum↗
PubMed1987

A behavioral evaluation of pest control workers with short-term, low-level exposure to the organophosphate diazinon.

Neurobehavioral effects of short-term, low-level exposure to diazinon were investigated among 99 pest control workers tested before and after their work shift with a computer-assisted neurobehavioral test battery. Each subject completed a brief neurological screening examination, a symptom questionnaire, and tests of concentration, eye-hand coordination, pattern recognition, visual memory, and finger tapping. The diazinon metabolite diethylthiophosphate (DETP) was measured in pre- and post-shift urine samples collected from 46 diazinon applicators applying granulated diazinon onto residential properties with lawn spreaders, and 56 non-applicators. Post-shift median DETP for applicators and non-applicators was 24 and 3 ppb, respectively. Full shift, whole body exposure to diazinon was quantitated for 19 subjects using personal air monitoring and passive badges. Median diazinon exposure for applicators and non-applicators was 2.1 and 0.03 mg, respectively. Mean duration of pesticide application was 39 days (SD = 12 days) before testing. No adverse DETP-related changes in pre- or post-shift neurobehavioral function were found with multiple linear regression models after adjusting for age, sex, education, and ethanol intake, although Symbol-Digit pairing speed was slower among the applicators as a group. The prevalence of 18 symptoms possibly related to diazinon exposure was not elevated among applicators. The study failed to demonstrate diverse behavioral effects of short-term, low-level diazinon exposure in a pest control program which emphasized personal protective equipment and direct supervision.

Adult↗
PubMed1986

Mortality among ferrous foundry workers.

Mortality analyses were carried out for 278 male hourly workers who were employed for at least 10 years at a gray iron foundry and who died between January 1, 1970 and December 31, 1981. Statistically significant excess proportional mortality due to non-malignant respiratory disease (SPMR = 177), lung cancer (SPMR = 148), and leukemia (SPMR = 284) was found among the 221 white males. Among nonwhite males there was a significant excess in proportional mortality due to circulatory diseases (SPMR = 143). White males in the Finishing classification experienced a significant excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 279) and lung cancer (SPMR = 179). White males in the Core Room classification experienced an excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 321). Case-control studies demonstrated a significant association between nonmalignant respiratory disease and the Finishing classification after controlling for the effects of age, prior occupations in coal mining or foundries, and smoking. A positive but nonsignificant association between lung cancer and Finishing was also found after controlling for age, prior work history, and smoking in case control studies.

Adult↗