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Tee L Guidotti

Publications and source records attributed to Tee L Guidotti.

At least 19 recordsLinked to original sources
PubMed2006

The big bang? An eventful year in workers' compensation.

Workers' compensation in the past two years has been dominated by events in California, which have been so fundamental as to merit the term big bang. Passage of Senate Bill 899 has led to a comprehensive program of reform in access to medical care, access to rehabilitation services, temporary and permanent disability, evidence-based management, dispute resolution, and system innovation. Two noteworthy developments thus arose: a new requirement for apportionment by cause in causation analysis, and the adoption of evidence-based criteria for impairment assessment, treatment guidelines, and, soon, utilization review. Elsewhere in the United States, changes were modest, but extensive legislative activity in Texas suggests that Texas will be next to make major changes. In Canada, the Workers' Compensation Board of British Columbia has adopted an ambitious strategic initiative, and there is a Canadawide movement to establish presumption for certain diseases in firefighters. Suggestions for future directions include an increased emphasis on prevention, integration of programs, worker participation, enhancing the expertise of health care professionals, evidence-based management, process evaluation, and opportunities for innovation.

British Columbia↗
PubMed2006

A case study of tire crumb use on playgrounds: risk analysis and communication when major clinical knowledge gaps exist.

Physicians and public health professionals working with the U.S. Environmental Protection Agency's Region 8 Pediatric Environmental Health Specialty Unit (PEHSU) received several telephone calls requesting information regarding the safety of recycled tire crumb as a playground surface constituent placed below children's play structures. There were no reported symptoms or adverse health effects in exposed children. The literature available on the safety and risk of exposure to crumb rubber constituents was limited and revealed no information quantifying exposures associated with product use. Callers were informed by the PEHSU that no evidence existed suggesting harm from intended use of the product, but gaps in knowledge about the product were identified and communicated. Here the case of crumb rubber on playgrounds is used as a model to present an approach to similar environmental medicine questions. From defining the question, to surveying traditional and nontraditional resources for information, synthesis of findings, and risk communication, the case provides a model to approach similar questions.

Child↗
PubMed2005

Ethics and skeptics: what lies behind ethical codes in occupational health.

OBJECTIVES: Ethical codes, or systems, are conditioned and their enforcement is permitted by social processes and attitudes. In occupational health, our efforts to adhere to our own ethical frameworks often are undermined by forces and interests outside the field. Failure to acknowledge the profoundly social nature of ethical codes impedes our ability to anticipate consequences, to legitimate decisions based on utility and benefit, and to find social structures that support, rather than invalidate, our view of ethical behavior. We examine three sets of social philosophies. METHODS: Jane Jacobs, the visionary urban planner, has written Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics, which is a restatement in modern terms of a critical passage in Plato's most important dialogue, the Republic. She (and Plato) postulate two major ethical systems, renamed here the "guardian system," which is characterized by loyalty, cohesiveness, and confidentiality, and the "marketplace system," which is characterized by trade, decentralization, and shared information. Occupational health, in this formulation, often runs afoul of the guardian mentality and also may be subject to inappropriate negotiation and compromise in the marketplace system. George Lakoff, a semiotician, has written Moral Politics: What Conservatives Know That Liberals Don't, which argues that there are two fundamental social paradigms based on concepts of the family. One, which he calls the Strict Father, emphasizes discipline, the positive aspects of taking risks, and the need to individuals to be self-sufficient. The other, which he calls the Nurturing Parent, emphasizes empowerment, the positive aspects of security, and the need for community and relationships. Occupational health practice violates aspects of both and therefore is supported by neither. Classical Chinese thought involved many schools of thought, including Confucianism and Legalism. It has been suggested that Confucianism provides little support for government regulation or occupational health, however this is questioned. CONCLUSIONS: Occupational health may improve its standing as a social priority by recognizing and maneuvering within social frameworks that accomodate it, rejecting social frameworks that invalidate it, and reinforcing positive cultural trends within society that support it.

China↗
PubMed2003

Comparison of two atmospheric-dispersion models to assess farm-site exposure to sour-gas processing-plant emissions.

We describe two approaches for exposure assessment that we used in a large-scale retrospective cattle study conducted in Alberta, Canada. Sulfur dioxide (SO(2)) was the surrogate measure of exposure to a complex mixture of combusted sour-gas emissions. Monthly air pollution dispersion modeling (1985-1994) (based on individual industrial source processing-plant engineering specifications, emission volumes, and meteorologic information) provided exposure isopleths of sulfur dioxide concentration from each of 231 sour-gas processing-plants across the province. In contrast, a simpler measure of proximity to source(s) of varying emission rates was applied in a geographical information system based on simplified pollution decay at increasing distances from each point source. Province-wide (663,000 km(2)) surface analysis (by exposure-level classification) produced a contingency coefficient of 0.68 between the two exposure estimates. Annual exposure estimates at the 1382 dairy and 5726 beef cow-calf farms studied were highly correlated over the 10-years period (r(spearman)=0.82 and 0.83, respectively), while monthly exposure estimates were somewhat less correlated (r(spearman)=0.80 and 0.82, respectively) for the two exposure assessment methods. Crude exposure estimates from each method were similar in both direction and magnitude.

Agriculture↗
PubMed2003

Atmospheric change: health/ecological linkages.

Human health studies emphasize the link between the human body and the immediate influences upon it. Ecosystem health studies (defined by David Rapport et al., this volume) has, as its primary objective, the relationships and system characteristics of viable ecosystems. As a practical application, ecosystem health studies describe the mechanisms and assesses the potential to threaten or enhance human health.

Ecology↗
PubMed2003

Toxicological evaluation for the hazard assessment of tire crumb for use in public playgrounds.

Disposal of used tires has been a major problem in solid waste management. New uses will have to be found to consume recycled tire products. One such proposed use is as ground cover in playgrounds. However, concern has been expressed regarding exposure of children to hazardous chemicals and the environmental impact of such chemicals. We designed a comprehensive hazard assessment to evaluate and address potential human health and environmental concerns associated with the use of tire crumb in playgrounds. Human health concerns were addressed using conventional hazard analyses, mutagenicity assays, and aquatic toxicity tests of extracted tire crumb. Hazard to children appears to be minimal. Toxicity to all aquatic organisms (bacteria, invertebrates, fish, and green algae) was observed; however, this activity disappeared with aging of the tire crumb for three months in place in the playground. We conclude that the use of tire crumb in playgrounds results in minimal hazard to children and the receiving environment.

Animals↗
PubMed2003

Occupational health and safety in the real "new economy".

The so-called New Economy of the 1990s failed to deliver its promise of clean work and huge leaps in productivity; what really happened was an intensification of economic pressures on marginal workers. The effects on employment include: increasing income disparities, fewer jobs that lead to viable career tracks, less secure employment, longer working hours, and higher risk of uncompensated unemployment. Workers who are either newly entering the workforce or who do not have the training or skills to trade up in employment are under pressure from falling middle- and lower-income wage scales and increasing income disparities. Their opportunities are increasingly limited, whether by seeking better-paying jobs with other employers or moving up the now-shortened ladder at one employer. They face a declining choice of employment opportunities and well-paying jobs that tend to be concentrated in residual dangerous work in manufacturing or service sub-sectors that are often small or economically marginal. These forces appear to be pushing workers into accepting jobs in the diminishing but still substantial number of jobs that remain that are dirty and dangerous, as illustrated by the extreme example of McWane Pipe. Those who are forced into these dangerous jobs will once again most likely be the poorly prepared, the new-entry, the recent immigrant, and the illiterate worker. National occupational injury statistics may conceal the experience of these marginal industries by aggregating them into much bigger economic sectors. To understand this phenomenon, we need studies that examine the social choices and tradeoffs involving employment from the point of view of the worker and develop a means of monitoring these tradeoffs.

Journal Article↗
PubMed2003

Associations between air emissions from sour gas processing plants and indices of cow retainment and survival in dairy herds in Alberta.

This paper describes the results of an investigation into the effects of air emissions from sour gas processing plants on indices of retainment or survival of adult female dairy cattle on farms in Alberta; namely, the productive lifespan of individual animals, and annual herd-level risks for culling and mortality. Using a geographical information system, 2 dispersion models--1 simple and 1 complex--were used to assess historical exposures to sour gas emissions at 1382 dairy farm sites from 1985 through to 1994. Multivariable survival models, adjusting for the dependence of survival responses within a herd over time, as well as potential confounding variables, were utilized to determine associations between sour gas exposure estimates and the time from the first calving date to either death or culling of 150210 dairy cows. Generalized linear models were used to model the relationship between herd-level risks for culling and mortality and levels of sour gas exposure. No significant (P < 0.05) associations were found with the time to culling (n = 70052). However, both dispersion model exposure estimates were significantly associated (P < 0.05) with a decreased hazard for mortality; that is, in cases where cattle had died on-farm (n = 8743). There were no significant associations (P > 0.05) between herd culling risks and the 2 dispersion model exposure estimates. There was no measurable impact of plant emissions on the annual herd risk of mortality.

Air Pollutants↗
PubMed2002

The 'morality' of occupational health.

Both ethics and law are based on value systems. George Lakoff has contributed to our understanding of the value systems that influence attitudes toward public issues in his book, Moral Politics: What Conservatives Know That Liberals Don't (University of Chicago Press, 1996). He argues that two antagonistic but co-existing moral systems influence attitudes toward public issues. Both are derived from metaphors of family life and child development and the "morality" of allowing certain actions. One moral system stresses individual responsibility and risk-taking, the other empathy and mutual assistance. The tension between these value systems explains much in political debate; issues generally tend to fall on one side or the other. Occupational health and related issues, almost uniquely, have the unfortunate characteristic of falling short in both. Our best efforts may be judged "immoral" by the strictest interpretations of both systems, even when they are successful. The practical implication is that we must not accept this pattern of thinking. The work relationship is not like a family. It is important to separate issues in occupational health from this pattern of thinking in both professional and public discourse.

Journal Article↗
PubMed2002

Apportionment in asbestos-related disease for purposes of compensation.

Workers' compensation systems attempt to evaluate claims for occupational disease on an individual basis using the best guidelines available to them. This may be difficult when there is more than one risk factor associated with the outcome, such as asbestos and cigarette smoking, and the occupational exposures is not clearly responsible for the disease. Apportionment is an approach that involves an assessment of the relative contribution of work-related exposures to the risk of the disease or to the final impairment that arises for the disease. This article discusses the concept of apportionment and applies it to asbestos-associated disease. Lung cancer is not subject to a simple tradeoff between asbestos exposure and smoking because of the powerful biological interaction between the two exposures. Among nonsmokers, lung cancer is sufficiently rare that an association with asbestos can be assumed if exposure has occurred. Available data suggest that asbestos exposure almost invariably contributes to risk among smokers to the extent that a relationship to work can be presumed. Thus, comparisons of magnitude of risk between smokers and nonsmokers are irrelevant for this purpose. Indicators of sufficient exposure to cause lung cancer are useful for purposes of establishing eligibility and screening claims. These may include a chest film classified by the ILO system as 1/0 or greater (although 0/1 does not rule out an association) or a history of exposure roughly equal to or greater than 40 fibres/cm3 x y. (In Germany, 25 fibres/cm3 x y is used.) The mere presence of pleural plaques is not sufficient. Mesothelioma is almost always associated with asbestos exposure and the association should be considered presumed until proven otherwise in the individual case. These are situations in which only risk of a disease is apportioned because the impairment would be the same given the disease whatever the cause. Asbestosis, if the diagnosis is correct, is by definition an occupational disease unless there is some source of massive environmental exposure; it is always presumed to be work-related unless proven otherwise. Chronic obstructive airways disease (COAD) accompanies asbestosis but may also occur in the context of minimal parenchymal fibrosis and may contribute to accelerated loss of pulmonary function. In some patients, particularly those with smoking-induced emphysema, this may contribute significantly to functional impairment. An exposure history of 10 fibre x years is suggested as the minimum associated with a demonstrable effect on impairment, given available data. Equity issues associated with apportionment include the different criteria that must be applied to different disorders for apportionment to work, the management of future risk (eg. risk of lung cancer for those who have asbestosis), and the narrow range in which apportionment is really useful in asbestos-associated disorders. Apportionment, attractive as it may be as an approach to the adjudication of asbestos-related disease, is difficult to apply in practice. Even so, these models may serve as a general guide to the assessment of asbestos-related disease outcomes for purposes of compensation.

Asbestos↗
PubMedDate not supplied

Occupational injuries among emergency medical services personnel.

BACKGROUND: Emergency medical services (EMS) personnel treat 22 million patients a year in the United States, yet little is known of their injury risks. OBJECTIVES: To describe the epidemiology of occupational injuries among EMS personnel, calculate injury rates, and compare the findings with those for other occupational groups. METHODS: This was a retrospective review of injury records kept by two urban agencies. The agencies submitted all 617 case reports for three periods between January 1, 1998, and July 15, 2002. The agency personnel worked an estimated 2,829,906 hours during the study periods. Cases were coded according to U.S. Department of Labor (DOL) criteria. RESULTS: Four hundred eighty-nine cases met the DOL inclusion criteria. The overall injury rate was 34.6 per 100 full-time (FT) workers per year (95% confidence interval [CI] 31.5-37.6). "Sprains, strains, and tears" was the leading category of injury; the back was the body part most often injured. Of the 489 cases, 277 (57%) resulted in lost workdays, resulting in a rate of 19.6 (95% CI 17.3-21.9) per 100 FT workers; in comparison, the relative risks for EMS workers were 1.5 (95% CI 1.35-1.72) compared with firefighters, 5.8 (95% CI 5.12-6.49) compared with health services personnel, and 7.0 (95% CI 6.22-7.87) compared with the national average. CONCLUSIONS: The injury rates for EMS workers are higher than rates reported by DOL for any industry in 2000. Funding and additional research are critical to further defining the high risks to EMS workers and developing interventions to mitigate this serious problem.

Accidents, Occupational↗