Abstract
We performed a medical audit of an asbestos disease screening program offered to New York City sheet metal workers by a corporate medical service. The screening program purported to evaluate the health status of workers exposed to asbestos in the past and present during construction and renovation of commercial buildings. Using current Occupational Safety and Health Administration (OSHA) regulations as a benchmark, medical records for more than 800 workers who took the examination between 1982-83 were reviewed; x-ray interpretations of the staff radiologist were compared with the interpretations of specialists in occupational lung diseases. The audit found inadequate record-keeping procedures, a lack of a comprehensive occupational history, poor notification and absence of any form of health education. Further, there was an extreme lack of concordance between the staff radiologist and the specialist readers in the interpretation of x-rays (kappa = .14 for pleural disease and .26 for asbestosis). To an increasing extent, occupational clinical services are being provided by corporate medical groups; such groups may not be familiar with occupational health problems.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Baker E. L., Dagg T., Greene R. E. Respiratory illness in the construction trades. I. The significance of asbestos-associated pleural disease among sheet metal workers. J Occup Med. 1985 Jul;27(7):483–489. [PubMed] [Google Scholar]
- Guidotti T. L., Kuetzing B. H. Competition and despecialization: an analytical study of occupational health services in San Diego, 1974-1984. Am J Ind Med. 1985;8(2):155–165. doi: 10.1002/ajim.4700080210. [DOI] [PubMed] [Google Scholar]
- Jenkins G., Kotelchuck D. Is there a doctor in the shop? The role of the company doctor. Health PAC Bull. 1979 Sep;11(1):8–13. [PubMed] [Google Scholar]
- McCunney R. J. A hospital-based occupational health service. J Occup Med. 1984 May;26(5):375–380. doi: 10.1097/00043764-198405000-00012. [DOI] [PubMed] [Google Scholar]
- Musch D. C., Landis J. R., Higgins I. T., Gilson J. C., Jones R. N. An application of kappa-type analyses to interobserver variation in classifying chest radiographs for pneumoconiosis. Stat Med. 1984 Jan-Mar;3(1):73–83. doi: 10.1002/sim.4780030109. [DOI] [PubMed] [Google Scholar]
- Orris P., Kennedy M. J., Guerriero J., Hessl S. M., Hryhorczuk D. O., Hoffman D. Activities of an employer independent Occupational Medicine Clinic, Cook County Hospital, 1979-1981. Am J Public Health. 1982 Oct;72(10):1165–1167. doi: 10.2105/ajph.72.10.1165. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Paik N. W., Walcott R. J., Brogan P. A. Worker exposure to asbestos during removal of sprayed material and renovation activity in buildings containing sprayed material. Am Ind Hyg Assoc J. 1983 Jun;44(6):428–432. doi: 10.1080/15298668391405085. [DOI] [PubMed] [Google Scholar]
- Reger R. B., Morgan W. K. On the factors influencing consistency in the radiologic diagnosis of pneumoconiosis. Am Rev Respir Dis. 1970 Dec;102(6):905–915. doi: 10.1164/arrd.1970.102.6.905. [DOI] [PubMed] [Google Scholar]
- Reitze W. B., Nicholson W. J., Holaday D. A., Selikoff I. J. Application of sprayed inorganic fiber containing asbestos: occupational health hazards. Am Ind Hyg Assoc J. 1972 Mar;33(3):178–191. doi: 10.1080/0002889728506628. [DOI] [PubMed] [Google Scholar]
- Rosenstock L., Heyer N. H. Emergence of occupational medical services outside the workplace. Am J Ind Med. 1982;3(2):217–223. doi: 10.1002/ajim.4700030213. [DOI] [PubMed] [Google Scholar]
- Rosenstock L. Hospital-based, academically affiliated occupational medicine clinics. Am J Ind Med. 1984;6(2):155–158. doi: 10.1002/ajim.4700060209. [DOI] [PubMed] [Google Scholar]
- Weill H., Jones R. The chest roentgenogram as an epidemiologic tool. Report of a workshop. Arch Environ Health. 1975 Sep;30(9):435–439. doi: 10.1080/00039896.1975.10666744. [DOI] [PubMed] [Google Scholar]
- Zoloth S., Michaels D. Asbestos disease in sheet metal workers: the results of a proportional mortality analysis. Am J Ind Med. 1985;7(4):315–321. doi: 10.1002/ajim.4700070407. [DOI] [PubMed] [Google Scholar]