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National Institute for Occupational Safety and Health World Health Organization ) NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH WORLD HEALTH ORGANIZATION A JOINT PUBLICATION on TEA CHI N G E P IDE M I 0 LOG YIN o C CUP A T ION A L H E A L T H / May 1987 , DHHS (NIOSH) Publication No. 87-112 ) ) PREFACE During the 1980s, the National Institute for Occupational Safety and Health (NIOSH) has helped to protect and preserve the health of workers in developing countries . The World Health Organization (WHO) is also dedicated to this end, and through its Programme of Action on Worker ' s Health has sought to protect and promote the health of working populations throughout the world. In reaching toward these objectives, NIOSH and WHO have been able to collaborate on several projects . One project has now resulted in this text, A Joint Publication on Teaching Epidemiology in Occupational Safety and Health. This volume focuses on the need to train occupational epidemiologists in the recognition and evaluation of occupational diseases and injuries. It is a training tool that uses the case approach to instruct epidemiolgists. It is with pride that we publish this boo of case studies ~ an aid to both epidemiologists and the many work rs w 0 will benefit f o'/t'eir services. ,! ,, . J i / 4" ;1 ;; ~ / tj· C,'L/ ~ J nald Millar, M.D., D.T.P.H. (Lo d.) sistant Surgeon General - irector, National Institute for Occupational Safety and Health . Centers for Disease Control United States of America ) ) A 1 TEACHING EPIDEMIOLOGY IN OCCUPATIONAL HEALtH ) INDEX SECTION CONTENT AUTHOR YEAR A INDEX PREFACE EDITORS AUTHORS MEETING PARTICIPANTS CONTENT OF CASES DISTRIBUTION OF USERS INTRODUCTION B VINYL CHLORIDE AND LUNG CANCER HENRY FALK 1975 RICHARD WAXWEILER CLARK HEATH Revised 1983 C OCCUPATIONAL NEUROLOGICAL DISEASE PHILIP J. LANDRIGAN 1979 Revised 1985 D LUNG CANCER IN CHEMICAL WORKERS WILLIAM HALPERIN 1979 Revised 1985 ) E URINARY SYMPTOMS IN POLYURETHANE KATHLEEN KREISS 1983 FOAM WORKERS Revised 1985 F GYNAECOMASTIA IN ESTROGEN EXPOSED J . MALCOLM HARRINGTON 1983 WORKERS Revised 1985 G LEAD AND RENAL ABNORMALITIES MICHAEL THUN 1983 EDWARD BAKER H WASHINGTON SURVEILLANCE PROGRAMME SAM MILHAM 1983 ARSENIC EXPERIENCE - A CASE STUDY Revised 1985 I MALE OCCUPATIONAL REPRODUCTIVE M. DONALD WHORTON 1983 DISEASE J MESOTHELIOMA IN RAILROAD WORKERS MARTIN SEPULVEDA 1983 Revised 1985 K HYPERSENSITIVITY PNEUMONITIS IN AN MICHAEL HODGSON 1983 OFFICE BUILDING (A new form of PHILIP R. MOREY occupational lung disease) L CANCER MORTALITY IN A DIE r::ASTING MICHAEL A. SILVERSTEIN 1983 AND ELECTROPLATING PLANT Revised 1985 M LEUKAEMIA IN NUCLEAR SHIPYARD MICHAEL THUN 1983 WORKERS (Uses and pitfai1s of JAY BEAUMONT proport iona1 mortality studies) Revised 1985 A 2 N MINING, SMOKING AND LUNG CANCER OLAV AXELSON 1985 (Problems of interaction and quantification of risk) 0 MORTALITY STUDY TESTING A POSSIBLE PIER A. BERTAZZI 1984 ASSOCIATION BETWEEN OCCUPATIONAL Revised 1985 EXPOSURE TO FORMALDEHYDE AND CANCER P EXPOSURE-RESPONSE; RELATIONSHIP SVEN HERNBERG 1984 BETWEEN EXPOSURE STYRENE AND CENTRAL HANNU HARKONEN NERVOUS FUNCTIONS Revised 1985 Q OCCUPATIONAL ASTHMA DUE TO DEAN BAKER 1985 PLATINUM SALTS Revised Dec 1985 R PESTICIDE POISONING AMONG J. JEYARATNAM 1985 ANTIMALARIA WORKERS Revised Dec 1985 S CHRONIC RESPIRATORY DISEASE IN GAMAL EL-SAMRA 1985 COTTON TEXTILE WORKERS Revised Dec 1985 T FARMER' SLUNG GU XUE-QI 1985 LU PEI-LIAN SHEN YI-E U EPIDEMIOLOGY IN PLANNING AND M.A. EL 8ATAWI 1985 DEVELOPMENT OF OCCUPATIONAL HEALTH C. HUSBUMRER SERVICES A 3 ) William Halperin Editor Michael Thun Associate Editor EDITORIAL COHMITTEE CHAIRMAN Mostafa E1 Batawi 1986- William Halperin 1979-1985 MEMBERS Hilliam Halperin 1979- Michael Thun 1983- Mostafa Batawi 1984- Sven Hernberg 1984- AUTHORS OLAV AXELSON, M.D. DEPARTMENT OF OCCUPATIONAL HEALTH UNIVERSITY HOSPITAL S-58185 LINKOPING SWEDEN DEAN BAKER, M.D. SCHOOL OF PUBLIC HEALTH UNIVERSITY OF CALIFORNIA LOS ANGELES, CALIFORNIA 90024 USA EDWARD BAKER, M.D. NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH 1600 CLIFTON ROAD ATLANTA, GEORGIA 30333 USA MOSTAFA EL BATAWI, M.D., SC.D. CHIEF OCCUPATIONAL HEALTH WORLD HEALTH ORGANIZATION CH- 1211 GENEVA 27 SWITZERLAND JAY BEAUMONT, PH.D. OCCUPATIONAL AND ENVIRONMENTAL UNIT UNIVERSITY OF CALIFORNIA DAVIS, CALIFORNIA 95616 USA A 4 PIER A. BERTAZZI, M.D. INSTITUTO DI MEDICINA DEL LAVORO UNIVERSITA' DEGLI STUDI VIA S. BARNABA, 8 1-20122 MILAN ITALY HENRY FALK, M.D. CENTER FOR ENVIRONMENTAL HEALTH 1600 CLIFTON ROAD ATLANTA, GEORGIA 30333 USA GU XUE-QI, M.D. SCHOOL OF PUBLIC HEALTH SHANGHAI FIRST ~mDICAL COLLEGE SHANGHAI 200032 PEOPLE'S REPUBLIC OF CHINA WILLIAM HALPERIN, M.D. NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH 4676 COLUMBIA PARKWAY CINCINNATI, OHIO 45226 USA HANNU HARKONEN, PH. D . INSTITUTE OF OCCUPATIONAL HEALTH HAARTMANINKATU 1 SF-00290 HELSINKI FINLAND MALCOLM HARRINGTON, M.B.B.S. INSTITUTE OF OCCUPATIONAL HEALTH UNIVERSITY OF BIRMINGHAM P.O. BOX 363 BIRMINGHAM BL5 2TT ENGLAND CLARK HEALTH, M.D. DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL J MARION SIMS BUILDING 2600 BULL ST. COLUMBIA, SOUTH CAROLINA 29201 USA A 5 SVEN HERNBERG, M.D. INSTITUTE OF OCCUPATIONAL HEALTH HAARTMANINKATU 1 SF-00290 HELSINKI FINLAND MICHAEL HODGSON, M.D. FALK CLINIC, UNIVERSITY OF PITTSBURGH 3601 FIFTH AVE PITTSBURGH, PENNSYLVANIA 15213 USA J. JEYARATNAM, M.B.B.S. DEPARTMENT OF SOCIAL MEDICINE AND PUBLIC HEALTH NATIONAL UNIVERSITY OF SINGAPORE OUTRAM HILL SINGAPORE 0316 REPUBLIC OF SINGAPORE KATHLEEN KREISS, M.D. NATIONAL JE1ITSH HOSPITAL AND RESEARCH CENTER 3800 E. COLFAX AVE DENVER, COLORADO 80206 USA PHILIP J. LANDRIGAN, M.D. THE MOUNT SINAI MEDICAL CENTER DIVISION OF ENVIRONMENTAL AND OCCUPATIONAL MEDICINE ONE GUSTAVE L. LEVY PLACE NEW YORK, NEW YORK 10029 USA LU PEI-LlAN, M.D. SCHOOL OF PUBLIC HEALTH SHANGHAI 8 FIRST MEDICAL COLLEGE SHANGHAI 200032 PEOPLE'S REPUBLIC OF CHINA SAM MILHA~, M.D. WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES ET 13 OLYMPIA, WASHINGTON 98504 USA A 6 PHILIP MOREY, PH.D. NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALT~ 944 CHESTNUT RIDGE ROAD MORGANTOWN, WEST VIRGINA 26505 USA GAMEL F.L-SAMRA, M.D. PROF. OF OCCUPATIONAL HEALTH UNIVERSITY OF CAIRO KASR-EL-EINI CAIRO EGYPT MARTIN-JOSE SEPULVEDA, M.D. NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH 944 CHESTNUT RIDGE ROAD MORGANTOWN, WEST VIRGINA 26505 USA SHEN YI -E, M.D. SCHOOL OF PUBLIC HEALTH SHANGHAI 8 FIRST MEDICAL COLLEGE SHANGHAI 200032 PEOPLES REPUBLIC OF CHINA MICHAEL SILVERSTEIN, M.D. UNITED AUTO WORKERS 8000 EAST JEFFERSON AVENUE DETROIT, MICHIGAN 48214 USA MICHAEL THUN, M.D. NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH 4676 COLUMBIA PARKWAY CINCINNATI, OHIO 45226 USA RICHARD WAXWEILER, PH.D. CENTER FOR ENVIRONMENTAL HEALTH 1600 CLIFTON ROAD ATLANTA, GEORGIA 30333 USA DONALD IVIIORTON, M.D. ENVIRONMENTAL HEALTH ASSOCIATES 2150 SHATTUCK STREET BERKELEY, CALIFORNIA 94704 USA A 7 PARTICIPANTS at the Interregional Workshop on Occupational Epidemiology WHO/EMRO, Alexandria, 25-29 November 1984 1) Professor Olav Axelson Department of Occupational Medicine University Hospital S-581 85 Linkoping Sweden 2) Dr Pier Alberto Bertazzi Associte Professor of Occupational Medicine Institute of Occupational Health Cl1nica del Lavoro "L. Devoto" University of Milan Via San Barnaba 8 20122 Milan Italy 3) Dr Patricia Buffler* Associate Dean for Research School of Public Health The University of Texas Health Science Center at Houston P.O. Box 201 86 Houston, Texas 77225 United States of America 4) Dr J. Jeyaratnam Department of Soc"al Me dicine and Public Health National University of Singapore Outram Hill Singapore 0316 Republic of Singapore 5) Professor GU Xue-Qi Director, Department of Industrial Health and Deputy Dean, School of Public Health Shanghai First Medical College Foon Lin Chiao Shanghai 200032 People's Republic of China * Unable to attend. A 8 ) 6) Dr William Halperin Chief, Industrywide Studies Branch National Institute of Safety and Health Robert A. Taft Laboratoriesf 4676 Columbia Parkway Cincinnati, Ohio 45226 United States of America 7) Dr Sven Hernberg Scientific Director Institute of Occupational Health Haartmaninkatu 1 SF-00290 Helsinki 29 Finland 8) Professor Gamal El-Samra Professor of Occupational Health University of Cairo Kasr-el-Eini Cairo Egypt 9) Professor Madbuli H. Noweir Head, Department of Occupational Health High School of Public Health 165, El-Horreya Avenue Alexandria Egypt 10) Dr Michael Thun Chief, Epidemiology Section Industrywide Studies Branch National Institute of Safety and Health Robert A. Taft Laboratories 4676 Columbia Parkway Cincinnati, Ohio 45226 United States of America 11) Dr M.A. El-Batawi Chief Medical Officer Office of Occupational Health World Health Organization 1211 Geneva 27 Switzerland 12) Dr M.A. Khalil Regional Adviser on Occupational Health World Health Organization Regional Office for the Eastern Mediterranean Alexandria Egypt ) A 9 ) CONTENT OF CASES SECTION B C D E CONTENT I SUBJECT VINYL OCCUPATIONAL LUNG URINARY CHLORIDE NEUROLOGY CANCER SYMPTOMS STUDY DESIGN CROSS SECTIONAL 3 3 COHORT 1 1 PROPORTIONAL 1 1 CASE CONTROL OTHER C0NCEPTUAL ISSUES CLUSTER INVESTIGATION 3 3 3 3 SCREENING 1 SURVEILLANCE 1 LATENCY 1 PERSON-YEARS 2 EXPOSURE ASSESSMENT 1 1 1 CHOOSING A COMPARISON POPULATION 3 POWER DATA ANALYSIS SIGNIFICANCE TESTING 2 CONFIDENCE INTERVALS 1 STRATIFIED ANALYSIS 1 REGRESSION DEGREE OF DIFFICULTY 2 1 3 1 -- = NOT APPLICABLE; 1 = LOW; 2 MEDIUM; 3 HIGH A 10 CONTENT OF CASES ) F G H I GYNAECO LEAD! ARSENIC MALE/ MASTIA RENAL REPRODUCTIVE STUDY DESIGN CROSS SECTIONAL 2 3 3 COHORT 1
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