Occupational Health Report - New York State Department Of Health
New York StateOCCUPATIONALClinic Network Report1988–2003New York State Department of Health Bureau of Occupational Health
Table of ContentsSource of Patient Referral .20Occupations of Clinic Patients .21Industries of Clinic Patients .22Table of Contents - Tables . iiTable of Contents - Figures .iiiExecutive Summary .viiChapter 3. Diagnoses, Selected Illnesses andConditions of Patients . 25Chapter 1. Background . 1Occupational Health Clinic Network Goals .2Scope of Report .2Services .2Clinical Services .2Industrial Hygiene Services .2Social Work Support Services.4Preventive Services .4Services to Special Populations .5World Trade Center Worker and VolunteerMedical Screening Program .5Low Income Populations .5Improving the Treatment and Management ofOccupational Disease in NYS .6Clinical Practice Reviews .6Quality Assurance/Quality Improvement.8Education and Outreach to theMedical Community .9Migrant Farmworker Clinics .9Emergency Response .9Disease Monitoring .9Community Benefits .10Occupational Health Clinic Network Data .11Definitions of Terms .11References.12Infectious and Parasitic Diseases(ICD-9-CM Codes 001-139) .27Neoplasms (ICD-9-CM Codes 140-239) .28Endocrine, Nutritional, and Metabolic Diseasesand Immunity Disorders(ICD-9-CM Codes 240-279) .29Mental Disorders (ICD-9-CM Codes 290-319) .30Diseases of the Nervous System and Sense Organs(ICD-9-CM Codes 320-389) .33Diseases of the Circulatory System(ICD-9-CM Codes 390-459) .36Diseases of the Respiratory System(ICD-9-CM Codes 460-519) .37Work-related Asthma .39Diseases of the Digestive System(ICD-9-CM Codes 520-579) .40Diseases of the Skin and Subcutaneous Tissue(ICD-9-CM Codes 680-709) .41Contact Dermatitis .41Diseases of the Musculoskeletal System and ConnectiveTissue (ICD-9-CM Codes 710-739) .42Symptoms, Signs and Ill-defined Conditions(ICD-9-CM Codes 780-799) .44Injuries and Poisonings(ICD-9-CM Codes 800-999) .45Diseases of Other Systems .46V-Codes ((ICD-9-CM Codes V01-V84) .47References.47Chapter 2. Patient Characteristics . 13Magnitude and Trend of Patient Population .13County of Residence .14Group Screening Patients .15Sex of Patient Population-Females .15Age of Patient Population .17Ethnicity of Patient Population.18Source of Payment for Services .20Chapter 4. Patient Exposures . 49iExposures to Mineral and Inorganic Dusts .51Non-specified Dusts or Asbestos .53Exposures to Metals and Metalloids .54Exposures to Miscellaneous Inorganic Compounds .55Exposures to Non-specified Hydrocarbons .55Exposures to Miscellaneous Chemicals and Materials .56
High-Risk Exposures .92Lead .92Asbestos .93Physical/Ergonomic Work Factors .93NYS Workforce Projections .93References.94Exposures to Pyrolysis Products .57Exposures to Physical Factors.58Exposures to Ergonomic Factors .59Exposures to Microorganisms .60References.60Chapter 5. Industries and Occupationsof Patients . 61Chapter 7. Future Challenges . 95Industries .65Agriculture, Forestry and Fishing(SIC Codes 01-09) .65Mining (SIC Codes 10-14).66Construction (SIC Codes 15-17) .67Manufacturing (SIC Codes 20-39) .68Transportation (SIC Codes 40-49) .69Wholesale Trade (SIC Codes 50-51) .71Retail Trade (SIC Codes 52-59) .73Finance, Insurance and Real Estate(SIC Codes 60-67) .75Services (SIC Codes 70-89) .76Public Administration (SIC Codes 91-97) .78Occupations .80Managerial and Professional Specialty Occupations(Codes 003-199) .80Technical, Sales and AdministrativeSupport Occupations (Codes 203-389) .81Service Occupations (Codes 403-469) .82Farming, Forestry and Fishing Occupations(Codes 473-499) .82Precision Production, Craft and Repair Occupations(Codes 503-699) .83Operators, Fabricators and Laborers(Codes 703-889) .84References.85Clinical Services.95Prevention Services .96Workforce Issues .96High Risk Exposures .96Outreach .97Research .97Supply of Occupational Health Professionals in NYS .97References.98Index .99Table of Contents - Tables1.1. Number of Industrial Hygiene Site Visits Conductedby the NYS Occupational Health Clinic Network in2003, by Industry .31.2. Audit Criteria for Each Clinical Practice Review .61.3. Summary of Outreach Activities Conducted by theNew York State Occupational Health ClinicNetwork in 2003.106.1. Percent Distribution of NYS Employed Personsby Occupation and Race, 2002 .886.2. Percent of Employment, by Industry, 1996-2002 –US, NYS without NYC and NYC.906.3. Five-year Average Fatality Rate, by Industry,1995-1999 – US, NYS without NYC and NYC .916.4. Number of Adults with Blood Lead Levels 25 μg/dLor Greater, Reported to the New York State HeavyMetals Registry, by Occupational Status, by Year.92Chapter 6. New York State Workforce . 87Race and Ethnicity .87Hispanics and Foreign-Born .88African-Americans .88Age. .89Older Workers .89Teen Workers.89Women in the Labor Force .89Minimum-Wage Workers .90Low Income Workers .90High-Risk Industries and Occupations .90ii
Table of Contents - Figures3.5. Percent of Neoplasm Diagnoses in NYS OHCNPatients, by Type of Neoplasm .283.6. Number of Endocrine, Nutritional, and MetabolicDisease and Immunity Disorder Diagnoses in NYSOHCN Patients, by Year.293.7. Number of Mental Disorder Diagnoses in NYSOHCN Patients, by Year and World Trade Center(WTC) Status . 303.8. Number of Work-related Mental Disorder Diagnosesin NYS OHCN Patients, by Industry of Employmentand World Trade Center (WTC) Status . 313.9. Percent of Mental Disorder Diagnoses in NYSOHCN Patients, by Type of Disorder andWorld Trade Center (WTC) Status. .323.10. Number of Diagnoses of Diseases of the NervousSystem and Sense Organs in NYS OHCN Patients,by Year .333.11. Percent of Diagnoses of Diseases of the NervousSystem and Sense Organs in NYS OHCN Patients,by Type of Disease and Sex .343.12. Number of NYS OHCN Patient Visits for Diseasesof the Nervous System and Sense Organs, by Year .353.13. Number of Circulatory System Disease Diagnosesin NYS OHCN Patients, by Year .363.14. Type of Group Screening for NYS OHCN PatientsDiagnosed with Diseases of the Circulatory System .363.15. Number of Respiratory Disease Diagnoses in NYSOHCN Patients, by Year and World Trade Center(WTC) Status .373.16. Number of NYS OHCN Patient Visits for Diseasesof the Respiratory System, by Year and World TradeCenter (WTC) Status .373.17. Percent of Work-related Respiratory DiseaseDiagnoses in NYS OHCN Patients, by Type ofDisease and World Trade Center Status (WTC) .383.18. Percent of Work-related Asthma Diagnoses in NYSOHCN Patients, by Industry of Employment andWorld Trade Center (WTC) Status .393.19. Number of Work-related Asthma Diagnoses in NYSOHCN Patients, not World Trade Center (WTC)Related, by Source of Exposure .403.20. Number of Digestive System Disease Diagnosesin NYS OHCN Patients, by Year and World TradeCenter (WTC) Status .401.1.2.1.2.2.2.3.2.4.Location of NYS Occupational Health Clinics .1Number of New NYS OHCN Patients Seen, by Year.13Percent of NYS OHCN Patients, by Type Seen .14Residence of NYS OHCN Patients, by County .14Percent of NYS OHCN Patients,by Geographic Region.152.5. Percent of Female NYS OHCN Patients,by Geographic Region.152.6. Percent of NYS OHCN Patients, by Sex,Geographic Region and Patient Type .162.7. Percent of NYS OHCN Patients, by Age .172.8. Percent of NYS OHCN Patients, by Type and Age .172.9. Percent of NYS OHCN Patients, by Ethnicityand Geographic Region .182.10. Percent of NYS OHCN Patients, by Ethnicity,Geographic Region and Year .192.11. Percent of NYS OHCN Patients, by Sourceof Payment and Patient Type.202.12. Percent of NYS OHCN Patients, by ReferralSource and Patient Type .202.13. Percent of NYS OHCN Patients, by ReferralSource and Geographic Region .212.14. Percent of Occupational NYS OHCN Patients,by Major Occupational Group and Patient Type.212.15. Percent of Occupational NYS OHCN Patients, byMajor Occupational Groupand Geographic Region.222.16. Percent of Occupational NYS OHCN Patients,by Major Industrial Group and Patient Type.222.17. Percent of Occupational NYS OHCN Patients,by Major Industrial Group and Geographic Region .233.1. Number of Diagnoses in NYS OHCN Patients, byMain ICD-9-CM Diagnostic Categories and Sex.263.2. Number of Infectious and Parasitic DiseaseDiagnoses in NYS OHCN Patients, by Year .273.3. Percent of Infectious and Parasitic Disease Diagnosesin NYS OHCN Patients, by Type of Disease andWork-relatedness.273.4. Number of Diagnoses of Neoplasms in NYS OHCNPatients, by Year .28iii
4.8. Number of NYS OHCN Exposures toMiscellaneous Chemicals and Materials, by Year .564.9. Percent of NYS OHCN Exposures to MiscellaneousChemicals and Materials, by Type of Chemicalor Material .564.10. Number of NYS OHCN Exposures toPyrolysis Products, by Year .574.11. Number of NYS OHCN Exposures toPhysical Factors, by Year .584.12. Percent of NYS OHCN Exposures to PhysicalFactors, by Physical Factor and Patient Type .584.13. Number of NYS OHCN Exposures to ErgonomicFactors, by Year .594.14. Percent of NYS OHCN Exposures to ErgonomicFactors, by Type of Factor .594.15. Number of NYS OHCN Exposures toMicroorganisms, by Year .605.1. Industries of Employment of NYS OHCN Patients,by Patient Type .625.2. Occupations of Employment of NYS OHCNPatients, by Patient Type .625.3. Percent of Industry of Employment of NYS OHCNPatients, by Sex .635.4. Geographic Region of Residence of NYS OHCNPatients, by Industry .645.5. Diagnoses Among NYS OHCN Patients Workingin the Agriculture, Forestry and Fishing Industry,by Patient Type .655.6. Exposures Among NYS OHCN SymptomaticPatients Working in the Agriculture, Forestry andFishing Industry .655.7. Diagnoses Among NYS OHCN Patients Workingin the Mining Industry, by Patient Type .665.8. Exposures Among NYS OHCN Patients Workingin the Mining Industry.665.9. Diagnoses Among NYS OHCN Patients Workingin the Construction Industry, by Patient Type .675.10. Exposures Among NYS OHCN Patients Workingin the Construction Industry .675.11. Diagnoses Among NYS OHCN Patients Workingin the Manufacturing Industry, by Patient Type .685.12. Exposures Among NYS OHCN Patients Workingin the Manufacturing Industry .683.21. Number of Skin and Subcutaneous Tissue DiseaseDiagnoses in NYS OHCN Patients, by Year andWork-relatedness .413.22. Number of Contact Dermatitis Diagnoses in NYSOHCN Patients, by Source of Exposure .413.23. Number of Musculoskeletal System and ConnectiveTissue Disease Diagnoses in NYS OHCN Patients,by Year .423.24. Percent of Work-related Musculoskeletal Systemand Connective Tissue Disease Diagnoses, in NYSOHCN Patients, by Occupation and Ethnicity.423.25. Percent of Musculoskeletal System and ConnectiveTissue Disease Diagnoses in NYS OHCN Patients,by Type of Disease .433.26. Number of Symptoms, Signs and Ill-definedCondition Diagnoses in NYS OHCN Patients,by Year and World Trade Center (WTC) Status .443.27. Number of Injury and Poisoning Diagnoses inNYS OHCN Patients, by Year .453.28. Percent of Injury and Poisoning Diagnoses in NYSOHCN Patients, by Type of Injury or Poisoning .453.29. Number of Diagnoses of Diseases in all OtherCategories in NYS OHCN Patients, by Year .463.30. Number of Diagnoses for Patients Not CurrentlySick, Seen for a Specific Purpose in NYS OHCNPatients, by Year .474.1. Percent of NYS OHCN Exposures, by ExposureCategory and Sex .504.2. Number of NYS OHCN Exposures to Mineral andInorganic Dust, by Year, World Trade Center (WTC)Status and Patient Type .514.3. Percent of NYS OHCN Exposures to Mineral andInorganic Dusts, by Type of Respiratory DiseaseDiagnosis and World Trade Center (WTC) Status .524.4. Percent of NYS OHCN Exposures to Non-specifiedDusts or Asbestos, not World Trade Center (WTC)Related, by Industry .534.5. Number of NYS OHCN Exposures to Metals andMetalloids, by Year .544.6. Number of NYS OHCN Exposures to MiscellaneousInorganic Compounds, by Year .554.7. Number of NYS OHCN Exposures to Non-specifiedHydrocarbons, by Year .55iv
5.13. Occupations of NYS OHCN Patients Workingin the Transportation Industry, by Patient Type .695.14. Diagnoses Among NYS OHCN Patients Workingin the Transportation Industry, by Patient Type .695.15. Exposures Among NYS OHCN Patients Workingin the Transportation Industry, by Patient Type .705.16. Occupations of NYS OHCN Patients Workingn the Wholesale Trade Industry, by Patient Type .715.17. Diagnoses Among NYS OHCN Patients Workingin the Wholesale Trade Industry, by Patient Type .715.18. Exposures Among NYS OHCN Patients Workingin the Wholesale Trade Industry .725.19. Occupations of NYS OHCN Patients Workingin the Retail Trade Industry, by Patient Type .735.20. Diagnoses Among NYS OHCN Patients Workingin the Retail Trade Industry, by Patient Type .735.21. Exposures Among NYS OHCN Patients Workingin the Retail Trade Industry .745.22. Diagnoses Among NYS OHCN Patients Workingin the Finance, Insurance and Real Estate Industry,by Patient Type .755.23. Exposures Among NYS OHCN Patients Workingin the Finance, Insurance and Real Estate Industry .755.24. Occupations of NYS OHCN Patients Workingin the Services Industry, by Patient Type .765.25. Diagnoses Among NYS OHCN Patients Workingin the Services Industry, by Patient Type .765.26. Exposures Among NYS OHCN Patients Workingin the Services Industry, by Patient Type .775.27. Diagnoses Among NYS OHCN Patients Workingin the Public Administration Industry, by WorldTrade Center (WTC) Status, by Patient Type .785.28. Exposures Among NYS OHCN Patients Workingin the Public Administration Industry, byPatient Type .795.29. Number of NYS OHCN Patients Working inManagerial and Professional Specialty Occupations,by Patient Type .805.30. Diagnoses Among NYS OHCN SymptomaticPatients Working in Managerial and ProfessionalSpecialty Occupations .805.31. Diagnoses Among NYS OHCN Patients Workingin Technical, Sales and Administrative SupportOccupations, by Patient Type .815.32. Diagnoses Among NYS OHCN SymptomaticPatients Working in Service Occupations .825.33. Diagnoses Among NYS OHCN SymptomaticPatients Working in Precision Production, Craftand Repair Occupations .835.34. Diagnoses Among NYS OHCN Patients Workingas Operators, Fabricators and Laborers, byPatient Type .846.1. Number of Full-Time Employees in NYS,1988-2003 .876.2. Percent of Civilian Employment, by Race, forNYS without NYC, NYC, the US, and theNYS OHCN, 2002.876.3. Annual Age-standardized Rates of AsbestosisHospital Discharges and Mesothelioma Cases,by Geographic Region and Year .93v
Executive SummaryThe Clinics have developed nine clinical practice reviews,which were published in the January 2000 issue of theAmerican Journal of Industrial Medicine.1 These were designedto assist clinicians in the diagnosis, treatment and preventionof the following occupational conditions: asbestos-relateddiseases, work-related asthma, work-related upper extremitydisorders, carpal tunnel syndrome, low back disorders, leadpoisoning, noise-induced hearing loss, and solvent-relateddisorders. A guide for respirator clearance examinations wasalso developed. The reviews integrate public health approaches (primary, secondary and tertiary disease prevention) intothe clinical model by emphasizing a team approach to thediagnosis and treatment of occupational diseases. These clinical practice reviews were utilized by the OHCN as a tool toguide clinical practice and to foster quality of care and consistent practice. A quality assurance/quality improvement (QA/QI) program was developed and implemented to evaluate thelevel and consistency of care provided in the diagnosis of eachof those conditions chosen for the clinical practice reviews.The QA/QI process also enables the Network to evaluate thequality and consistency of case management and the degreeto which prevention is integrated into the Clinics’ practices.Since 1988, the New York State Occupational Health ClinicNetwork (OHCN) has contributed to maintaining a healthyworkforce in New York State. Utilizing a public health approach, the eight regionally-based clinics in the Networkhave diagnosed and treated occupational diseases and helpedimprove the working environments in New York. The work ofthese Clinics has extended to entire communities by providing education and training tools to workers, employers andmedical care providers. The Clinic Network has also contributed to occupational medicine by publishing in peer-reviewedjournals, developing clinical practice reviews for occupationalillnesses, and defining new examples of work-related diseases.The Clinics employ multidisciplinary teams of physicians,nurses, industrial hygienists, health educators and socialworkers trained in occupational health to perform a variety ofprevention activities as well as provide clinical services. Staffare able to provide diagnosis and basic treatment for the fullrange of occupational diseases, evaluate the work conditionsof the patients to determine whether other co-workers areat risk and suggest measures and make recommendations toimprove the workplace environment. The Clinics are open toanyone in NYS with a potential work-related illness. A slidingfee scale assures access for those without health insurance. Receiving funding from NYS allows Clinic staff to spend moretime with each of their patients than typical health care facilities. Patients are seen primarily for work-related conditions,but are also seen for environmental exposures. The Clinicsoffer screening services for groups of exposed workers.The World Trade Center (WTC) disaster on September 11,2001 provided a number of significant public health challenges. The Clinics worked closely with local, state andfederal governmental agencies, as well as with employers andunions to assist in providing a coherent public response. TheClinics helped obtain and/or interpret environmental andoccupational samples to evaluate the physical, chemical andpsychological risks posed by the disaster and its cleanup. Theyassisted in providing medical certification and fit-testing forrespirator use. The Clinics were also part of a nationwideconsortium of providers, led by Mount Sinai in NYC, fundedby the CDC’s National Institute for Occupational Safety andHealth (NIOSH) and private philanthropic funding thatdeveloped, coordinated and provided medical evaluation,monitoring and treatment services for WTC responders. Thisprogram continues to provide free, standardized medical assessments, clinical referrals, and occupational health education for workers and volunteers exposed to hazards during theWTC rescue and recovery effort.The Clinics are located throughout the state in order to meetspecific regional needs. One clinic is specifically designatedto provide services in the area of agricultural safety andhealth. While occupational medicine practice is generallysimilar through all regions of the United States, integration ofpractice with specific local needs is desirable. Therefore, eachClinic maintains a local advisory committee which is usedto reach into its own community and raise awareness of itsservices and learn more about local needs. Each Clinic alsofocuses on the high-risk industries and occupations within itsarea. The Clinic Network works together to meet the generalneeds of New York workers.vii
Patient Characteristics– The majority of the diagnoses were disorders of thecervical region and other disorders of the back.– More than a third of the diagnoses were due torepetitive stress injuries.This report includes more than 100 figures and tables describing the patient population seen by the New York StateOHCN from its inception in 1988 through 2003. Overall,there were 47,210 patients seen in 115,406 visits. In 2003,the Clinics conducted 127 industrial hygiene site visits, andreached out to a minimum of 35,437 people at educationalevents and meetings. Patients were seen from all but one county in New YorkState with large percentages residing in counties withlarge metropolitan areas such as New York City, Albany,Erie, Monroe and Onondaga counties. Among those patients seen for occupational exposures,23% were employed in the services industry, and 22%were employed in construction with another 22%employed in public administration.ExposuresPatients seen by the NYS OHCN are evaluated to determinenot only the medical diagnosis, but also the likely etiologicagents responsible for causing or exacerbating the disease.Appropriate identification of an etiologic agent can sometimes improve the treatment and management of a disease.More importantly, identification of workplace hazards canalso be used to prevent occupational diseases through trainingand education of workers and companies; along withestablishing effective workplace intervention programs. Almost a quarter of the exposures were to mineraland inorganic dusts which includes asbestos, silica andnon-specified dusts.– Diagnoses due to these exposures included pleural thickening due to asbestos, asbestosis, asthma,chronic obstructive pulmonary disease, and chronicbronchitis.– Among those patients with WTC dust exposures,diagnoses included chronic pharyngitis, chronicsinusitis, and asthma.– Patients exposed to mineral and inorganic dustsworked primarily in the construction industry,followed closely by the services industry. Another quarter of the exposures were to ergonomicfactors.– 66% were repetitive motion including keyboard use,8% were stress, and 6% were lifting.– Exposures to repetitive motion were primarilyassociated with diagnoses of carpal tunnel syndrome,tenosynovitis of the hand or wrist, lateral or medialepicondylitis, and cubital tunnel syndrome.DiagnosesThe primary diagnoses for both males and females werediseases of the respiratory system, nervous system andmusculoskeletal system. Almost one-third of the work-related non-WTCrespiratory system disease diagnoses were classified aspneumoconioses, including asbestosis.– Other respiratory diagnoses included conditionsdue to chemical fumes and vapors and workrelated asthma. WTC-related respiratory system disease diagnosesincluded chronic pharyngitis, sinusitis and asthma. Diseases of the nervous system included carpal tunnelsyndrome, noise-induced hearing loss, and cubitaltu
2.14. P ercent of Occupational NYS OHCN Patients, by Major Occupational Group and Patient Type .21 2.15. Percent of Occupational NYS OHCN Patients, by Major Occupational Group and Geographic Region .22 2.16. P ercent of Occupational NYS OHCN Patients,
New York Buffalo 14210 New York Buffalo 14211 New York Buffalo 14212 New York Buffalo 14215 New York Buffalo 14217 New York Buffalo 14218 New York Buffalo 14222 New York Buffalo 14227 New York Burlington Flats 13315 New York Calcium 13616 New York Canajoharie 13317 New York Canaseraga 14822 New York Candor 13743 New York Cape Vincent 13618 New York Carthage 13619 New York Castleton 12033 New .
Occupational therapists around the world are obligated to promote occupational rights as the actualization of human rights. This obligation requires addressing occupational injustices, initially named as occupational deprivation, occupational imbalance, occupational marginalisation, and occupational alienation (Wilcock & Townsend, 2000 .
Documentation of occupational therapy services is necessary whenever professional services are provided to a client. Occupational therapists and occupational therapy assistants1 determine the appropriate type of documentation structure and then record the services provided within their scope of practice. This document, based on the Occupational .File Size: 540KBPage Count: 9Explore furtherDocumentation & Reimbursement - AOTAwww.aota.orgNEW OT Evaluation and Reevaluation - AOTA Guidelinestherapylog.typepad.comWriting progress notes in occupational therapy jobs .www.aureusmedical.comDocumentation & Data Collection For Pediatric Occupational .www.toolstogrowot.comSOAP Note and Documentation Templates & Examples Seniors .seniorsflourish.comRecommended to you b
1When the term occupational therapy practitioner is used in this document, it refers to both occupational therapists and occupational therapy assistants (AOTA, 2015b). Occupational therapists are responsible for all aspects of occupational therapy service delivery and are accountable for the safety and effectiveness of the occupational therapy .
403-1 Occupational health and safety management system 403-2 Hazard identification, risk assessment, and incident investigation 403-3 Occupational health services 403-4 Worker participation, consultation, and communication on occupational health and safety 403-5 Worker training on occupational health and safety 403-6 Promotion of worker health
This Occupational Safety and Health Manual implements one of the elements of the National Weather Service (NWS) Occupational Safety and Health Program defined in NWS Policy Directive NWSPD-50-11, Occupational Safety and Health. The manual includes 32 safety procedures developed in accordance with Occupational Safety and Health Administration
5 .2 To assess compliance with HSE Standards for Occupational Health Services 2018 Research 6 .1 To develop a research plan for Occupational Health Nursing to include data relevant and applicable to occupational health settings 6 .2 To develop a forum for sharing and communication of relevant research and data to the Occupational Health Nursing .
The coronavirus pandemic is having a devastating impact around the world. In the UK, people affected by dementia have been hardest hit and our fragmented social care system has been exposed for all to see. Alzheimer’s Society is the UK’s leading dementia charity, and in this report we bring together evidence from a wide range of sources to shine a light on the impact of coronavirus disease .
