Development of a medical examination program for former workers at a Department of Energy national laboratory

Our plain-English summary of Development of a medical examination program for former workers at a Department of Energy national laboratory, by P.N. Breysse, V. Weaver, M. Cadorette, et al (American Journal of Industrial Medicine, 2002).

The study

• Authors: P.N. Breysse, V. Weaver, M. Cadorette, L. Wiggs, B. Curbow, A. Stefaniak, J. Melius, L. Newman, H. Smith, B. Schwartz
• Journal: American Journal of Industrial Medicine
• Published: 2002;42(5):443-54
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: As a part of the U.S. Department of Energy (DOE) Former Workers' Medical Surveillance Program, a Needs Assessment was conducted at Los Alamos National Laboratory (LANL). The objective was to identify former LANL employees who may be at significant risk for occupational disease and determine whether a medical examination program could reduce morbidity or mortality. We describe the needs assessment approach used at LANL.

Methods: An algorithm was developed to make needs determinations. Information on factors including exposure, health impacts, size of exposed populations, and LANL worker concerns and recommendations were obtained. Each of these factors was scored from 1 to 3. The resulting factor sum was then multiplied by a binary (1 or 0) intervention suitability factor which was 1 if both of the following were available: (1) a screening test with acceptable sensitivity and specificity for the health outcome of concern; and (2) an intervention that decreases morbidity or mortality. This resulted in an Intervention Needs Score that was used to set priorities for the medical examination program for the estimated 35,000 former LANL workers.

Results: Analysis of the algorithm output suggested that six exposure categories be recommended for consideration in a medical examination program. Beryllium, asbestos, and noise clearly warranted inclusion. Lead and ionizing radiation required careful consideration regarding availability of screening tests. Solvents were problematic due to the lack of screening tests and suitable intervention in formerly exposed workers.

Conclusions: The algorithm approach to the needs assessment at LANL documented that six chemical and physical agents should be considered as candidates for inclusion in a medical examination program for former workers.

Copyright 2002 Wiley-Liss, Inc.

In plain English

This article described a needs assessment, part of the U.S. Department of Energy's Former Workers' Medical Surveillance Program, to decide which past exposures a medical examination program for former Los Alamos National Laboratory (LANL) workers should cover. It did not measure disease rates. The authors built a job exposure matrix and scored each agent on numbers exposed, significance of past exposure, documented health effects, severity, and worker concern gathered from focus groups with 30 former workers. An agent counted only if an acceptable screening test and a beneficial intervention existed. For asbestos the screening tests were chest X-ray and spirometry. Rosters listed 25,140 former University of California workers and 11,273 former contractor workers. Asbestos was assigned as a potential exposure to 6,614 former contractor workers, the most of any agent in that group, and to 4,184 University of California workers. Beryllium, asbestos and noise were clearly included. Lead, solvents and ionizing radiation were included after careful consideration, and solvents remained problematic. The authors stated that the scoring does not imply risk and that historical data and rosters were incomplete.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Needs assessment using a semi-quantitative scoring algorithm, a job exposure matrix, records review and focus groups; not an epidemiologic study of disease rates
• Who was studied: Former workers of Los Alamos National Laboratory, New Mexico. After removing current workers and the deceased, the rosters included 25,140 former University of California employees and 11,273 former employees of the trades contractors Zia, Pan Am World Services and Johnson Controls. Four focus groups had 30 former workers in total.
• Exposure: 39 chemical and physical agents in a job exposure matrix, including asbestos, beryllium, lead, noise, solvents and ionizing radiation. Asbestos-containing materials included pipe and boiler insulation, acoustic treatments, floor coverings, gaskets, friction products and transite wall board, and were found in every technical area. All construction workers were assigned asbestos exposure. No asbestos fiber types were named.
• Main results:
  • Asbestos was the agent with the largest number of potentially exposed former Zia/Pan Am/JCI workers (6614). The table also lists 4184 potentially exposed former University of California workers, 10798 in total.
  • Asbestos-containing materials were present in every technical area of LANL, with some areas having them in every building.
  • Nine agents met the screening-test and intervention criterion. For asbestos the listed screening tests were chest X-ray and spirometry, and the listed interventions included smoking cessation, pulmonary rehabilitation, and influenza and pneumococcal vaccines.
  • About one-quarter of focus group former workers mentioned asbestos (and lead) as exposure concerns.
  • Agents scoring 11 to 15 were recommended for inclusion in the screening program.
  • Beryllium, asbestos and noise were clearly included.
  • Lead, solvents and ionizing radiation were also included after careful consideration. Solvents remained problematic because liver function tests are not useful once exposure has stopped.
• The authors' conclusion: The authors concluded that six chemical and physical agents should be considered as candidates for a medical examination program for former LANL workers. They described the approach as iterative, with decisions to be re-evaluated as new information arises.
• Limitations the authors state:
  • The scoring algorithm does not imply risk; it only provides a relative ranking of surveillance needs.
  • Apart from beryllium and noise, historical exposure data were not in electronic form and could not be used in the one-year effort.
  • The worker rosters were incomplete, with gaps for some years.
  • Exposed-worker counts were initial estimates. Everyone in a job code was counted as exposed even if exposure occurred only in some decades.
  • No incidence, prevalence or relative risk was calculated because existing data were inadequate.
  • Gaps in knowledge of historical exposures and health effects required simplifying assumptions.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Disease.

Related studies

• Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites — J.M. Dement, L. Welch, et al. (2003)
• Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: findings of a dedicated rehabilitation service — R. Bentley, A. Hussain, et al. (2013)
• The National Sheet Metal Worker Asbestos Disease Screening Program: radiologic findings. National Sheet Metal Examination Group — L.S. Welch, D. Michaels, et al. (1994)
• Airways obstruction among older construction and trade workers at Department of Energy nuclear sites — J.M. Dement, L. Welch, et al. (2010)
• Mortality of older construction and craft workers employed at Department of Energy (DOE) nuclear sites — J.M. Dement, K. Ringen, et al. (2009)
• Mortality of older construction and craft workers employed at department of energy (DOE) nuclear sites: follow-up through 2011 — K. Ringen, J. Dement, et al. (2015)

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