The 10-year experience of an academically affiliated occupational and environmental medicine clinic

Our plain-English summary of The 10-year experience of an academically affiliated occupational and environmental medicine clinic, by L. Rosenstock, W. Daniell, S. Barnhart, et al (The Western Journal of Medicine, 1992).

The study

• Authors: L. Rosenstock, W. Daniell, S. Barnhart, B. Stover, J. Castorina, S.E. Mason, N.J. Heyer, R. Hubbard, J.D. Kaufman, C.A. Brodkin
• Journal: The Western Journal of Medicine
• Published: 1992;157(4):425-9
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Occupational and environmental diseases are underrecognized. Among the barriers to the successful diagnosis, treatment, and prevention of these conditions are inadequate consultative and information resources. We describe the 10-year clinical and training experiences of an academically affiliated referral center that has as its primary goal the identification of work-related and other environmental diseases. The University of Washington Occupational and Environmental Medicine Program has evaluated 6,048 patients in its diagnostic and screening clinics. Among the 2,841 seen in the diagnostic clinics, 1,553 (55%) had a work-related condition. The most prevalent diagnoses included asbestos-related lung disease (n = 603), toxic encephalopathy (n = 160), asthma (n = 119), other specific respiratory conditions (n = 197), carpal tunnel syndrome (n = 86), and dermatitis (n = 82). The clinics serve as a training site for fellows in the specialty training program, primary care internal medicine residents, residents from other medical specialties, and students in industrial hygiene, toxicology, and occupational health nursing. The program serves two additional important functions: providing consultative services to community physicians and training specialists and other physicians in this underserved area of medicine.

In plain English

This article was a descriptive report of the first ten years (July 1981 to July 1991) of the University of Washington occupational medicine clinic at Harborview Medical Center in Seattle. Of 6,048 people evaluated, 2,841 were seen in diagnostic clinics and 3,207 in 18 screening programs for worker groups, including asbestos-exposed workers. Among the 2,841 diagnostic-clinic patients, 1,553 (55%) were judged probably or definitely to have a work-related condition. Asbestosis was the most common diagnosis (389 patients), followed by asbestos-related pleural disease (214), out of 1,824 work-related conditions recorded. Asbestos was the most often recorded hazardous exposure, in 1,069 patients (38%). Of those with asbestos-related disease, 121 (20%) came from the screening programs, and new asbestos-related diagnoses peaked in 1986 after a large screening effort. The authors said the high number of asbestos patients was largely due to selective referral and screening follow-up. They also said their selection criteria and research interests limit how far the findings apply to the wider community. The authors concluded that academic clinics can help identify local exposure and disease patterns.

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: Descriptive report of a single clinic's 10-year patient database (clinic experience review)
• Who was studied: 6,048 people evaluated at the University of Washington Occupational and Environmental Medicine Program, Harborview Medical Center, Seattle, from July 1981 to July 1991: 2,841 in diagnostic clinics and 3,207 in 18 screening programs
• Exposure: Workplace exposures of many kinds, coded from a list of about 70. Asbestos was the most common. Screening programs included asbestos-exposed workers, firefighters and hazardous waste workers. No fiber types were specified.
• Main results:
  • Among the 2,841 diagnostic-clinic patients, 1,553 (55%) were identified as probably or definitely having a work-related condition
  • Asbestosis was the leading work-related condition in the diagnostic clinics: 389 patients (21% of the 1,824 work-related conditions noted in 1,553 patients). Asbestos-related pleural disease was second, with 214 (12%).
  • Asbestos was the most common potentially hazardous exposure recorded among the 2,841 diagnostic-clinic patients: 1,069 (38%). Each patient could be assigned up to 2 exposures.
  • Of the diagnostic-clinic patients found to have an asbestos-related disease, 121 (20%) were referred from the program's screening activities
  • New asbestos-related diagnoses peaked in 1986, following a large screening effort
• The authors' conclusion: The authors concluded that academically based clinics can serve several purposes: helping identify local exposure and disease patterns, acting as a consultative resource for community physicians, and training physicians and other health professionals.
• Limitations the authors state:
  • The large number of asbestos-related patients was due largely to selective referral and follow-up from screening programs
  • The clinic's changing triage criteria, research interests and referral patterns limit how well its experience reflects occupational disease in the local area, state or region
  • General underrecognition and underreporting of occupational disease likely cause the clinic's data to underrepresent and skew the true distribution of these conditions in the community
  • Conditions readily attributed to non-occupational causes were generally not coded in the database

Topics

Medical terms in this study, explained in our Lexicon: Industrial Hygiene.

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• Position Paper on Asbestos of the Italian Society of Occupational Medicine — P. Apostoli, P. Boffetta, et al. (2019)
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