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Environmental Medicine: Integrating a Missing Element into Medical Education
D
Resources: Agencies, Organizations, Services, References, and Tables of Environmental Health Hazards
CONTENTS
INTRODUCTION
911
GOVERNMENT AGENCIES
911
Federal Agencies
912
Agency for Toxic Substances and Disease Registry
912
Centers for Disease Control and Prevention
913
Consumer Product Safety Commission
913
Department of Energy
913
Department of Health and Human Services
914
Environmental Protection Agency
914
Food and Drug Administration
915
Health Resources and Services Administration
915
National Cancer Institute
915
National Center for Environmental Health
916
National Institute for Occupational Safety and Health
916
Project EPOCH-Envi
917
NIOSH Educational Resource Centers
918
National Institute of Environmental Health Sciences
919
Environmental/Occupational Medicine Academic Awards
920
National Institutes of Health
921
Nuclear Regulatory Commission
921
Occupational Safety and Health Administration
922
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State Agencies
922
State Health Departments and Radon Contacts
922
ASSOCIATIONS AND ORGANIZATIONS
928
American Association of Occupational Health Nurses
928
American Association of Poison Control Centers
928
American Board of Medical Toxicology
931
American College of Obstetricians and Gynecologists
931
American College of Occupational and Environmental Medicine
932
Occupational Physicians Scholarships Fund
932
American College of Preventive Medicine
933
American Lung Association
933
Association of Occupational and Environmental Clinics
933
Association of Teachers of Preventive Medicine
939
Center for Safety in the Arts
939
Committees on Occupational Safety and Health
940
Consortium for Environmental Education in Medicine
940
MotherRisk Program
940
National Association of Physicians for the Environment
941
Pesticide Education Center
941
Physicians for Social Responsibility
941
Society for Occupational and Environmental Health
942
Teratogen Exposure Registry and Surveillance
942
WorldWatch Institute
943
SELECTED TOPICAL RESOURCES
943
COMPUTERIZED INFORMATION SERVICES
944
Internet
944
List Servers
946
Other Gophers Relevant to Environmental Health, Medicine, and Safety
947
Computer-Based Databases
948
GENERAL REFERENCES
950
Books and Reports
950
Curriculum Resources
951
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Environmental Medicine: Integrating a Missing Element into Medical Education
TABLES OF TOXIC CHEMICALS, HEALTH EFFECTS, AND OCCUPATIONAL EXPOSURES
953
Table D-1: Environmental Agents, Their Sources and Potential Exposures, and Adverse Health Effects: Metals and Metallic Compounds, Hydrocarbons, Irritant Gases, Chemical Asphyxiants, and Pesticides
953
Table D-2: Selected Work-Related Diseases, Disorders, and Conditions Associated with Various Agents, Industries, or Occupations: Infections, Malignant Neoplasms, Hematological, Cardiovascular, Pulmonary, Neurological, and Other Disorders
963
Table D-3: Selected Job Categories, Exposures, and Associated Work-Related Diseases and Conditions
969
* * *
INTRODUCTION
For those readers who are interested in learning more about environmental medicine, or have other resource needs related to environmental medicine, this appendix presents names, addresses, and phone numbers of relevant government agencies and professional associations and organizations, as well as information about computerized information services, and a listing of general references. Several lists of medical schools with federally funded environmental health activities are also provided. Finally, three tables are presented that describe (1) selected environmental agents and their associated sources and potential exposures, (2) selected work-related diseases, disorders, and conditions associated with various agents, and (3) selected job categories, exposures, and associated work-related diseases and conditions.
The information presented in this appendix is not intended to be comprehensive or exhaustive, but rather supplemental and complementary.
GOVERNMENT AGENCIES
Throughout our history, numerous federal and state agencies have been created to address the issues related to safety and health in the workplace, as well as the surrounding environment. Federal and state agencies have become increasingly involved in examining and monitoring the impact of the environment on the health of the public. The following list highlights several of the federal and state agencies currently involved in monitoring, evaluating, and protecting the environment and its relation to public health. Each agency is an invaluable source of information
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and can readily provide additional resources upon one’s request. The agencies are listed in alphabetical order with federal organizations first, followed by state agencies.
Federal Agencies
Agency for Toxic Substances and Disease Registry
The Agency for Toxic Substances and Disease Registry (ATSDR) was created by Superfund legislation in 1980 as a part of the U.S. Department of Health and Human Services. ATSDR’s mission is to prevent or mitigate adverse human health effects and diminished quality of life resulting from exposure to hazardous substances in the environment. In order to carry out its mission and to serve the needs of the American people, ATSDR conducts activities in public health assessments, health investigations, exposure and disease registry, emergency response, toxicological profiles, health education, and applied research.
ATSDR’s Division of Health Education is mandated to assemble, develop, and distribute to the states, medical colleges, physicians, and other health professionals, educational materials on medical surveillance, screening, and methods of diagnosis and treatment of injury or disease related to exposure to hazardous substances. The Division also provides training and education for primary care physicians to diagnose and treat illness caused by hazardous substances and supports curriculum development and applied research in the area of environmental health.
The Division has developed a self-study series called Case Studies in Environmental Medicine which uses case studies to guide physicians through the diagnosis and treatment of illnesses related to hazardous substances exposure.
Several projects have also been developed and implemented to advance these goals. Some of the programs are described below:
State Cooperative Agreements offer funding and assistance to state health departments for developing educational materials and activities in environmental medicine for health care professionals;
National Association of County Health Officials Environmental Health Project is a cooperative agreement with ATSDR to conduct instructional sessions and develop supporting materials for local health officials and the medical community concerning the communication of health risks from exposure to hazardous substances;
Project EPOCH-Envi is co-sponsored by ATSDR and the National Institute for Occupational Safety and Health (NIOSH). Through the cooperative agreement, a consortium of medical schools works towards introducing curricula in occupational and environmental medicine in primary care residency programs;
The National Medical Association (NMA) is the largest organization of African-American physicians in the United States. ATSDR co-sponsors sessions and lectures on environmental health through the NMA’s Regional Environmental Workshops. NMA has recognized the seriousness of environmental contamination in minority communities and is now working with ATSDR to provide training in environmental health for its members.
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Agency for Toxic Substances and Disease Registry
1600 Clifton Road, N.E.
Mail Stop E-28
Atlanta, GA 30333
(404) 639–0501
Emergencies (404) 639–0615
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is charged with protecting the public health of the nation by providing leadership and direction in the prevention and control of diseases and other preventable conditions and responding to public health emergencies.
Centers for Disease Control and Prevention
1600 Clifton Road, N.E.
Atlanta, GA 30333
(404) 639–3286
Consumer Product Safety Commission
The Consumer Products Safety Commission provides information on health and safety effects related to consumer products. It has direct jurisdiction over chronic and chemical hazards in consumer products; assists consumers in evaluating the comparative safety of consumer products; develops uniform safety standards for consumer products and minimizes conflicting state and local regulations; and promotes research and investigation into the causes and prevention of product-related deaths, illnesses, and injuries.
Consumer Product Safety Commission
East West Towers
4340 East West Highway
Bethesda, MD 20814
(301) 504–0580
(800) 638–2772
Department of Energy
The Department of Energy (DOE) provides the framework for a comprehensive and balanced national energy plan through the coordination and administration of the energy functions of the federal government. The Department is responsible for long-term, high-risk research and development of energy technology; the marketing of federal power; energy conservation; the nuclear weapons program; energy regulatory programs; and a central energy data collection and analysis program.
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The Environment, Safety and Health Office of the DOE provides independent oversight of departmental execution of environmental, occupational safety and health, and nuclear/nonnuclear safety and security laws, regulations, and policies; ensures that departmental programs are in compliance with environmental, health, and nuclear/nonuclear safety protection plans, regulations, and procedures; provides an independent overview and assessment of Department-controlled activities to ensure that safety-impacted programs receive management review; and carries out legal functions of the nuclear safety civil penalty and criminal referral activities mandated by the Price-Anderson Amendments Act.
Department of Energy
1000 Independence Avenue, S.W.
Washington, DC 20585
(202) 586–5000
Department of Health and Human Services
The Department of Health and Human Services (HHS) is the Cabinet-level department of the federal executive branch most concerned with people and most involved with then nation’s human concerns. In one way or another—whether it is mailing out social security checks or making health services more widely available—HHS touches the lives of more Americans than any other federal agency. It is literally a department of people saving people, from newborn infants to our most elderly citizens.
Department of Health and Human Services
200 Independence Ave., S.W.
Washington, DC 20201
(202) 679–0257
Environmental Protection Agency
The Environmental Protection Agency (EPA) was established in 1970 in order to permit coordinated and effective governmental action on behalf of the environment. It endeavors to abate and control pollution systematically, by proper integration of a variety of research, monitoring, standard setting, and enforcement activities. As a complement to its other activities, the Agency coordinates and supports research and antipollution activities by state and local governments, private and public groups, individuals, and educational institutions. It also reinforces efforts among other federal agencies with respect to the impact of their operations on the environment, and it is specifically charged with publishing its determinations when those hold that a proposal is unsatisfactory from the standpoint of public health or welfare or environmental quality. In all, the EPA is designed to serve as the public’s advocate for a livable environment.
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Environmental Protection Agency
401 M Street, S.W.
Washington, DC 20460
(202) 260–2090
Food and Drug Administration
The Food and Drug Administration (FDA) inspects manufacturing plants and warehouses, collects and analyzes samples of foods, drugs, cosmetics, and therapeutic devices for adulteration and misbranding. Responsibilities also extend to sanitary preparation and handling of foods, waste disposal on interstate carriers, and enforcement of the Radiation Control Act as related to consumer products. Epidemiological and other investigations are conducted to determine causative factors or possible health hazards involved in adverse reactions or hazardous materials accidents. Investigators are located in resident posts in major cities throughout the country.
Food and Drug Administration
National Headquarters
200 C Street, S.W.
Washington, DC 20204
(301) 443–2410
Health Resources and Services Administration
Health Resources and Services Administration (HRSA) is responsible for general health services and resource issues relating to issues of access, equity, quality, and cost of care. In order to accomplish this goal, the Administration supports states and communities in their efforts to deliver health care to underserved segments of the population; participates in the federal campaign against AIDS; provides leadership in improving the education, distribution, quality, and use of the health professionals needed to staff the nation’s health care system; tracks the supply of and requirements for health professionals and addresses their competence through the development of a health practitioner data bank; and strengthens the public health system by working with state and local public health agencies.
Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857
(301) 443–2086
National Cancer Institute
The National Cancer Institute (NCI) conducts and funds research on the causes, diagnosis, treatment, prevention, control, and biology of cancer and the rehabilitation of people with cancer.
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NCI also funds projects for innovative and effective approaches to preventing and controlling cancer, establishes multidisciplinary cancer care and clinical research activities in community hospitals, and supports cancer research training, clinical training, continuing education, and career development.
National Cancer Institute
National Institutes of Health
9000 Rockville Pike
Bethesda, MD 20892
(301) 496–5615
(800) 422–6237/(800) 4CANCER
National Center for Environmental Health
The mission of the National Center for Environmental Health (NCEH) is to promote health and quality of life by preventing or controlling disease, injury, and disability related to the interactions between people and their environment outside the workplace. To achieve these goals, NCEH directs programs both to prevent the adverse health effects of exposure to toxic substances and to combat the societal and environmental factors that increase the likelihood of exposure and disease. NCEH also works to prevent injuries and diseases resulting from natural or technologic disasters and to prevent birth defects and development disabilities resulting from nutritional deficiencies or exposure to environmental toxins in utero or during early childhood.
National Center for Environmental Health
Mailstop F29
4770 Buford Highway, N.E.
Atlanta, GA 30341–3724
(404) 488–7003
National Institute for Occupational Safety and Health
The National Institute for Occupational Safety and Health (NIOSH) was established by the Occupational Safety and Health Act of 1970 to conduct research on occupational diseases and injuries, respond to requests for assistance by investigating problems of health and safety in the workplace, recommend standards to the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA), and train professionals in occupational safety and health.
National Institute for Occupational Safety and Health
200 Independence Avenue, S.W.
Washington, DC 20201
(800) 356–4674
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NIOSH Technical Information Branch provides a toll-free technical information service (1– 800–35-NIOSH) that provides convenient public access to NIOSH and its information resources. Callers may request information about NIOSH activities or about any aspect of occupational safety and health.
NIOSH Technical Information Branch
Robert A. Taft Laboratory
Mail Stop C-19
4676 Columbia Parkway
Cincinnati, OH 45226–1998
(800) 35-NIOSH
Project EPOCH-Envi. In conjunction with ATSDR, NIOSH established Project EPOCH-Envi to provide support and training to medical schools from around the country who wish to implement curricula in occupational and environmental medicine in primary care residency programs. Through this cooperative agreement, Project EPOCH-Envi conducts workshops and training programs for interested medical school faculty. The sessions focus on instructing faculty members how to develop curricula in occupational and environmental medicine.
Project EPOCH-Envi
National Institute for Occupational Safety and Health
Division of Training and Manpower Development
Curriculum Development Branch
Robert A. Taft Laboratories
4676 Columbia Parkway
Cincinnati, OH 45226–1998
(800) 356–4674
In 1992–1993, the following medical schools were involved in Project EPOCH-Envi or represented by faculty members:
University of Arkansas College of Medicine
University of California, San Francisco, School of Medicine
University of Connecticut School of Medicine
University of Florida College of Medicine
University of Miami School of Medicine
Emory University School of Medicine
Medical College of Georgia
Morehouse School of Medicine
University of Illinois College of Medicine at Peoria
University of Illinois College of Medicine at Urbana-Champaign
University of Illinois College of Medicine at Chicago
Loyola University Chicago, Stritch School of Medicine
Southern Illinois University School of Medicine
University of Massachusetts Medical School
University of Missouri, Columbia School of Medicine
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Saint Louis University School of Medicine
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School
Cornell University Medical Center
University of Rochester School of Medicine
State University of New York at Brooklyn College of Medicine
State University of New York at Syracuse College of Medicine
Bowman Gray School of Medicine
Duke University School of Medicine
East Carolina University School of Medicine
University of North Carolina at Chapel Hill School of Medicine
Medical University of South Carolina College of Medicine
University of South Carolina School of Medicine
University of Texas Medical Center at San Antonio
University of Vermont College of Medicine
West Virginia University School of Medicine
NIOSH Educational Resource Centers
The National Institute for Occupational Safety and Health (NIOSH) funds Educational Resource Centers (ERCs) which conduct research and administer graduate training programs in occupational medicine, occupational health nursing, and industrial hygiene and safety. They also provide continuing education programs for safety and health professionals and outreach programs for the community.
ALABAMA
Deep South Center for Occupational Health and Safety
University of Alabama at Birmingham
Elizabeth Murray
Continuing Education
(205) 934–7178
CALIFORNIA
Northern California ERC
Center for Occupational and Environmental Health
University of California at Berkeley
Barbara Plog, Continuing Education
(510) 231–5647
Southern California ERC
University of Southern California
Ramona Cayuela, Continuing Education
(213) 740–3995
ILLINOIS
Illinois ERC
Occupational Health and Safety Center
University of Illinois, Chicago
Leslie Nickels, School of Public Health
(312) 996–7473
MARYLAND
Johns Hopkins ERC
Johns Hopkins University
Department of Environmental Health Sciences
Dr. Jacqueline Corn,
Continuing Education
(410) 955–2609
MASSACHUSETTS
Harvard ERC
Harvard Educational Resource Center
Daryl Bichel, Continuing Education
(617) 432–3314
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MICHIGAN
Michigan ERC
University of Michigan
Center for Occupational Health and Safety
Randy Rabourn, Continuing Education
(313) 936–0148
MINNESOTA
Midwest Center for Occupational Health and Safety
University of Minnesota
Jeanne Ayers, Continuing Education
(612) 221–3992
NEW YORK/NEW JERSEY
UMDNJ-Robert Wood
Johnson Medical School
Barbara Young, Registrar
(908) 235–5062
NORTH CAROLINA
Occupational Safety and Health ERC
University of North Carolina
Larry Hyde, Continuing Education
(919) 962–2101
OHIO
University of Cincinnati ERC
University of Cincinnati
Department of Environmental Health
Judy Jarrell, Continuing Education
(513) 558–1730
TEXAS
Southwest Center for Occupational Health and Safety
Pam Parker, Continuing Education
(713) 792–4648
UTAH
Rocky Mountain Center for Occupational and Environmental Health
University of Utah
Connie Crandall, Continuing Education
(801 581–5710
WASHINGTON
Northwest Center for Occupational Health and Safety
University of Washington
Jan Schwert, Continuing Education
(206) 543–1069
National Institute of Environmental Health Sciences
The National Institute of Environmental Health Sciences (NIEHS) is the principal federal agency for biomedical research on the effects of chemical, physical, and biological environmental agents on human health and well-being. The Institute supports research and training focused on the identification, assessment, and mechanism of action of potentially harmful agents in the environment. Research results form the basis for preventive programs for environmentally-related diseases and for action by regulatory agencies.
The NIEHS currently sponsors several programs available to the medical school community, individual researchers, and other organizations or centers interested in studying the effects of the
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Agent
Exposure
Route of Entry
Systems(s) Affected
Primary Manifestations
Aids in Diagnosis
Remarks
Chlorine
Paper and textile bleaching; water disinfection; chemical manufacturing; metal fluxing; detinning and dezincing iron
Inhalation of gas
Middle respiratory tract
Tracheobronchitis, pulmonary edema, pneumonitis
Chest x ray, pulmonary function tests
Chlorine combines with body moisture to form acids, which irritate tissues from nose to alveoli.
Ozone
Inert gas-shielded arc welding; food, water, and air purification; food and textile bleaching; emitted around high-voltage electrical equipment
Inhalation of gas
Lower respiratory tract
Delayed pulmonary edema (generally 6–8 h following exposure)
Chest x ray, pulmonary function tests
Ozone has a free radical structure and can produce experimental chromosome aberrations; it may thus have carcinogenic potential.
Nitrogen oxides
Manufacturing of acids, nitrogen containing chemicals, explosives, and more; byproduct of many industrial processes
Inhalation of gas
Lower respiratory tract
Pulmonary irritation, bronchiolitis fibrosa obliterans (“silo filler’s disease”), mixed obstructive-restrictive changes
Chest x ray, pulmonary function tests
Phosgene
Manufacturing and burning of isocyanates, and manufacturing of dyes and other organic chemicals; in metallurgy for ore separation; burning or heat source near trichloroethylene
Inhalation of gas
Lower respiratory tract
Delayed pulmonary edema (delay seldom longer than 12 h)
Chest x ray, pulmonary function tests
Isocyanates
TDI (toluene diisocyanate)
MDI (methylene diphenyldiisocyanate)
Hexamethylene diisocyanate and others
Polyurethane manufacture; resinbinding systems in foundries; coating materials for wires; used in certain types of paint
Inhalation of vapor
Predominantly lower respiratory tract
Asthmatic reaction and accelerated loss of pulmonary function
Chest x ray, pulmonary function tests
Isocyanates are both respiratory tract “sensitizes” and irritants in the conventional sense.
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Asphyxiant gases
Simple asphyxiants: nitrogen hydrogen, methane, and others
Enclosed spaces in a variety of industrial settings
Inhalation of gas
CNS
Anoxia
O2 in environment
No specific toxic effect; act by displacing O2
Chemical Asphyxiants
Carbon monoxide
Incomplete combustion in foundries, coke ovens, refineries, furnaces, and more
Inhalation of gas
Blood (hemoglobin)
Headache, dizziness, double vision
Carboxyhemoglobin
Hydrogen sulfide
Used in manufacturing of sulfur-containing chemicals; produced in petroleum production; byproduct of petroleum product use; decay of organic matter
Inhalation of gas
CNS
Respiratory center paralysis, hypoventilation
PaO2
Pulmonary
Respiratory tract irritation
Cyanide
Metallurgy, electroplating
Inhalation of vapor, percutaneous absorption, ingestion
Cellular metabolic enzymes (especially cytochrome oxidase)
Enzyme inhibition with metabolic asphyxia and death
SCN− in urine
Pesticides
Organophophates: malathion, parathion, and others
Inhalation, ingestions, percutaneous absorption
Neuromuscular
Cholinesterase inhibition, cholinergic symptoms: nausea and vomiting, salivation, diarrhea, headache, seating, meiosis, muscle fasciculations, seizures, unconsciousness, death
Refractoriness to atropine; plasma or red cell cholinesterase
As with many acute toxins, rapid treatment of organophosphate toxicity is imperative. Thus, diagnosis is often made based on history and a high index of suspicion rather than on biochemical tests. Treatment is atropine to block cholinergic effects and 2-PAM (2-pyridine-alsoxine methiodide) to reactivate cholinesterase.
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Agent
Exposure
Route of Entry
Systems(s) Affected
Primary Manifestations
Aids in Diagnosis
Remarks
Carbamates: carbaryl (Sevin) and others
Inhalation, ingestion, percutaneous absorption
Neuromuscular
Same as organophosphates
Plasma cholinesterase; urinary 1-naphthol (index of exposure)
Treatment of carbamate poisoning is the same as that of organophosphate poisoning except that 2-PAM is contra-indicated.
Chlorinated hydrocarbons: chlordane, DDT, heptachlor, chlordecone (Kepone), aldrin, dieldrin, uridine
Ingestion, inhalation, percutaneous absorption
CNS
Stimulation or depression
Urinary organic chlorine, or p-chlorophenol acetic acid
The chlorinated hydrocarbons may accumulate in body lipid stores in large amounts.
Bipyridyls: paraquat, diquat
Inhalation, ingestion, percutaneous absorption
Pulmonary
Rapid massive fibrosis, only following paraquat ingestion
An interesting toxin in that the major toxicity, pulmonary fibrosis, apparently occurs only after ingestion.
SOURCE: Principles and Practice of Environmental Health, A.B.Tarcher, ed., Plenum, New York, 1992.
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TABLE D-2: Selected Work-Related Diseases, Disorders, and Conditions Associated with Various Agents, Industries, or Occupations: Infections, Malignant Neoplasms, and Hematological, Cardiovascular, Pulmonary, Neurological, and Miscellaneous Disorders
Diseases, Disorders, and Conditions
Industry or Occupation
Agent
Infections
Anthrax
Shepherds, farmers, butchers, handlers of imported hides or fibers, veterinarians, veterinarian pathologists, weavers
Bacillus anthraces
Brucellosis
Farmers, shepherds, vets, lab and slaughterhouse workers
Brucella abortus, suis
Plague
Shepherds, farmers, ranchers, hunters, field geologists
Yersinia pestis
Hepatitis A
Day-care center, orphanage, and mental retardation institution staff, medical personnel
Hepatitis A virus
Hepatitis B
Nurses and aides, anesthesiologists, orphanage and mental institution staffs, medical lab workers, general dentists, oral surgeons, physicians
Hepatitis B virus
Hepatitis C (formerly included in non-A, non-B)
Same as hepatitis A and B
Hepatitis C virus
Ornithosis
Psittacine bird breeders, pet shop and zoo workers, poultry producers, vets
Chlamydia psittaci
Rabies
Veterinarians, game wardens, lab workers, farmers, ranchers, trappers
Rabies virus
Rubella
Medical personnel
Rubella virus
Tetanus
Farmers, ranchers
Clostridium tetani
Tuberculosis Pulmonary
Physicians, medical personnel, medical lab workers
Mycobacterium tuberculosis
Tuberculosis Silicotuberculosis
Quarrymen, sandblasters, silica processors, miners, foundry workers, ceramic industry
Silicon dioxide (silica), M. tuberculosis
Tularemia
Hunters, fur handlers, sheep industry, cooks, veterinarians, ranchers, veterinarian pathologists
Francisella tularensis
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Diseases, Disorders, and Conditions
Industry or Occupation
Agent
Malignant Neoplasms
Bladder
Rubber and dye workers
Benzidine, 1- and 2-naphthylamine, auramine, magenta, 4-aminobiphenyl, 4-nitrophenyl
Bone
Dial painters, radium chemists and processors
Radium
Kidney and other urinary organs
Coke oven workers
Coke oven emissions
Liver
Vinyl chloride polymerization industry
Vinyl chloride monomer
Liver hemangiosarcoma
Vintners
Arsenical pesticides
Lung, bronchial, tracheal
Asbestos industry, users
Topside coke oven workers
Uranium and flourspar miners
Chromium producers, processors, users
Smelters
Mustard gas formulators
Ion-exchange resin makers, chemists
Asbestos
Coke oven emissions
Radon daughters
Chromates
Arsenic
Mustard gas
Bis(chloromethyl)-ether,
chloromethyl methyl ether
Nasal cavity
Woodworkers, furniture makers
Boot and shoe industry
Radium chemists and processors, dial painters
Chromium producers, processors, users
Nickel smelting and refining
Hardwood dusts
Unknown
Radium
Chromates
Nickel
Asbestos
Peritoneal, pleural mesothelioma
Asbestos industry, users
Asbestos
Scrotal
Automatic lathe operators, metalworkers
Coke oven workers, petroleum refiners, tar distillers
Mineral, cutting oils
Soots and tars, tar distillates
Hematological Disorders
Agranulocytosis or neutropenia
Workers exposed to benzene
Explosives, pesticide industries
Pesticide, pigment, pharmaceutical industries
Benzene
Phosphorous
Inorganic arsenic
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Diseases, Disorders, and Conditions
Industry or Occupation
Agent
Anemia
Aplastic
Explosives manufacturing
Workers exposed to benzene
Radiologists, radium chemists, dial painters
TNT
Benzene
Ionizing radiation
Anemia Hemolytic, nonautoimmune
Whitewashing and leather industry
Electrolytic processes, arsenical ore smelting
Plastics industry
Dye, celluloid, resin industries
Copper sulfate
Arsine
Trimellitic anhydride
Naphthalene
Leukemia
Acute lymphoid
Rubber industry
Radiologists
Unknown
Ionizing radiation
Leukemia
Acute myeloid
Workers exposed to benzene
Radiologists
Benzene
Ionizing radiation
Leukemia
Erythroleukemia
Workers exposed to benzene
Benzene
Methemoglobinemia
Explosives, dye industries
Aromatic amino and nitro compounds (e.g., aniline, TNT, nitroglycerin)
Cardiovascular Disorders
Angina
Auto mechanics, foundry workers, wood finishers, traffic control, driving in heavy traffic
Carbon monoxide
Arrhythmias
Metal cleaning, solvent use, refrigerator maintenance
Solvents, fluorocarbons
Raynaud’s phenomenon
(secondary)
Lumberjacks, chain sawyers, grinders, chippers
Vinyl chloride polymerization
Whole-body or segmental vibration
Vinyl chloride monomer
Pulmonary Disorders
Alveolitis (extrinsic, allergic)
Farmer’s lung bagassosis, bird-breeder’s lung, suberosis, maltworker’s lung, mushroom worker’s lung, maple bark disease, cheese-washer’s lung, coffee-worker’s lung, fish-meal-worker’s lung, furrier’s lung, sequoiosis, woodworker’s lung, miller’s lung
Various agents
Asbestosis
Asbestos workers, users
Asbestos
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Diseases, Disorders, and Conditions
Industry or Occupation
Agent
Asthma (extrinsic)
Jewelry, alloy, catalyst makers
Polyurethane, adhesive, paint workers
Alloy, catalyst, refinery workers
Solderers
Platinum
Isocyanates
Chromium, cobalt
Aluminum soldering flux
Phthalic anhydride
Formaldehyde
Gum arabic
Nickel sulfate
Flour
Trimellitic anhydride
Red cedar, wood dusts
Bacillus-derived exoenzymes
Animal dander
Plastic, dye, insecticide makers
Foam workers, latex makers, biologists
Printing industry
Nickel platers
Bakers
Plastics industry
Woodworkers, furniture makers
Detergent formulators
Animal handlers
Beryllium disease (chronic)
Beryllium alloy, ceramic, cathode-ray tube, nuclear reactor workers
Beryllium
Bronchitis, pneumonitis, pulmonary edema (acute)
Refrigeration, fertilizer, oil-refining industries
Alkali, beach industries
Silo fillers, arc welders, nitric acid workers
Paper, refrigeration, oil-refining industries
Cadmium smelters, processors
Plastics industry
Ammonia
Chlorine
Nitrogen oxides
Sulfur dioxide
Cadmium
Trimellitic anhydride
Byssinosis
Cotton industry
Cotton, flax, hemp, cotton-synthetic dusts
Pneumoconiosis
Coal miners, bauxite workers
Coal dust, bauxite fumes
Silicosis
Mining, metal, and ceramic industries, quarry men, sand blasters, silica processors
Silica
Talcosis
Talc processors
Talc
Neurological Disorders
Cerebellar ataxia
Chemical industry
Electrolytic chlorine production, battery manufacturing, fungicide formulators
Toluene
Organic mercury
Encephalitis (toxic)
Battery, smelter, foundry workers
Electrolytic chlorine production, battery manufacturing, fungicide formulators
Lead
Organic, inorganic mercury
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Diseases, Disorders, and Conditions
Industry or Occupation
Agent
Neuropathy (toxic and inflammatory)
Pesticide, pigment, pharmaceutical industries
Arsenic, arsenic compounds
Hexane
Methyl butyl ketone
TNT
Carbon disulfide
Tri-o-cresyl phosphate
Inorganic lead
Inorganic mercury
Organic mercury
Acrylamide
Furniture refinishers, degreasers
Plastic-coated-fabric workers
Explosives industry
Rayon manufacturing
Plastics, hydraulics, coke industries
Battery, smelter, foundry workers
Dentists, chloralkali workers
Chloralkali, fungicide, battery workers
Plastics, paper manufacture
Parkinson’s disease (secondary)
Manganese processors, battery manufacturing, welders
Internal combustion engine industries
Manganese
Carbon monoxide
Miscellaneous
Abdominal pain
Battery manufacturing, enamelers, smelter, painters, ceramics workers, plumbers, welders
Lead
Cataract
Microwave, radar technicians
Explosives industry
Radiologists
Blacksmiths, glass blowers, bakers
Moth repellent formulators, fumigators
Explosives, dye, herbicide, pesticide industries
Microwaves
TNT
Ionizing radiation
Infrared radiation
Naphthalene
Dinitrophenol, dinitro-o-cresol
Dermatitis (contact, allergic)
Adhesives, sealants, and plastics industries, leather tanning, poultry dressing, fish packing, boat building and repair, electroplating, metal cleaning, machining, housekeeping
Irritants (cutting oils, solvents, phenol, acids, alkalies, detergents, fibrous glass), allergens (nickel, epoxy resins, chro mates, formaldehyde, dyes, rubber products)
Headache
Firefighters, foundry workers, wood finishers, dry cleaners, traffic control, driving in heavy traffic
Carbon monoxide, solvents
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Diseases, Disorders, and Conditions
Industry or Occupation
Agent
Hepatitis (toxic)
Solvent users, dry cleaners, plastics industry
Carbon tetrachloride, chloroform, tetrachloroethane trichloroethylene
Phosphorous, TNT
Chloronaphthalene
4,4-Methylene-dianiline
Ethylene dibromide
Cresol
Explosives and dye industries
Fire and waterproofing additive formulators
Plastics formulators
Fumigators, gasoline and fire-extinguishers formulators
Disinfectant, fumigant, synthetic resin formulators
Inner ear damage
Various
Excessive noise
Infertility (male)
Formulators
Producers, formulators, applicators
Kepone
1,2-Dibromo-3-chloropropane
Psychosis (acute)
Gasoline, seed, and fungicide workers, wood preservation, rayon manufacturing
Lead (especially organic), mercury, carbon disulfide
Renal failure (acute, chronic)
Battery manufacturing, plumbers, solderers
Electrolytic processes, arsenical ore smelting
Battery manufacturing, jewelers, dentists
Fluorocarbon, fire-extinguisher formulators
Antifreeze manufacturing
Inorganic lead
Arsine
Inorganic mercury
Carbon tetrachloride
Ethylene glycol
SOURCE: Principles and Practice of Environmental Medicine, Tarcher, AB, ed., Plenum, New York, 1992.
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TABLE D-3: Selected Job Categories, Exposures, and Associated Work-Related Diseases and Conditions
Job Categories
Exposures
Work-Related Diseases and Conditions
Agricultural workers
Pesticides, infectious agents, gases, sunlight
Pesticide poisoning, “farmers’ lung,” skin cancer
Anesthetists
Anesthetic gases
Reproductive effects, cancer
Animal handlers
Infectious agents, allergens
Asthma
Automobile workers
Asbestos, plastics, lead, solvents
Asbestosis, dermatitis
Bakers
Flour
Asthma
Battery makers
Lead, arsenic
Lead poisoning, cancer
Butchers
Vinyl plastic fumes
“Meat wrappers’ asthma”
Caisson workers
Pressurized work environments
“Caisson disease,” “the bends”
Carpenters
Wood dust, wood preservatives, adhesives
Nasopharyngeal cancer, dermatitis
Cement workers
Cement dust, metals
Dermatitis, bronchitis
Ceramic workers
Talc, clays
Pneumoconiosis
Demolition workers
Asbestos, wood dust
Asbestosis
Drug manufacturers
Hormones, nitroglycerin, etc.
Reproductive effects
Dry cleaners
Solvents
Liver disease dermatitis
Dye workers
Dyestuffs, metals, solvents
Bladder cancer, dermatitis
Embalmers
Formaldehyde, infectious agents
Dermatitis
Felt makers
Mercury, polycyclic hydrocarbons
Mercuralism
Foundry workers
Silica, molten metals
Silicosis
Glass workers
Heat, solvents, metal powders
Cataracts
Hospital workers
Infectious agents, cleansers, radiation
Infections, accidents
Insulators
Asbestos, fibrous glass
Asbestosis, lung cancer, mesothelioma
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Job Categories
Exposures
Work-Related Diseases and Conditions
Jack hammer operators
Vibration
Raynaud phenomenon
Lathe operators
Metal dusts, cutting oils
Lung disease, cancer
Laundry workers
Bleaches, soaps, alkalies
Dermatitis
Lead burners
Lead
Lead poisoning
Miners (coal, hard rock, metals, etc.)
Talc, radiation, metals, coal dust, silica
Pneumoconiosis, lung cancer
Natural gas workers
Polycyclic hydrocarbons
Lung cancer
Nuclear workers
Radiation, plutonium
Metal poisoning, cancer
Office workers
Poor lighting, poorly designed equipment
Joint problems, eye problems
Painters
Paints, solvents, spackling compounds
Neurologic problems
Paper makers
Acids, alkalies, solvents, metals
Lung disorders, dermatitis
Petroleum workers
Polycyclic hydrocarbons, catalysts, zeolites
Cancer, pneumoconiosis
Plumbers
Lead, solvents, asbestos
Lead poisoning
Railroad workers
Creosote, sunlight, oils, solvents
Cancer, dermatitis
Seamen
Sunlight, asbestos
Cancer, accidents
Smelter workers
Metals, heat, sulfur dioxide, arsenic
Cancer
Steel workers
Heat, metals, silica
Cataracts, heat stroke
Stone cutters
Silica
Silicosis
Textile workers
Cotton dust, fabrics, finishers, dyes, carbon disulfide
Byssinosis, dermatitis, psychosis
Varnish makers
Solvents, waxes
Dermatitis
Vineyard workers
Arsenic, pesticides
Cancer, dermatitis
Welders
Fumes, nonionizing radiation
Lead poisoning, cataracts
SOURCE: Principles and Practice of Environmental Medicine, A.B.Tarcher, ed., Plenum, New York, 1992.
Representative terms from entire chapter:
environmental medicine
