Del Meyer, MD, Pulmonary Medicine

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2004

Foreword to "Encyclopedia of Work-Related Injuries, Illnesses and Health Issues," by Ada Kahn, PhD

Injuries are a ubiquitous phenomenon in almost every work environment. When the field of industrial medicine began, the primary concern was to provide first aid after an accident, such as physical trauma or chemical body injury, and to diagnose occupational diseases, such as skin allergies, contact dermatitis, occupational asthma or pneumoconiosis.

Today, industrial medicine encompasses a wide range of multidisciplinary specialists ranging from orthopedists who treat back injuries of construction workers and plastic surgeons who treat burn injuries, to psychiatrists who treat people dealing with mental health issues resulting from the stress of a bullying supervisor or a passive-aggressive coworker. In addition, the field has gained the attention of epidemiologists and researchers interested in occupational-related allergies, toxic substances, mineral fibers, cancer, inhalation lung diseases, ergonomics, continual use of computer screens, and repetitive stress issues, just to name a few.

The Journal of the American Medical Association reports that 3.6 million Americans were treated at hospital emergency rooms for occupational injuries or illnesses in 1998. This translates to an overall occupational injury and illness rate of 2.9 per 100 full-time employees over age 15. Injury rates were highest in men and younger workers.

OSHA reported that in 2000, occupational injury and illness rates dropped to their lowest level, 6.1 injuries per 200 workers, reflecting an eight-year downward trend since the U.S. began collecting this information.

Although we may think of external impact on the human body as a workplace injury, many injuries are more subtle. I remember diagnosing a patient with ulnar neuropathy three months after she had been issued an expensive ergonomic chair with armrests. I suggested she either get rid of the chair or at least remove the armrests. Within two months after removing the armrests, the ulnar neuropathy resolved. Physicians treat many work-related injuries that don’t warrant loss of work. Consequently, there may be considerably more work-related injuries than the statistic would reflect.

Health Maintenance Organizations (HMOs) and their Managed Care Organizations (MCOs) may have further skewed the data. Physicians who are being forced to make decisions more rapidly will not be able to explore the possible causes of an illness. Empirical treatment will be less focused and thus less effective. Minor injuries that normally would not require time away from work would progress into something major and disabling.

A medical interview can reveal the true source of an injury. For example, a patient who attributes back pain to the work environment may come to realize that it occurred on the weekend while doing yard work or lifting heavy furniture or moving an aquarium. These correlations take time. A physician, complying with the HMO or MCO, is expected to see a patient every 12 or 15 minutes and may be unable to evaluate the exact causation. Lack of interview and examination time could falsely inflate the number of workplace injuries.

A worker’s lifestyle can make it difficult to correlate an illness to the work environment. A smoker with asbestosis will be more likely to develop lung cancer than either a smoker without asbestosis or a nonsmoker with asbestosis. It becomes difficult, however, to say that a smoker has developed lung cancer due to industrial asbestos exposure. This is the assessment that most worker compensation evaluations must address.

It is the responsibility of the working people of America to understand safety and health issues related to their work environment and to take the appropriate precautions. They should also understand their health and safety rights. Workers do have the right to refuse a job if they think it will create a potentially unsafe workplace condition. If they are discriminated against for refusing, they can report this to the Occupational Safety & Health Administration (OSHA) of the U.S. Department of Labor. Many laws, including the OSHA Act of 1970 and the Asbestos Hazard Emergency Response Act, have whistleblower protections.

Ada P. Kahn makes an excellent selection of the injuries and illnesses that occur in the workplace. She covers a wide variety of occupations and outlines the hazards and injuries unique to those occupations. Psychosocial issues such as burnout, bullying and stress, also important for a worker’s well being, are addressed. Kahn interconnects the stress of one worker to the diagnosis of a fellow worker. For instance, an AIDS patient in the workplace is not considered infectious. However, there may be insurmountable anxiety or panic attacks in coworkers if they become aware of that diagnosis. These contemporary issues are alphabetically tabulated for easy reference in this readable, user-friendly compendium of 600 entries in 220,000 words. It contains many entries of conditions that physicians see every day, including physical and emotional disorders. Preventive measures are also included in some instances.

This book is not intended to provide complete information on any one topic. Instead, this reference is designed for individuals who want an overview of work-related issues. Kahn’s earlier books for Facts on File, Inc: The Encyclopedia of Mental Health, The Encyclopedia of Phobias, Fears and Anxieties, and Stress A-Z, were written for the lay reader but have become desk references for many professionals. The Encyclopedia of Work-Related Injuries, Illnesses and Health Issues will also be an important volume for professionals in many fields, including health care, human resources, employee benefits, insurance carriers, employee assistance programs, librarians and others. It gives the type of information employers and employees frequently need.

Dr Kahn's books can be purchased at http://www.factsonfile.com/. Enter Kahn in the search box.

 


Foreword to "The Encyclopedia of Stress and Stress-Related Diseases" (2nd Edition), (2nd Edition), by Ada Kahn, PhD

The topic of stress seems to be discussed more frequently in homes, workplaces and schools. As today's world becomes more complex in terms of changing economies, organizational structure, competition and safety, stress seems to be escalating.

Issues of personal, family and national safety face us on a daily basis. Airline travelers experience frustration waiting in lines, then again at the check-in points with the many questions and procedures. Workers in factories and high-rise buildings must undergo elaborate safety precautions in order to enter and leave the work place. Young people in many schools must pass through metal detectors before entering campus. These are just a few of the everyday challenges that can cumulatively increase the stress level for people of all ages.

In this second edition of The Encyclopedia of Stress and Stress-Related Diseases, author Ada P. Kahn has added numerous contemporary issues that contribute to stress. Many of the new terms relate to technological advancements, aging, work-related issues, family life and mental health.

Although technology has given us exciting developments in computer and telecommunications capabilities, it has also caused stress in many people. How many older folks experience exasperation when trying to use electronic gadgets that are used so facilely by younger people? How many employers now ban camera phones from company property? Telecommunication capabilities have surged ahead. But at the same time, annoyances related to recorded messages, particularly in service sectors, are overwhelming. While some of these situations fall into the category Kahn refers to as “random nuisances,” the cumulative effects on an individual can interfere with good health.

As people live longer, aging becomes an increasingly contemporary stressor for the elderly, as well as their middle-aged “children” who themselves may also be approaching senior status and early infirmities. Debilitating illnesses and loss of capabilities are major stressors for the elderly. In many families, middle-aged “children” live far from their elderly parents and become long-distance caregivers. The technology of communication cannot compete with the old-fashioned comfort of personal visits, kind words and handholding in familiar surroundings. Moving a surviving parent closer may relieve some stresses but could also create new ones – it may be difficult for the parent to make new friends in strange surroundings and for the “children” to have a new boarder or more immediate and demanding responsibilities.

In the area of work-related stress, issues abound on a global scale. In many sectors, mergers and acquisitions may reduce the number of available jobs. Outsourcing, while creating jobs elsewhere, may reduce opportunities for work. Asking for service assistance by telephone can be stressful for the information seeker when connected to a technician for whom English is a second language.

As the author of The Encyclopedia of Work-Related Injuries, Illnesses and Health Issues, Kahn has researched and described many work-related sources of stress. She has included a number of these topics in this edition of The Encyclopedia of Stress and Stress-Related Diseases. Readers will find entries on bullying, Employee Assistance Programs, smoking in the workplace, violence, and challenges faced by accountants, lawyers, taxi drivers, miners, construction workers, among many others.

In looking at family situations, Kahn includes topics relating to domestic violence, commuter marriages and changing patterns of children’s activities. Are children still allowed to be children? Overscheduling of afterschool activities can be a source of stress for young people and their parents.

Finally, this edition of The Encyclopedia of Stress and Stress-Related Diseases includes comprehensive explanations of many mental health issues that caused 40 million people to schedule office visits with physicians in 2002. Indeed, anxiety disorders are the most common mental health concern in the United States and probably in other developed countries. Kahn draws on her background of research as co-author of three books on fears and anxieties (Encyclopedia of Phobias, Fears and Anxieties, 2nd ed, Facts on File, Inc., 2000, Facing Fears, Facts on File, 2000, and Phobias, Scholastic, 2003) to provide readers of this second edition with informative details to help differentiate fears from phobias, both of which are serious sources of stress thereby threatening good health. Commonly shared fears, such as earthquakes and terrorism, and specific phobias, such as public speaking and heights, are explained in order to help readers recognize their fears and phobias. They can then take steps to cope with these stressors in ways that are more effective.

Stress is inevitable in human beings. Understanding that stress represents an overload that throws our physical and mental systems off balance can help us better cope with daily challenges. However, as Kahn explains, the key to healthy living is how we adapt and cope with everyday and ongoing stressors. These can range from serious situations (such as a life-threatening illness) to everyday random nuisances (such as traffic delays or telemarketing calls at dinnertime).

As a physician, I see many patients whose concerns may stem from personally stressful issues. Some people cope effectively with difficult situations, while others find that ongoing stress leads to digestive problems, headaches, difficulty sleeping, and ineffective and destructive coping methods, such as eating disorders, alcoholism and substance abuse. I had a patient who suffered a myocardial infarction with documented cardiac muscle destruction. However, when the coronary angiograms were done, there was not a plaque or thrombosis seen suggesting that coronary spasm was the etiology that in turn was most likely the result of an acute very stressful event.

In taking a medical history, physicians can better serve patients by including questions about their home, workplace, community or school. Is there marital discord? Are there concerns about elderly parents? Are difficulties at work or school present? When linking the stressful challenge to the presenting symptom, a physician can also provide suggestions for relaxation rather than (or in addition to, where appropriate) anxiolytic medications.

Kahn describes many strategies for relaxation. These range from aromatherapy, breathing exercises, physical exercise, meditation, music, yoga and tai chi. Indeed, learning to relax and to deal with everyday challenges in a calmer manner may be the best advice for many of us who present as “stressed-out’ individuals.

Being properly informed is the key to coping effectively with daily challenges in the many areas of contemporary life that could lead to stress. To this end, Kahn’s work on this second edition of The Encyclopedia of Stress and Stress-Related Diseases is truly outstanding. The book will be useful for concerned individuals, reference librarians, employers, human resource personnel, therapists and physicians, as well as all curious readers.

Dr Kahn's books can be purchased at http://www.factsonfile.com/. Enter Kahn in the search box.