Knut Ringen - Academia.edu (original) (raw)

Papers by Knut Ringen

American Journal of Industrial Medicine

Occupational and Environmental Medicine, 2020

ObjectivesThis study examined predictors of lung cancer mortality, beyond age and smoking, among ... more ObjectivesThis study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening.MethodsPredictive models were based on 17 069 workers and 352 lung cancer deaths. Risk factors included age, gender, race/ethnicity, cigarette smoking, years of trade or DOE work, body mass index (BMI), chest X-ray results, spirometry results, respiratory symptoms, beryllium sensitisation and personal history of cancer. Competing risk Cox models were used to obtain HRs and to predict 5-year risks.ResultsFactors beyond age and smoking included in the final predictive model were chest X-ray changes, abnormal lung function, chronic obstructive pulmonary disease (COPD), respiratory symptoms, BMI, personal history of cancer and having worked 5 or more years at a DOE site or in construction. Risk-based LDCT eligibility demonstrated improved sensitivity,...

American Journal of Industrial Medicine, Feb 28, 2018

PubMed, Apr 1, 1995

Construction differs markedly from many other types of manufacturing in that the nature of the wo... more Construction differs markedly from many other types of manufacturing in that the nature of the work exacerbates the safety and health risks faced by workers. Even for workers who have health care coverage, the authors point out, the transient nature of the industry makes it difficult to trace an individual's exposure to health hazards.

American Journal of Industrial Medicine, 2009

Background A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former... more Background A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former workers participating in medical screening programs at Department of Energy (DOE) nuclear weapons facilities through September 2008 was undertaken. Methods Participants provided a detailed work and exposure history and underwent a respiratory examination that included a respiratory history, respiratory symptoms, a posterior-anterior (P-A) chest radiograph classified by International Labour Office (ILO) criteria, and spirometry. Statistical models were developed to generate group-level exposure estimates that were used in multivariate logistic regression analyses to explore the risk of COPD in relation to exposures to asbestos, silica, cement dust, welding, paints, solvents, and dusts/fumes from paint removal. Risk for COPD in the study population was compared to risk for COPD in the general US population as determined in National Health and Nutrition Examination Survey (NHANES III). Results The age-standardized prevalence ratio of COPD among DOE workers compared to all NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and duration of DOE employment. Statistically significant associations were observed for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks associated with exposures to paints, solvents, and removal of paints. Conclusions Our study of construction workers employed at DOE sites demonstrated increased COPD risk due to occupational exposures and was able to identify specific exposures increasing risk. This study provides additional support for prevention of both smoking and occupational exposures to reduce the burden of COPD among construction workers.

J Occup Environ Med, 1986

Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are... more Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are still in the preclinical disease stage. A large proportion of workers in these populations have been exposed to aromatic amines, but have not yet experienced the average latent period for bladder cancer. A need exists for definition of what constitutes optimal management for asymptomatic workers in these cohorts. Promising advances in the epidemiology, pathology, detection, and treatment of bladder cancer pressure for a reassessment of current practices and the application of the most current scientific knowledge. Some of these apparent advances, however, have not yet been rigorously evaluated. The time has come to evaluate these advances so that their application can occur while high risk cohorts are still amenable to and likely to benefit from intervention. This commentary calls for such an evaluation leading to a comprehensive approach to managing cohorts at high risk of bladder cancer.

Occupational medicine (Philadelphia, Pa.)

The construction industry has one of the highest proportions of workers without health insurance.... more The construction industry has one of the highest proportions of workers without health insurance. The authors review the two types of insurance systems that are generally used to cover the cost of health care for construction workers in the U.S.: health and welfare funds and workers' compensation. Recent developments in health care delivery in the U.S. are discussed, as are the more comprehensive occupational medicine services offered in France, Germany, The Netherlands, and Sweden.

Progress in clinical and biological research

Journal of occupational medicine.: official publication of the Industrial Medical Association

ABSTRACT

Occupational medicine (Philadelphia, Pa.)

American journal of industrial medicine, Jan 29, 2015

While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational ex... more While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational exposures to vapors, gases, dusts, and fumes (VGDF) increase COPD risk. This case-control study estimated the risk of COPD attributable to occupational exposures among construction workers. The study population included 834 cases and 1243 controls participating in a national medical screening program for older construction workers between 1997 and 2013. Qualitative exposure indices were developed based on lifetime work and exposure histories. Approximately 18% (95%CI = 2-24%) of COPD risk can be attributed to construction-related exposures, which are additive to the risk contributed by smoking. A measure of all VGDF exposures combined was a strong predictor of COPD risk. Construction workers are at increased risk of COPD as a result of broad and complex effects of many exposures acting independently or interactively. Control methods should be implemented to prevent worker exposures, and sm...

Background and Objective: Construction workers are at significant risk for a range of occupationa... more Background and Objective: Construction workers are at significant risk for a range of occupational injuries and illnesses. To describe the impact of occupational exposures on construction workers, we developed an estimate of the lifetime probability of a construction worker having a fatal or nonfatal occupational injury, and of developing a Chronic Obstructive Pulmonary Disease (COPD), Noise Induced Hearing Loss (NIHL), or a lost time musculoskeletal disorder (MSD). Methods: We used multiple years of data from the Census of Fatal Occupational Injuries (CFOI), the Survey of Occupational Injuries and Illnesses (SOII), Health and Retirement Study (HRS), two national medical surveillance programs for construction workers, and published research to estimate incidence and prevalence of these conditions at different ages and in different cohorts. Data from the Occupational Health Supplement to 2010 National Health Interview Survey (NHIS) will be included in the analyses. Results: Using nat...

American journal of industrial medicine, 2014

Estimates of occupational risk are typically computed on an annual basis. In contrast, this artic... more Estimates of occupational risk are typically computed on an annual basis. In contrast, this article provides estimates of lifetime risks for fatal and nonfatal injuries among construction workers. A companion paper presents lifetime risks for occupational illnesses. Using 2003-2007 data from three large data sources, lifetime risk was computed based on the number of fatal and nonfatal injuries per 100 FTEs for a working lifespan of 45 years. For a working life in construction, the risk of fatal injuries were approximately one death per 200 FTE, and the leading causes were falls and transportation incidents. For nonfatal injuries resulting in days away from work, the adjusted lifetime risk was approximately 78 per 100 FTEs, and the leading causes were contact with objects/equipment, overexertion, and falls to a lower level. Lifetime risk estimates help inform both workers and policymakers. Despite improvements over the past decades, risks in construction remain high.

Journal of comparative effectiveness research, 2013

Evaluation of: National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR et al.... more Evaluation of: National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR et al. Results of initial low-dose computed tomographic screening for lung cancer. N. Engl. J. Med. 368, 1980-1991 (2013). In 2011, the US NLST trial demonstrated that mortality from lung cancer can be reduced by using low-dose computed tomography (LDCT) screening rather than chest x-ray (CXR) screening. This paper from the US NLST research team focuses on the results of the initial round of LDCT for lung cancer. A total of 53,439 participants were included and randomly assigned to LDCT screening (n = 26,715) or CXR screening (n = 26,724). In total, 27.3% of the participants in the LDCT group and 9.2% in the CXR group had a positive screening result. As a result, 3.8% (LDCT group) and 5.7% (CXR group) of these subjects were diagnosed with lung cancer. The sensitivity (93.8%) and specificity (73.4%) for lung cancer were higher for LDCT compared with CXR screening; 73.5 and 91.3%, respectively.

American journal of industrial medicine, 2010

International journal of occupational and environmental health

Injury rates in all industries and in construction in particular have been declining. Inconsisten... more Injury rates in all industries and in construction in particular have been declining. Inconsistencies in the information suggest some of the apparent decrease may be due to changes in the ways injuries are treated, misclassification of employees, or underreporting. Lost-time injury rates for the largest construction employers declined by as much as 92% between 1988 and 1999. Yet the rate for cases with restricted work activity actually increased from 0.7 to 1.2 per 100 full-time workers between 1990 and 2000, and fatalities among construction workers remain high. In Massachusetts, at least 14% of construction employers misclassified workers as independent contractors, with the effect that injuries to these workers are not recordable. Studies that compare OSHA logs with other data sources find that the OSHA logs do not include a significant proportion of injuries and illnesses identified elsewhere.

American Journal of Industrial Medicine, 2014

Background We developed working-life estimates of risk for dust-related occupational lung disease... more Background We developed working-life estimates of risk for dust-related occupational lung disease, COPD, and hearing loss based on the experience of the Building Trades National Medical Screening Program in order to (1) demonstrate the value of estimates of lifetime risk, and (2) make lifetime risk estimates for common conditions among construction workers. Methods Estimates of lifetime risk were performed based on 12,742 radiographic evaluations, 12,679 spirometry tests, and 11,793 audiograms. Results Over a 45-year working life, 16% of construction workers developed COPD, 11% developed parenchymal radiological abnormality, and 73.8% developed hearing loss. The risk for occupationally related disease over a lifetime in a construction trade was 2-6 times greater than the risk in non-construction workers.

The Hastings Center Report, 1980

Journal of Occupational and Environmental Medicine, 1986

Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are... more Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are still in the preclinical disease stage. A large proportion of workers in these populations have been exposed to aromatic amines, but have not yet experienced the average latent period for bladder cancer. A need exists for definition of what constitutes optimal management for asymptomatic workers in these cohorts. Promising advances in the epidemiology, pathology, detection, and treatment of bladder cancer pressure for a reassessment of current practices and the application of the most current scientific knowledge. Some of these apparent advances, however, have not yet been rigorously evaluated. The time has come to evaluate these advances so that their application can occur while high risk cohorts are still amenable to and likely to benefit from intervention. This commentary calls for such an evaluation leading to a comprehensive approach to managing cohorts at high risk of bladder cancer.

American Journal of Industrial Medicine

Occupational and Environmental Medicine, 2020

ObjectivesThis study examined predictors of lung cancer mortality, beyond age and smoking, among ... more ObjectivesThis study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening.MethodsPredictive models were based on 17 069 workers and 352 lung cancer deaths. Risk factors included age, gender, race/ethnicity, cigarette smoking, years of trade or DOE work, body mass index (BMI), chest X-ray results, spirometry results, respiratory symptoms, beryllium sensitisation and personal history of cancer. Competing risk Cox models were used to obtain HRs and to predict 5-year risks.ResultsFactors beyond age and smoking included in the final predictive model were chest X-ray changes, abnormal lung function, chronic obstructive pulmonary disease (COPD), respiratory symptoms, BMI, personal history of cancer and having worked 5 or more years at a DOE site or in construction. Risk-based LDCT eligibility demonstrated improved sensitivity,...

American Journal of Industrial Medicine, Feb 28, 2018

PubMed, Apr 1, 1995

Construction differs markedly from many other types of manufacturing in that the nature of the wo... more Construction differs markedly from many other types of manufacturing in that the nature of the work exacerbates the safety and health risks faced by workers. Even for workers who have health care coverage, the authors point out, the transient nature of the industry makes it difficult to trace an individual's exposure to health hazards.

American Journal of Industrial Medicine, 2009

Background A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former... more Background A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former workers participating in medical screening programs at Department of Energy (DOE) nuclear weapons facilities through September 2008 was undertaken. Methods Participants provided a detailed work and exposure history and underwent a respiratory examination that included a respiratory history, respiratory symptoms, a posterior-anterior (P-A) chest radiograph classified by International Labour Office (ILO) criteria, and spirometry. Statistical models were developed to generate group-level exposure estimates that were used in multivariate logistic regression analyses to explore the risk of COPD in relation to exposures to asbestos, silica, cement dust, welding, paints, solvents, and dusts/fumes from paint removal. Risk for COPD in the study population was compared to risk for COPD in the general US population as determined in National Health and Nutrition Examination Survey (NHANES III). Results The age-standardized prevalence ratio of COPD among DOE workers compared to all NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and duration of DOE employment. Statistically significant associations were observed for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks associated with exposures to paints, solvents, and removal of paints. Conclusions Our study of construction workers employed at DOE sites demonstrated increased COPD risk due to occupational exposures and was able to identify specific exposures increasing risk. This study provides additional support for prevention of both smoking and occupational exposures to reduce the burden of COPD among construction workers.

J Occup Environ Med, 1986

Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are... more Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are still in the preclinical disease stage. A large proportion of workers in these populations have been exposed to aromatic amines, but have not yet experienced the average latent period for bladder cancer. A need exists for definition of what constitutes optimal management for asymptomatic workers in these cohorts. Promising advances in the epidemiology, pathology, detection, and treatment of bladder cancer pressure for a reassessment of current practices and the application of the most current scientific knowledge. Some of these apparent advances, however, have not yet been rigorously evaluated. The time has come to evaluate these advances so that their application can occur while high risk cohorts are still amenable to and likely to benefit from intervention. This commentary calls for such an evaluation leading to a comprehensive approach to managing cohorts at high risk of bladder cancer.

Occupational medicine (Philadelphia, Pa.)

The construction industry has one of the highest proportions of workers without health insurance.... more The construction industry has one of the highest proportions of workers without health insurance. The authors review the two types of insurance systems that are generally used to cover the cost of health care for construction workers in the U.S.: health and welfare funds and workers' compensation. Recent developments in health care delivery in the U.S. are discussed, as are the more comprehensive occupational medicine services offered in France, Germany, The Netherlands, and Sweden.

Progress in clinical and biological research

Journal of occupational medicine.: official publication of the Industrial Medical Association

ABSTRACT

Occupational medicine (Philadelphia, Pa.)

American journal of industrial medicine, Jan 29, 2015

While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational ex... more While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational exposures to vapors, gases, dusts, and fumes (VGDF) increase COPD risk. This case-control study estimated the risk of COPD attributable to occupational exposures among construction workers. The study population included 834 cases and 1243 controls participating in a national medical screening program for older construction workers between 1997 and 2013. Qualitative exposure indices were developed based on lifetime work and exposure histories. Approximately 18% (95%CI = 2-24%) of COPD risk can be attributed to construction-related exposures, which are additive to the risk contributed by smoking. A measure of all VGDF exposures combined was a strong predictor of COPD risk. Construction workers are at increased risk of COPD as a result of broad and complex effects of many exposures acting independently or interactively. Control methods should be implemented to prevent worker exposures, and sm...

Background and Objective: Construction workers are at significant risk for a range of occupationa... more Background and Objective: Construction workers are at significant risk for a range of occupational injuries and illnesses. To describe the impact of occupational exposures on construction workers, we developed an estimate of the lifetime probability of a construction worker having a fatal or nonfatal occupational injury, and of developing a Chronic Obstructive Pulmonary Disease (COPD), Noise Induced Hearing Loss (NIHL), or a lost time musculoskeletal disorder (MSD). Methods: We used multiple years of data from the Census of Fatal Occupational Injuries (CFOI), the Survey of Occupational Injuries and Illnesses (SOII), Health and Retirement Study (HRS), two national medical surveillance programs for construction workers, and published research to estimate incidence and prevalence of these conditions at different ages and in different cohorts. Data from the Occupational Health Supplement to 2010 National Health Interview Survey (NHIS) will be included in the analyses. Results: Using nat...

American journal of industrial medicine, 2014

Estimates of occupational risk are typically computed on an annual basis. In contrast, this artic... more Estimates of occupational risk are typically computed on an annual basis. In contrast, this article provides estimates of lifetime risks for fatal and nonfatal injuries among construction workers. A companion paper presents lifetime risks for occupational illnesses. Using 2003-2007 data from three large data sources, lifetime risk was computed based on the number of fatal and nonfatal injuries per 100 FTEs for a working lifespan of 45 years. For a working life in construction, the risk of fatal injuries were approximately one death per 200 FTE, and the leading causes were falls and transportation incidents. For nonfatal injuries resulting in days away from work, the adjusted lifetime risk was approximately 78 per 100 FTEs, and the leading causes were contact with objects/equipment, overexertion, and falls to a lower level. Lifetime risk estimates help inform both workers and policymakers. Despite improvements over the past decades, risks in construction remain high.

Journal of comparative effectiveness research, 2013

Evaluation of: National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR et al.... more Evaluation of: National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR et al. Results of initial low-dose computed tomographic screening for lung cancer. N. Engl. J. Med. 368, 1980-1991 (2013). In 2011, the US NLST trial demonstrated that mortality from lung cancer can be reduced by using low-dose computed tomography (LDCT) screening rather than chest x-ray (CXR) screening. This paper from the US NLST research team focuses on the results of the initial round of LDCT for lung cancer. A total of 53,439 participants were included and randomly assigned to LDCT screening (n = 26,715) or CXR screening (n = 26,724). In total, 27.3% of the participants in the LDCT group and 9.2% in the CXR group had a positive screening result. As a result, 3.8% (LDCT group) and 5.7% (CXR group) of these subjects were diagnosed with lung cancer. The sensitivity (93.8%) and specificity (73.4%) for lung cancer were higher for LDCT compared with CXR screening; 73.5 and 91.3%, respectively.

American journal of industrial medicine, 2010

International journal of occupational and environmental health

Injury rates in all industries and in construction in particular have been declining. Inconsisten... more Injury rates in all industries and in construction in particular have been declining. Inconsistencies in the information suggest some of the apparent decrease may be due to changes in the ways injuries are treated, misclassification of employees, or underreporting. Lost-time injury rates for the largest construction employers declined by as much as 92% between 1988 and 1999. Yet the rate for cases with restricted work activity actually increased from 0.7 to 1.2 per 100 full-time workers between 1990 and 2000, and fatalities among construction workers remain high. In Massachusetts, at least 14% of construction employers misclassified workers as independent contractors, with the effect that injuries to these workers are not recordable. Studies that compare OSHA logs with other data sources find that the OSHA logs do not include a significant proportion of injuries and illnesses identified elsewhere.

American Journal of Industrial Medicine, 2014

Background We developed working-life estimates of risk for dust-related occupational lung disease... more Background We developed working-life estimates of risk for dust-related occupational lung disease, COPD, and hearing loss based on the experience of the Building Trades National Medical Screening Program in order to (1) demonstrate the value of estimates of lifetime risk, and (2) make lifetime risk estimates for common conditions among construction workers. Methods Estimates of lifetime risk were performed based on 12,742 radiographic evaluations, 12,679 spirometry tests, and 11,793 audiograms. Results Over a 45-year working life, 16% of construction workers developed COPD, 11% developed parenchymal radiological abnormality, and 73.8% developed hearing loss. The risk for occupationally related disease over a lifetime in a construction trade was 2-6 times greater than the risk in non-construction workers.

The Hastings Center Report, 1980

Journal of Occupational and Environmental Medicine, 1986

Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are... more Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are still in the preclinical disease stage. A large proportion of workers in these populations have been exposed to aromatic amines, but have not yet experienced the average latent period for bladder cancer. A need exists for definition of what constitutes optimal management for asymptomatic workers in these cohorts. Promising advances in the epidemiology, pathology, detection, and treatment of bladder cancer pressure for a reassessment of current practices and the application of the most current scientific knowledge. Some of these apparent advances, however, have not yet been rigorously evaluated. The time has come to evaluate these advances so that their application can occur while high risk cohorts are still amenable to and likely to benefit from intervention. This commentary calls for such an evaluation leading to a comprehensive approach to managing cohorts at high risk of bladder cancer.