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NIOSH Safety and Health Topic:Occupational Sentinel Health Events SHE(O) |
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An Occupational Sentinel Health Event (SHE[O]) is a disease, disability, or untimely death, which is occupationally related and whose occurrence may:
The genesis
of the SHEO arises from a table of disease events that was developed by David
D. Rutstein based on the concept of the Sentinel Health Event (SHE). According
to Rutstein, an SHE is a preventable disease, disability, or untimely death
whose occurrence serves as a warning signal that the quality of preventive
and/or therapeutic medical care may need to be improved. (Ref.
2) Thus, these events serve as negative indices of the quality of medical
care. For example, a case of polio is an SHE. The occurrence of this disease
signals a breakdown in the immunization aspect of health care. This approach of identifying and counting the number of preventable tragedies in the health care field was also used in the 1930s in New York State in preventing maternal mortality and in the 1960s for preventing infant deaths in the State of Massachusetts. Based on the experience with maternal and infant mortality, Rutstein collaborated with NIOSH and successfully applied the SHE concept to the field of occupational disease. Thus the SHEO concept evolved with appropriate modification of the SHE table. Following survey of the scientific literature, a list of 50 disease conditions linked to the workplace was published in 1983; these were codable within the framework of WHO's International Classification of Diseases system (ICD-9). (Ref. 1 ) An updated list of 64 disease conditions was published in 1991. (Ref. 3) Criteria used for inclusion in the original list presented in 1983 were: documentation of associated agent(s), of involved industries, and of involved occupations. For the 1991 update, the following additional criteria were considered:
Studies that were equivocal were not included in the updated list. Reports that needed confirmation by more supportive studies were also not included in the updated list. These included the following:
In the updated list, two broad categories of SHE(O) were represented. The first group included those diseases or conditions that, by their inherent nature, are occupationally related, e.g., the pneumoconioses. It is unlikely that these diseases would occur in the absence of the inciting agent. The second set of conditions included diseases such as lung cancer, leukemia, peripheral neuropathy, and ornithosis, which may or may not be occupationally related; further information on the industry and occupation is required to establish a possible link between disease condition and occupation. References
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