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Archive for October, 2009

Women and Medical Surveillance Programs: New challenges as the female workforce grows

Sunday, October 25th, 2009

Employees who participated in medical surveillance programs up until recently were overwhelmingly male.  That has changed in recent years and nearly every employer now has both male and female employees who are required to participate in annual medical surveillance requirements.  Yet, here has been no  medical surveillance program design, testing requirements or interpretation of findings based on gender.  Well, that may be changing very soon…

Recently, Corporate Wellness identified a pattern of abnormal laboratory findings in female employees who completed serum cholinesterase screens as baseline tests for a new environmental consulting client. They have more female employees than many others in the industry.  While the laboratory normal range for this test is 1900 to 3800 units per milliliter (U/mL), more than half of the female employees we tested this year had significantly lower results – some hovering around the 1000 U/mL mark even after retesting.  Normally,  we’d recommend limited potential for exposure and retest for 75% of normal and removal from all assignments that might include exposures for findings that are 60% of normal or below.

Together with Dr. Randy Young who heads clinical operations for LabCorp, we took a closer look.  We found that although there is currently only a single normal range for both males and females, normal findings for females, and especially females using estrogen based birth control, are more likely to be in the 1000 to 1800 units range – well below the published “normals” of 1800- to 3800 units.

LabCorp examined its own results, for our clients’ employees and their entire patient population and found that our observations appear to be correct.  And they will be publishing a new set of “normals” for both serum and rbc cholinesterase that are gender based.

For the moment, we are sending letters to all female employees whose laboratory results are below 1800 units, explaining where we are in the process of helping set new gender based normals but also offering retest if they’d like it.

We suspect that this may be the first of many things we learn as a result of the changing workforce.

What’s new with flu this week

Tuesday, October 13th, 2009

Flu continues to receive a great deal of media coverage and sometimes it is hard to figure out why the media covers one story and glosses over others. Here are what we think were the most important flu stories of this past week and our comments on them:

1. A small study from Mexico showed that individuals who received seasonal flu shots and contracted H1N1 flu had a significantly lower mortality rate. In fact, none of the critically ill patients in the study who had received a seasonal flu shot died while 34% of those critically ill patients who had not received a seasonal flu shot did. We will have more and better US data, hopefully validating this study , within the next week or two.

This study’s findings were directly opposite from the findings from a small Canadian study several weeks ago.

2. The shortage of seasonal flu vaccine is widespread. Unlike other flu shot seasons, it will not resolve itself over time.

In past flu seasons when there were vaccine delays or shortages, the manufacturers would continue to make vaccine as long as necessary. This year, they have converted their production lines over to H1N1 production lines and are no longer manufacturing seasonal flu vaccine. There are always vaccine “losses” when vials are filled after their lots are approved by the FDA. This year, those fill losses are three times normal which adds to the shortage (that one has received nearly no media coverage).

As a result, most retail flu clinics (like those in Costcos and CVS pharmacies) will be ending weeks ahead of schedule as they run out of vaccine.

3. There appears to be a renewed shortage of hand sanitizer. Don’t wait until you are out before re-ordering because there are back orders.

4. Flu activity is now present in all 50 states with high activity reported in 37 states.

5. Flu “burnout” is our newest concern. Dr. Anne Schuchat from the CDC reports that we will likely see flu activity levels similar to this week’s for the next seven months (until the end of traditional flu season). Remaining vigilant for that long of a period of time will be challenging for most businesses. As we hear how different clients and employers are creatively addressing ways to prevent flu burnout, we’ll pass them along.