February 01, 2001

Finding up-to-date health information just became a bit easier with the addition of a daily health news feed from the major U.S. print media to the National Library of Medicine's MEDLINE "plus" consumer-friendly site.

Every weekday morning the home page of "" (that's the complete address) will be updated with health-related articles selected from the Associated Press, New York Times Syndicate, and United Press International. The Library has made special arrangements with the publishers to make the articles available, and more sources will be added in the future. They will not only be listed on the home page, but each will be linked to one or more of the 430 "health topics" within MEDLINE "plus". Thus, for example, someone interested in diabetes will find a section called "Latest News" at the top of the diabetes page.

In addition to highlighting important news items on the MEDLINE "plus" home page, a complete list of news items from the last 30 days is also available, a feature that may prove especially useful to librarians.

"We realize how important it is for people who search for information on the web, for their personal health and that of their families, to be able to go to a site they trust. This latest news feature from authoritative press sources is a new and welcome addition to our service," said Donald A.B. Lindberg, M.D., director of the National Library of Medicine. MEDLINE "plus" draws on the extensive resources of the National Institutes of Health and other reliable, non-commercial sites. No registration is ever required for MEDLINE "plus" users.

MEDLINE "plus," which was introduced in October 1998, receives a remarkable 5 million page hits each month. Usage has doubled in just the past 6 months. In addition to the "health topics" on individual diseases and medical conditions, the site also has an extensive medical encyclopedia with thousands of illustrations, detailed information about more than 9,000 brand name and generic prescription and over the counter drugs, a medical dictionary, directories of doctors and hospitals, and links to, the NIH web site listing more than 5,000 clinical studies. There are even links to the scientific database, MEDLINE, so that users have access to the latest published research.

The National Library of Medicine, which is the world's largest library of the health sciences, is a part of the National Institutes of Health in Bethesda, Maryland. The Library has an extensive Web site at that provides a great variety of information for the general public and for health professionals.


The National Toxicology Program announced the publication of an addendum to its Ninth Report on Carcinogens that adds 2,3,7,8-tetrachlorodibenzo-p-dioxin, also known as TCDD or Dioxin, to the list of substances "known to be human carcinogens."

Kenneth Olden, Ph.D., Director of the National Institute of Environmental Health Sciences and the National Toxicology Program, which has the responsibility for preparation of this report, said that publication of this addendum follows the recent ruling by the U.S. Court of Appeals for the District of Columbia Circuit dismissing a request for an injunction to prevent the listing of TCDD as a "known human carcinogen" pending appeal of the district court's decision upholding the listing.

The change in the listing of TCDD from the "reasonably anticipated" to the "known to be a human carcinogen" category had been planned to occur in the Ninth Report, but the designation was delayed by litigation. The plaintiffs in the lawsuit claim that the Department of Health and Human Services and National Toxicology Program had improperly applied the Report on Carcinogens' listing criteria in listing TCDD as a "known human carcinogen." The Ninth Report was published last May 15 with TCDD listed as a "reasonably anticipated" human carcinogen but with a statement included indicating an addendum may be published following the Court's ruling on the litigation.

The National Toxicology Program's listing of TCDD in the "known" category is based on sufficient evidence of carcinogenicity from studies in humans, involving a combination of epidemiological and mechanistic information which indicates a causal relationship between exposure to TCDD and human cancer.

TCDD is not deliberately produced today but has been found as a contaminant in some herbicides and pesticides and is formed as an inadvertent by-product of incineration of waste. TCDD levels in Americans have declined in recent years as a result of environmental controls but is still widely detected in the environment and can be found in very small amounts in the general population. The Report on Carcinogens is a cancer health hazard identification document that discusses substances that may pose a carcinogenic hazard to human health. The report does not present quantitative assessments of carcinogenic risk, an assessment that defines the conditions under which the hazard may be unacceptable. The listing of substances in the report, therefore, does not establish that such substances present carcinogenic risks to individuals in their daily lives. Such formal risk assessments are the purview of the appropriate Federal, State, and local health regulatory and research agencies. Both the Environmental Protection Agency and the Food and Drug Administration have quantitative assessments of dioxin's cancer risks.

The Report on Carcinogens is a Congressionally mandated listing of known and reasonably anticipated human carcinogens. Its preparation is delegated to the National Toxicology Program, which is headquartered at the National Institute of Environmental Health Sciences, by the Secretary, Department of Health and Human Services. Section 301(b)(4) of the Public Health Service Act, as amended, provides that the Secretary, Department of Health and Human Services shall publish a report and also states that the reports should provide available information on the nature of exposures, the estimated number of persons exposed and the extent to which the implementation of Federal regulations decreases the risk to public health from exposure to these chemicals. The revised Ninth Report that contains all addendum materials is available on the Internet from the National Toxicology Program's web page at

NTP is headquartered at the NIEHS in Research Triangle Park, N.C.


Naphthalene, the chemical that gives mothballs that strong, familiar scent, showed clear evidence of causing cancer in male and female laboratory rats in a two-year study by the National Toxicology Program headquartered at the National Institute of Environmental Health Sciences in Research Triangle Park, N.C. The rats in the study were exposed by inhalation, just as most people are, in doses comparable to some human consumer and workplace exposures.

NIEHS-NTP Study Scientist Kamal Abdo said naphthalene was nominated for study by the National Institute of Occupational Safety and Health, the Occupational Safety and Health Administration, and the U.S. Environmental Protection Agency - all of which are represented on the NTP Executive Committee -- after some German workers exposed to naphthalene were found to have a variety of cancers - including laryngeal, gastric, nasal, and colon cancer. Regulatory agencies will have the opportunity to review the study and current labeling and take regulatory action as appropriate, using other studies and data as well.

The most widely known use of naphthalene is in mothballs and bathroom deodorizers, but it also has a number of chemical manufacturing uses, and is used in veterinary medicine to control lice and as a disinfectant for lesions and incisions. It enters the human food chain when used on livestock that then ingest or inhale it. Naphthalene manufacture and use goes back at least to the early part of the 20th Century.


The Mine Safety and Health Administration has announced two final rules to protect all underground miners from diesel exhaust particulate matter, a serious health hazard created by diesel-powered equipment. The rules were published in the Federal Register on Friday, January 19, 2001.

Diesel particulate matter, or DPM, consists of tiny particles present in diesel engine exhaust that can readily penetrate into the deepest recesses of the lungs. Despite ventilation, the confined underground mine work environment may contribute to significant concentrations of particles produced by equipment used in the mine. Underground miners are exposed to higher concentrations of DPM than any other occupational group. As a result, they face a significantly greater risk than other workers of developing such diseases as lung cancer, heart failure, serious allergic responses and other cardiopulmonary problems.

The new diesel regulations will affect 145 underground coal mines employing nearly 15,000 miners and 196 underground metal and nonmetal mines employing nearly 19,000 miners.

The new rules will ensure that miner exposures do not exceed those of other groups of workers regularly exposed to diesel exhaust, such as truck and bus drivers.

Since underground conditions vary between coal mines and metal and nonmetal mines, the regulations take different approaches to reduce DPM exposure to the same level. The final rule to protect underground metal and nonmetal miners will establish an "interim" DPM concentration limit of 400 micrograms of total carbon per cubic meter of air and, after five years, that level must be reduced to 160.

Following publication of the regulation, metal and nonmetal mines have up to 18 months to reach compliance with the interim concentration limit in their underground operations. These operators have the option of using engineering controls and best practices to reduce DPM to the proper limit.

In underground coal mines, the new rule sets a specific emission limit of 2.5 grams per hour of DPM for permissible and non-permissible equipment. These limits will be phased in for an operation's existing equipment inventory over a 48-month period, but new equipment must meet the emission limits sooner. Coal mine operators may use a combination of controls (cleaner engine, filter, etc.) to comply with the emission limit.

Annual training is required for all underground miners exposed to diesel emissions. Workers will be trained on the health risks associated with DPM exposure, control methods being used at the mine, identification of personnel responsible for maintaining those controls, and actions miners must take to ensure the controls operate as intended.

To assist mine operators in understanding the requirements of the rules, MSHA will offer compliance assistance and a series of informational workshops throughout the country (dates and locations to be announced). A compliance guide and tool-box also will be available on MSHA's web site at

MSHA estimates that at least 8.5 cases of lung cancer per year will be avoided as a result of the metal and nonmetal rule, and at least 1.8 cases per year will be avoided as a result of the coal rule.

MSHA first proposed regulations regarding diesel emissions in April 1998 for coal mines and October 1998 for metal and nonmetal mines. Public hearings were held in November and December for the coal rule and the following May for the metal and nonmetal rule. Public comments were accepted on the coal rule for 15 months and on the metal and nonmetal rule for nine months.


OSHA has cited General Chemical Corporation Delaware Valley Works for alleged safety and health violations at both the North plant in Marcus Hook, Pa., and the South plant in Claymont, Del., and proposed penalties totaling $487,000.

According to Phyllis Kyner, area director of the Philadelphia OSHA office, an inspection was initiated on Aug. 4, 2000 at the company's North plant when six employees were hospitalized after a release of Hydrogen Fluoride. The inspection at the South plant began on Sept. 14, 2000 as a result of a complaint.

"The hazardous conditions found at these sites foster a continuously unsafe work environment for General Chemical employees," said Kyner. "Immediate action must be taken to prevent future incidents and ensure the safety and health of these workers."

The citations issued are the result of both inspections and have been issued so that the company is not penalized twice for the same violations found in each plant.

Eight willful violations with a proposed penalty of $365,000; 25 serious violations with a penalty of $104,000; and, two other-than-serious violations with a penalty of $1,000 have been issued for both the North and South Plants.

Citations for four serious violations, with a proposed penalty of $17,000, were issued for the South plant only.

A description of the alleged willful violations follows:

  • one willful violation of the process safety management standard: specifically, not addressing the Process Hazard Analysis teams' recommendations in a timely manner and not establishing a written schedule of correction or documenting completion of those recommendations. More than 70 instances of the teams' recommendations from 1991 until present were not resolved.
  • one willful violation of the process safety management standards - not correcting deficiencies in equipment.
  • one willful violation of the confined space standard in that the company did not ensure that all procedures specified by the permit had been conducted before entering a hydrogen fluoride tank
  • one willful violation of the lockout/tagout standard for not implementing an adequate program (lockout/tagout procedures are designed to safeguard employees from the unexpected startup or release of stored energy in machines or equipment).
  • one willful eyewash and shower violation which involved defective facilities at both plants.
  • three willful violations for recordkeeping for over 100 instances of not recording or misrecording lost time in calendar years 1998, 1999 and 2000.

The serious citations cover a range of violations of the process safety management standard; failure to notify the emergency actions team and failure to implement an emergency response plan when an emergency occurred; various violations of the personal protective equipment standard; confined space violations; failure to conduct periodic inspections of energy control procedures; and, failure to train employees in the hazards of hydrogen fluoride.

The serious citations issued to the South plant involve the process safety management standard for failure to have operating procedures on how to deal with airborne exposure to ammonia; problems with the mechanical integrity program; and failure to conduct inspection of valves or repair structural defects when discovered; and failure to maintain the hydrogen sulfide alarm in working condition.

The other-than-serious violations concern the certification of lockout/tagout training and other procedural inadequacies.

Willful violations are those committed with an intentional disregard of, or plain indifference to, the requirements of the Occupational Safety and Health Act and regulations. Serious violations involve a substantial probability that death or serious physical harm could result and that the employer knew or should have known of the hazard.

The company has 15 working days from receipt of the citations to decide to comply, request an informal conference with the OSHA area director or contest the citations and proposed penalties before the Independent Occupational Safety and Health Review Commission.


Following a January incident in which 13 employees of a Chelsea, Massachusetts, meat wholesaler were overcome by carbon monoxide from a borrowed forklift truck, OSHA has cited the wholesaler, James J. Derba, Inc., and the company which supplied the forklift, Big T&D Trucking, also of Chelsea, for alleged serious and other than serious violations of the Occupational Safety and Health Act. OSHA has proposed combined penalties against the two employers totaling $22,600.

According to Brenda Gordon, OSHA area director for Suffolk County and Southeastern Massachusetts, the alleged violations encompass overexposure to carbon monoxide, lack of adequate engineering controls to reduce such exposure, the use of defective forklift trucks, lack of employee training in the safe operation of forklift trucks and pallet jacks, and failure to maintain required employee illness and injury logs.

On January 3rd, 2001, Derba employees were using a propane-powered forklift truck borrowed from Big T&D Trucking to help hang 200-300 pound beef sections in a meat hanging cooler. Carbon monoxide from the truck's exhaust built up to dangerous levels in the enclosed space of the unventilated cooler. As a result of this, the workers experienced symptoms of carbon monoxide poisoning including headaches, nausea, dizziness, vomiting, shortness of breath and loss of consciousness. All required medical attention.

"This was a close call, a textbook example of the dangers of carbon monoxide exposure that clearly illustrates why employers need to take effective steps to safeguard workers," said Gordon. "In this case, the employees were acutely exposed to excess levels of carbon monoxide that were potentially lethal. This forklift truck should not have been allowed to operate in this cooler."

Gordon explained that carbon monoxide is a colorless, odorless, tasteless poisonous gas produced by the incomplete burning of any material containing carbon, such as gasoline, natural gas, oil, propane, coal or wood. One of the most common sources of exposure in the workplace is the internal combustion engine.

"Carbon monoxide is a chemical asphyxiant," she said. "Exposure to it restricts the ability of the blood system to carry necessary oxygen to body tissues. Prolonged overexposure to carbon monoxide can result in death or permanent damage to those parts of the body which require a lot of oxygen, such as the heart and brain."

Among the means of reducing carbon monoxide hazards are providing adequate ventilation in the workplace and ensuring that fossil-fuel-powered equipment is in proper working order so as to minimize its carbon monoxide levels. Where appropriate ventilation in unavailable, effective controls -- for example, the use of an electric rather than a gas-powered vehicle -- should be implemented. Cold weather can increase carbon monoxide hazards since traditional warm weather sources of workplace ventilation -- windows, doors, vents, bays -- may be closed or sealed against low outside temperatures.

An OSHA fact sheet on carbon monoxide poisoning is available through area offices or on line at

Specifically, the citations and proposed penalties against the two employers are:

James J. Derba, Inc. faces a total of $15,600 in fines for:

  • Two alleged serious violations, with $12,600 in proposed penalties, for:
    • excess levels of carbon monoxide in the forklift truck's exhaust; employees exposed to excess levels of carbon monoxide; and failure to adequately determine engineering controls to reduce carbon monoxide hazards in a location (the meat hanging cooler) where ventilation was unavailable;
    • failure to train employees in the safe operations of powered pallet jacks and the forklift; failure to certify employee pallet jack and forklift training and evaluation.
  • One alleged other than serious violation, with a proposed penalty of $3,000, for: failure to maintain an illness and injury log.
  • Big T&D Trucking faces $7,000 in fines for:

    • Two alleged serious violations, with $5,000 in proposed penalties, for:
      • failure to ensure that operators had been adequately trained and evaluated in the safe operation of forklift trucks; failure to certify operator training and evaluation;
      • excess levels of carbon monoxide measured in the exhaust from two forklift trucks; two defective forklift trucks not removed from service for repairs.
    • One alleged other than serious violation, with a $2,000 penalty proposed, for: failure to maintain an illness and injury log.

    An other-than-serious violation is a condition which would probably not cause death or serious physical harm but would have a direct and immediate relationship to the safety and health of employees.

    OSHA is empowered by the Occupational Safety and Health Act of 1970 to issue standards and rules requiring employers to provide their employees with safe and healthful workplaces and jobsites, and to assure through workplace inspections that those standards are followed.

    Each company has 15 working days from receipt of its citations and proposed penalties to either elect to comply with them, to request and participate in an informal conference with the OSHA area director, or to contest them before the independent Occupational Safety and Health Review Commission.