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Provide for timely updates to the NORA priorities. Periodically review and communicate the overall role and effectiveness of NORA in occupational safety and health.


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An example of this approach is provided in Table The sectors, listed in Table , are agriculture, forestry, and fishing; construction; health care and social assistance; manufacturing; mining; services; wholesale and retail trade; and transportation, warehousing, and utilities. Emerging technologies Indoor environment Mixed exposures Organization of work Special populations at risk Research Tools and Approaches Cancer research methods Control technology and personal protective equipment Exposure assessment methods Health services research Intervention effectiveness research Risk assessment methods Social and economic consequences of workplace illness and injury Surveillance research methods aRespiratory disease focus.

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Additionally, NORA2 identified 15 cross-sector programs and 7 coordinated emphasis areas, also shown in Table The RDRP is one of the cross-sector programs. Each cross-sector program has a steering committee made up of staff from all NIOSH divisions and laboratories as well as the Office of the Director and the Office of Extramural Programs.

In , five divisions, three laboratories, and three offices were involved in the RDRP. The mission statement for the RDRP Weissman is To provide national and international leadership for the prevention of work-related respiratory diseases, using a scientific approach to gather and synthesize information, create knowledge, provide recommendations, and deliver products and services to those who can effect prevention.

To pursue these goals, the RDRP activities include multidisciplinary approaches to respiratory diseases through laboratory studies and short- and long-term field studies; surveillance and reporting on disease frequencies; assessment of control technologies and respiratory protection; communication, education, and training; and recommendations on exposure and other practices. Facilities and equipment exist for biomedical research, development of analytical methods, research on exposure assessment, research on engineering and industrial hygiene, respirator research, mining research, and epidemiologic investigations.

The document has a high level of specificity, with measurable goals and target time frames. Intramural funding supports staff salaries and benefits as well as goods and services related to staff research activities. This is in contrast to research funding at NIH agencies, including the National Institute of Environmental Health Sciences, that tend to spend most of their research funding on extramural research.

Because the committee was not asked to review the extra- mural program, the committee is not in a position to evaluate the balance between extramural and intramural funding.

The RDRP was selected as one of the programs to undergo such a review. Each evaluation will be conducted by an ad hoc committee, using a methodology and framework developed by the Committee to Review NIOSH Research Programs framework committee. In conducting the review, the evaluation committee will address the following elements: 1.

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Collaborative Care Model Improves Mental Health in Respiratory Disease - Pulmonology Advisor

Impact may be assessed directly e. Qualitative narrative evaluations should be included to explain the numerical ratings. The com- mittee met three times in the period October through March The first two meetings were data-gathering sessions that included presentations by NIOSH staff and other invited speakers in open session.

At the end of each open session stakeholders and the general public had an opportunity to comment. The committee wanted to hear from a broad range of stakeholders and created an online question- naire for them to provide comments see Appendix B. Presentations and discus- sions during the open session as well as the online questionnaire helped in shaping additional questions and giving background to areas under review. Meyer identifies COPD as one of the most serious and dangerous respiratory illnesses, and COPD is the number one problem seen in most pulmonology offices.

Chronic bronchitis is a form of COPD emphasized by a chronic cough. Usually people cough up sputum mucus from the lungs , especially in the morning.

Studies on Respiratory Disorders

Meyer says this happens because mucus glands in the airways increase output, and patients have to cough that extra secretion out. People can also develop acute bronchitis, which is not a long-term disease but rather an infectious problem. It develops from a viral or bacterial infection and can be treated with antibiotics. Symptoms associated with acute bronchitis will subside once the infection has resolved. Emphysema is a serious respiratory disease, which is another form of COPD. The most common cause is smoking. Those who suffer from emphysema have trouble exhaling air from their lungs.

Cigarette smoke damages the air sacs in the lungs to a point where they can no longer repair themselves. Meyer says this respiratory system illness most commonly leads to respiratory failure and the need for extra oxygen to meet breathing needs. With the ability to develop in any part of the lungs, this cancer is difficult to detect.

Most often, the cancer develops in the main part of the lungs near the air sacs.

Cognitive Behavioral Therapy for Management of Dyspnea: A Pilot Study

DNA mutations in the lungs cause irregular cells to multiply and create an uncontrolled growth of abnormal cells, or a tumor. These tumors interfere with the regular functions of the lungs. Symptoms can take years to appear, but include things like chronic coughing, changes in voice, harsh breathing sounds and coughing up blood.

Obstructive vs. Restrictive Lung Disease -- USMLE

According to the American Cancer Society , lung cancer is by far the leading cause of cancer death among both men and women in the U. Cystic fibrosis is a genetic respiratory disease caused by a defective gene that creates thick and sticky mucus that clogs up tubes and passageways. This mucus causes repeat, and dangerous, lung infections, as well as obstructions in the pancreas that prevent important enzymes from breaking down nutrients for the body.

According to the Cystic Fibrosis Foundation , this disease affects 30, people in the U. Symptoms of cystic fibrosis include salty-tasting skin, chronic coughing, frequent lung infections and a poor growth rate in children. Meyer says people who have cystic fibrosis will also develop bronchiectasis. Comorbid mental health disorders have been linked with a range of adverse outcomes in these patient groups, including reduced survival, more frequent exacerbations and hospital readmissions, and reduced performance on the 6-minute walk test specifically in patients with COPD.

The psychiatric collaborative care model CCM is one approach that has shown promise in the treatment of patients with comorbid medical and psychiatric diseases, as described in a review published recently in Chest. Pulmonology Advisor: What is known thus far about psychiatric comorbidity in respiratory disease? Dr Yohannes: Depression and anxiety are common in patients with chronic respiratory diseases and are associated with increased disability, impaired QoL, acute exacerbations, and increased emergency healthcare utilization and hospital admission.

Furthermore, these disorders are often underrecognized and untreated.


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Pulmonary rehabilitation and cognitive behavioral therapy have shown promising results in ameliorating mild to moderate anxiety and depressive symptoms in patients with chronic respiratory diseases in short-term follow-up. However, the long-term benefits are inconclusive. Pulmonology Advisor: How should these issues be addressed in practice, and what are the benefits of a collaborative care model? Dr Yohannes: Clinicians and healthcare professionals should actively engage in identifying anxiety and depressive symptoms using screening tools like the Patient Health Questionnaire-9 or Hospital Anxiety and Depression Scale.

Patients identified as having significant depressive and anxiety symptoms should be monitored and treated with appropriate treatment using a CCM. The benefits of CCM include patient support to receive targeted treatments, patient education about the importance of treatment, patient support to adhere to their exercise regimens, and demystifying the fear of taking of antidepressants. It also provides the opportunity for the CCM team to collaborate with patients, monitor their treatment, and evaluate progress.

Pulmonology Advisor: How does this model play out in practice?