Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Correction: Opioid prescriptions among the World Trade Center Health Program population
Liu R , Calvert GM , Anderson KR , Malcolm H , Cimineri L , Dupont H , Martinez M . BMC Health Serv Res 2024 24 (1) 551 |
Opioid prescriptions among the World Trade Center Health Program population
Liu R , Calvert GM , Anderson KR , Malcolm H , Cimineri L , Dupont H , Martinez M . BMC Health Serv Res 2023 23 (1) 1323 BACKGROUND: The World Trade Center Health Program (Program) provides limited health care to those directly affected by the 9/11 terrorist attacks. Because of physical/mental trauma arising from the 9/11 attacks, Program members might be at high risk of opioid use. To prevent prescription opioid overuse, in 2018 the Program implemented various measures to improve opioid prescribing and expand access to non-opioid pain management among Program members. However, the characteristics of opioid prescriptions dispensed among this population has never been described. METHODS: Administrative and claims data from 07/01/2011 to 09/30/2022 were used to describe opioid prescriptions dispensed during 2013-2021. RESULTS: From 2013-2021, 108,285 members were Program-enrolled for ≥ 10 months, 4,053 (3.7%) had 22,938 outpatient opioid prescriptions, of which, 62.1% were for cancer-related pain, 11.1% for hospice/end of life care, 4.8% for surgery pain, and 9.8% for acute/chronic pain. Among members with Program-paid diagnostic/treatment claims (n = 70,721), the proportion with opioid prescriptions for cancer/hospice/end of life care increased from 0.5% in 2013 to 1.6% in 2018 (p = 0.010), then decreased to 1.1% in 2021 (p = 0.070), and the proportion for non-cancer surgery/acute/chronic pain decreased from 0.6% in 2013 to 0.23% in 2021 (p = 0.0005). Among members prescribed opioids without cancer/hospice/sickle cell disease, the proportion who started with long-acting opioids or had opioid prescriptions from ≥ 4 prescribers were below 6.5% annually; the proportion receiving a high-dose (≥ 90 morphine milligram equivalents per day [MED]), or with concurrent opioids and benzodiazepines use, or who started opioids with MED ≥ 50 or with long duration (≥ 7 days' supply) were above 10% annually, but decreased since 2017. CONCLUSIONS: Prevalence of outpatient opioid prescriptions paid by the Program was very low and prescriptions were primarily dispensed for cancer/hospice/end of life care. Although Program efforts to improve opioid prescribing coincided with improvements in outcomes, ongoing surveillance is needed. |
The World Trade Center Health Program: Cancer screening and cancer care best practices
Calvert GM , Lilly G , Cochran J . Arch Environ Occup Health 2023 78 (4) 1-7 The events of September 11, 2001 (9/11) exposed nearly a half million persons to many carcinogenic chemicals and dusts, as well as psychological and physical stressors. Subsequent epidemiologic studies of 9/11-exposed persons have suggested elevated risks for some cancers, e.g., prostate cancer, thyroid cancer, and melanoma. To detect cancer at an early stage, the US Preventive Services Task Force recommends screening certain asymptomatic persons for lung, colorectal, cervical and breast cancer, but not for other cancers. High quality cancer diagnosis and treatment guidelines are available from the National Comprehensive Cancer Network and the National Cancer Institute. For enrolled members, the WTC Health Program provides coverage for cancer screening and diagnosis, and covers medically necessary treatment costs for all types of cancer, assuming 9/11-exposure and minimum latency requirements are met, and a Program-affiliated physician attests that 9/11 exposures were substantially likely to have been a significant factor in aggravating, contributing to, or causing the enrolled WTC member's cancer. |
The World Trade Center Health Program: Smoking cessation
Lilly G , Calvert GM . Arch Environ Occup Health 2023 78 (4) 1-4 Cigarette smoking can cause and/or worsen a variety of health conditions. The U.S. Preventive Services Task Force (USPSTF) recommends that smoking cessation services be offered to all adults who currently smoke, and governmental and non-governmental professional organizations support providing these interventions to patients who smoke. The World Trade Center (WTC) Health Program, a federal program that provides health monitoring and treatment to those directed exposed to the September 11, 2001 terrorist attacks, provides smoking cessation therapy for eligible members. This paper identifies treatment strategies for smoking cessation and references the treatment coverage policy in the WTC Health Program. In addition, this paper notes the higher smoking prevalence among those with mental health conditions such as posttraumatic stress disorder (PTSD), and the need for heightened cessation efforts given the lower quit success rates among such persons. |
Tracking diseases related to the terrorist attacks of September 11, 2001
Calvert GM . Arch Environ Occup Health 2023 78 (5) 1-7 Accurate, timely, and complete disease reporting is essential to understanding the extent and long-term consequences of diseases related to the terrorist attacks of September 11, 2001 (9/11). Although there are no public health disease reporting requirements that specifically mention 9/11, other mechanisms exist to track 9/11-related illnesses. These include the availability of 9/11-exposed cohorts, some open to new member recruitment and others closed. Record linkages of 9/11 cohorts to various data registries (eg statewide cancer registries and the National Death Index) are periodically performed. This paper describes these 9/11 cohorts and the efforts to track their health experience. |
World Trade Center Health Program best practices for the diagnosis and treatment of gastroesophageal reflux disease
Lin RA , Calvert GM , Udasin IG . Arch Environ Occup Health 2023 78 (4) 1-5 Gastroesophageal reflux disease (GERD) is one of the most common health conditions reported among persons exposed to the dust, debris and chemicals after the September 11, 2001 attacks in the United States. In the 9/11-exposed population, GERD is often found to be co-morbid with other conditions, such as asthma, post-traumatic stress disorder, and obesity. High-quality clinical practice guidelines for GERD are available from the American College of Gastroenterology. GERD diagnostic services and medically necessary treatment are covered by the WTC Health Program for persons who meet eligibility criteria. |
The World Trade Center Health Program: an introduction to best practices
Calvert GM , Anderson K , Cochran J , Cone JE , Harrison DJ , Haugen PT , Lilly G , Lowe SM , Luft BJ , Moline JM , Reibman J , Rosen R , Udasin IG , Werth AS . Arch Environ Occup Health 2022 78 (4) 1-7 More than 20 years have elapsed since the September 11, 2001 (9/11) terrorist attacks on the World Trade Center (WTC), Pentagon and at Shanksville, PA. Many persons continue to suffer a variety of physical and mental health conditions following their exposures to a mixture of incompletely characterized toxicants and psychological stressors at the terrorist attack sites. Primary care and specialized clinicians should ask patients who may have been present at any of the 9/11 sites about their 9/11 exposures, especially patients with cancer, respiratory symptoms, chronic rhinosinusitis, gastroesophageal reflux disease, psychiatric symptoms, and substance use disorders. Clinicians, especially those in the NY metropolitan area, should know how to evaluate, diagnose, and treat patients with conditions that could be associated with exposure to the 9/11 attacks and its aftermath. As such, this issue of Archives contains a series of updates to clinical best practices relevant to medical conditions whose treatment is covered by the WTC Health Program. This first paper in the 14-part series describes the purpose of this series, defines the WTC Health Program and its beneficiaries, and explains how relevant Clinical Practice Guidelines were identified. This paper also reminds readers that because physical and mental health conditions are often intertwined, a coordinated approach to care usually works best and referral to health centers affiliated with the WTC Health Program may be necessary, since all such Centers offer multidisciplinary care. |
World Trade Center Health Program: 20 years after 9/11
Calvert GM , Reissman D , Howard J . Occup Environ Med 2021 78 (10) 697-698 The September 11, 2001 terrorist attacks in New York City, at the Pentagon in Arlington, Virginia, and at the crash site near Shanksville, Pennsylvania caused over 3000 deaths in the immediate aftermath, and adversely affected the health of hundreds of thousands of responders—those involved in the rescue, recovery and clean-up efforts following the 9/11 attacks—and survivors—building occupants, residents, workers and students attending schools in the New York City disaster area. The James Zadroga 9/11 Health and Compensation Act of 2010 enacted by Congress and signed into law by President Obama created the World Trade Center (WTC) Health Program to provide healthcare to responders and survivors affected by toxic agent exposures arising from the 9/11 terrorist attacks and their aftereffects. Originally authorised for only 5 years, the WTC Health Program was reauthorised by Congress in 2015 until the year 2090—thereby assuring a lifetime of care for those affected by 9/11 (42 US Code §§ 300 mm—300 mm-61). |
First Month of COVID-19 Vaccine Safety Monitoring - United States, December 14, 2020-January 13, 2021.
Gee J , Marquez P , Su J , Calvert GM , Liu R , Myers T , Nair N , Martin S , Clark T , Markowitz L , Lindsey N , Zhang B , Licata C , Jazwa A , Sotir M , Shimabukuro T . MMWR Morb Mortal Wkly Rep 2021 70 (8) 283-288 Two coronavirus disease 2019 (COVID-19) vaccines are currently authorized for use in the United States. The Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine on December 11, 2020, and for the Moderna COVID-19 vaccine on December 18, 2020; each is administered as a 2-dose series. The Advisory Committee on Immunization Practices issued interim recommendations for Pfizer-BioNTech and Moderna COVID-19 vaccines on December 12, 2020 (1), and December 19, 2020 (2), respectively; initial doses were recommended for health care personnel and long-term care facility (LTCF) residents (3). Safety monitoring for these vaccines has been the most intense and comprehensive in U.S. history, using the Vaccine Adverse Event Reporting System (VAERS), a spontaneous reporting system, and v-safe,* an active surveillance system, during the initial implementation phases of the COVID-19 national vaccination program (4). CDC conducted descriptive analyses of safety data from the first month of vaccination (December 14, 2020-January 13, 2021). During this period, 13,794,904 vaccine doses were administered, and VAERS received and processed(†) 6,994 reports of adverse events after vaccination, including 6,354 (90.8%) that were classified as nonserious and 640 (9.2%) as serious.(§) The symptoms most frequently reported to VAERS were headache (22.4%), fatigue (16.5%), and dizziness (16.5%). A total of 113 deaths were reported to VAERS, including 78 (65%) among LTCF residents; available information from death certificates, autopsy reports, medical records, and clinical descriptions from VAERS reports and health care providers did not suggest any causal relationship between COVID-19 vaccination and death. Rare cases of anaphylaxis after receipt of both vaccines were reported (4.5 reported cases per million doses administered). Among persons who received Pfizer-BioNTech vaccine, reactions reported to the v-safe system were more frequent after receipt of the second dose than after the first. The initial postauthorization safety profiles of the two COVID-19 vaccines in current use did not indicate evidence of unexpected serious adverse events. These data provide reassurance and helpful information regarding what health care providers and vaccine recipients might expect after vaccination. |
A workshop on cognitive aging and impairment in the 9/11-exposed population
Daniels RD , Clouston SAP , Hall CB , Anderson KR , Bennett DA , Bromet EJ , Calvert GM , Carreón T , DeKosky ST , Diminich ED , Finch CE , Gandy S , Kreisl WC , Kritikos M , Kubale TL , Mielke MM , Peskind ER , Raskind MA , Richards M , Sano M , Santiago-Colón A , Sloan RP , Spiro A 3rd , Vasdev N , Luft BJ , Reissman DB . Int J Environ Res Public Health 2021 18 (2) The terrorist attacks on 11 September 2001 potentially exposed more than 400,000 responders, workers, and residents to psychological and physical stressors, and numerous hazardous pollutants. In 2011, the World Trade Center Health Program (WTCHP) was mandated to monitor and treat persons with 9/11-related adverse health conditions and conduct research on physical and mental health conditions related to the attacks. Emerging evidence suggests that persons exposed to 9/11 may be at increased risk of developing mild cognitive impairment. To investigate further, the WTCHP convened a scientific workshop that examined the natural history of cognitive aging and impairment, biomarkers in the pathway of neurodegenerative diseases, the neuropathological changes associated with hazardous exposures, and the evidence of cognitive decline and impairment in the 9/11-exposed population. Invited participants included scientists actively involved in health-effects research of 9/11-exposed persons and other at-risk populations. Attendees shared relevant research results from their respective programs and discussed several options for enhancements to research and surveillance activities, including the development of a multi-institutional collaborative research network. The goal of this report is to outline the meeting's agenda and provide an overview of the presentation materials and group discussion. |
Elevated blood lead levels in adults - Missouri, 2013
Victory KR , Braun CR , de Perio MA , Calvert GM , Alarcon W . Am J Ind Med 2019 62 (4) 347-351 BACKGROUND: Over 90% of adults with elevated blood lead levels (BLLs) in the United States are exposed occupationally. Missouri historically has been among the states with the highest prevalence rates of elevated BLLs. We characterized cases of elevated BLLs among Missouri adults to target preventive interventions. METHODS: We reviewed 2013 data on Missouri residents >/=16 years from the Missouri Adult Blood Lead Epidemiology and Surveillance system and analyzed characteristics of those with elevated BLLs. We used the contemporaneous CDC definition of elevated BLL as >/=10 mug/dL. RESULTS: Of the 15 123 residents with a BLL in 2013 (median: 1.5 mug/dL, range: 0-151 mug/dL), 3145 (21%) had BLLs >/=10 mug/dL. Occupational exposures accounted for the majority of residents (n = 3099, 98%) with elevated BLLs, mostly in battery manufacturing (n = 1373, 44%) and lead mining (n = 821, 26%) industries. CONCLUSIONS: Our findings highlight the need for focused interventions targeting battery manufacturing and lead mining, the high-risk industries, to further reduce overexposures to lead. |
Phosphine exposure among emergency responders - Amarillo, Texas, January 2017
Hall EM , Patel K , Victory KR , Calvert GM , Nogueira LM , Bojes HK . MMWR Morb Mortal Wkly Rep 2018 67 (13) 387-389 Phosphine is a highly toxic gas that forms when aluminum phosphide, a restricted-use pesticide* typically used in agricultural settings, reacts with water. Acute exposure can lead to a wide range of respiratory, cardiovascular, and gastrointestinal symptoms, and can be fatal (1). On January 2, 2017, the Texas Department of State Health Services (DSHS) was notified by the Texas Panhandle Poison Center of an acute phosphine exposure incident in Amarillo, Texas. DSHS investigated potential occupational phosphine exposures among the 51 on-scene emergency responders; 40 (78.4%) did not use respiratory protection during response operations. Fifteen (37.5%) of these 40 responders received medical care for symptoms or as a precaution after the incident, and seven (17.5%) reported new or worsening symptoms consistent with phosphine exposure within 24 hours of the incident. Emergency response organizations should ensure that appropriate personal protective equipment (PPE) is used during all incidents when an unknown hazardous substance is suspected. Additional evaluation is needed to identify targeted interventions that increase emergency responder PPE use during this type of incident. |
Codability of industry and occupation information from cancer registry records: Differences by patient demographics, casefinding source, payor, and cancer type
Silver SR , Tsai RJ , Morris CR , Boiano JM , Ju J , Scocozza MS , Calvert GM . Am J Ind Med 2018 61 (6) 524-532 INTRODUCTION: Industry and occupation (I&O) information collected by cancer registries is useful for assessing associations among jobs and malignancies. However, systematic differences in I&O availability can bias findings. METHODS: Codability by patient demographics, payor, identifying (casefinding) source, and cancer site was assessed using I&O text from first primaries diagnosed 2011-2012 and reported to California Cancer Registry. I&O were coded to a U.S. Census code or classified as blank/inadequate/unknown, retired, or not working for pay. RESULTS: Industry was codable for 37% of cases; 50% had "unknown" and 9% "retired" instead of usual industry. Cases initially reported by hospitals, covered by preferred providers, or with known occupational etiology had highest codable industry; cases from private pathology laboratories, with Medicaid, or diagnosed in outpatient settings had least. Occupation results were similar. CONCLUSIONS: Recording usual I&O for retirees and improving linkages for reporting entities without patient access would improve I&O codability and research validity. |
Cardiovascular conditions, hearing difficulty, and occupational noise exposure within US industries and occupations
Kerns E , Masterson EA , Themann CL , Calvert GM . Am J Ind Med 2018 61 (6) 477-491 BACKGROUND: The purpose of this study was to estimate the prevalence of occupational noise exposure, hearing difficulty and cardiovascular conditions within US industries and occupations, and to examine any associations of these outcomes with occupational noise exposure. METHODS: National Health Interview Survey data from 2014 were examined. Weighted prevalence and adjusted prevalence ratios of self-reported hearing difficulty, hypertension, elevated cholesterol, and coronary heart disease or stroke were estimated by level of occupational noise exposure, industry, and occupation. RESULTS: Twenty-five percent of current workers had a history of occupational noise exposure (14% exposed in the last year), 12% had hearing difficulty, 24% had hypertension, 28% had elevated cholesterol; 58%, 14%, and 9% of these cases can be attributed to occupational noise exposure, respectively. CONCLUSIONS: Hypertension, elevated cholesterol, and hearing difficulty are more prevalent among noise-exposed workers. Reducing workplace noise levels is critical. Workplace-based health and wellness programs should also be considered. |
Acute illnesses and injuries related to total release foggers - 10 States, 2007-2015
Liu R , Alarcon WA , Calvert GM , Aubin KG , Beckman J , Cummings KR , Graham LS , Higgins SA , Mulay P , Patel K , Prado JB , Schwartz A , Stover D , Waltz J . MMWR Morb Mortal Wkly Rep 2018 67 (4) 125-130 Total release foggers (TRFs) (also known as "bug bombs") are pesticide products often used indoors to kill insects. After an earlier report found that TRFs pose a risk for acute illness (1), the Environmental Protection Agency required improved labels on TRFs manufactured after September 2012 (2). To examine the early impact of relabeling, the magnitude and characteristics of acute TRF-related illness were evaluated for the period 2007-2015. A total of 3,222 TRF-related illnesses were identified in 10 participating states, based on three data sources: Sentinel Event Notification System for Occupational Risk-Pesticides (SENSOR) programs, the California Department of Pesticide Regulation (CDPR) program, and poison control centers (PCCs) in Florida, Texas, and Washington. No statistically significant decline in the overall TRF-illness incidence rate was found. Failure to vacate treated premises during application was the most commonly reported cause of exposure. To reduce TRF-related illness, integrated pest management strategies (3) need to be adopted, as well as better communication about the hazards and proper uses of TRFs. Redesigning TRFs to prevent sudden, unexpected activation might also be useful. |
Prevalence of hearing loss among noise-exposed workers within the agriculture, forestry, fishing, and hunting sector, 2003-2012
Masterson EA , Themann CL , Calvert GM . Am J Ind Med 2017 61 (1) 42-50 BACKGROUND: The purpose of this study was to estimate the prevalence of hearing loss among noise-exposed US workers within the Agriculture, Forestry, Fishing, and Hunting (AFFH) sector. METHODS: Audiograms for 1.4 million workers (17 299 within AFFH) from 2003 to 2012 were examined. Prevalence, and the adjusted risk for hearing loss as compared with the reference industry (Couriers and Messengers), were estimated. RESULTS: The overall AFFH sector prevalence was 15% compared to 19% for all industries combined, but many of the AFFH sub-sectors exceeded the overall prevalence. Forestry sub-sector prevalences were highest with Forest Nurseries and Gathering of Forest Products at 36% and Timber Tract Operations at 22%. The Aquaculture sub-sector had the highest adjusted risk of all AFFH sub-sectors (PR = 1.70; CI = 1.42-2.04). CONCLUSIONS: High risk industries within the AFFH sector need continued hearing conservation efforts. Barriers to hearing loss prevention and early detection of hearing loss need to be recognized and addressed. |
Prevalence of hearing loss among noise-exposed workers within the healthcare and social assistance sector, 2003-2012
Masterson EA , Themann CL , Calvert GM . J Occup Environ Med 2017 60 (4) 350-356 OBJECTIVE: The purpose was to estimate the prevalence of hearing loss for noise-exposed U.S. workers within the Healthcare and Social Assistance (HSA) sector. METHODS: Audiograms for 1.4 million workers (8,702 within HSA) from 2003-2012 were examined. Prevalences and adjusted risks for hearing loss as compared with a reference industry were estimated for the HSA sector and all industries combined. RESULTS: While the overall HSA sector prevalence for hearing loss was 19%, the prevalences in the Medical Laboratories sub-sector and the Offices of All Other Miscellaneous Health Practitioners sub-sector were 31% and 24%, respectively. The Child Day Care Services sub-sector had a 52% higher risk than the reference industry. CONCLUSIONS: High risk industries for hearing loss exist within the HSA sector. Further work is needed to identify the sources of noise exposure and protect worker hearing. |
Summary of notifiable noninfectious conditions and disease outbreaks: Surveillance data published between April 1, 2016 and January 31, 2017 - United States
Thomas K , Jajosky R , Coates RJ , Calvert GM , Dewey-Mattia D , Raymond J , Singh SD . MMWR Morb Mortal Wkly Rep 2017 64 (54) 1-6 The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks: Surveillance Data Published Between April 1, 2016 and January 31, 2017 - United States, herein referred to as the Summary (Noninfectious), contains official statistics for nationally notifiable noninfectious conditions and disease outbreaks. This Summary (Noninfectious) is being published in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases and Conditions. Data on notifiable noninfectious conditions and disease outbreaks from prior years have been published previously. |
Acute Pesticide-Related Illness Among Farmworkers: Barriers to Reporting to Public Health Authorities
Prado JB , Mulay PR , Kasner EJ , Bojes HK , Calvert GM . J Agromedicine 2017 22 (4) 395-405 Farmworkers are at high risk of acute occupational pesticide-related illness (AOPI) and AOPI surveillance is vital to preventing these illnesses. Data on such illnesses are collected and analyzed to identify high-risk groups, high-risk pesticides, and root causes. Interventions to address these risks and root causes include farmworker outreach, education, and regulation. Unfortunately, it is well known that AOPI is underreported, meaning that the true burden of this condition remains unknown. This article reviews the barriers to reporting of farmworker AOPI to public health authorities and provides some practical solutions. Information is presented using the social-ecological model spheres of influence. Factors that contribute to farmworker AOPI underreporting include fear of job loss or deportation, limited English proficiency (LEP), limited access to health care, lack of clinician recognition of AOPI, farmworker ineligibility for workers' compensation (WC) benefits in many states, insufficient resources to conduct AOPI surveillance, and constraints in coordinating AOPI investigations across state agencies. Solutions to address these barriers include: emphasizing that employers encourage farmworkers to report safety concerns; raising farmworker awareness of federally qualified health centers (FQHCs) and increasing the availability of these clinics; improving environmental toxicology training to health-care students and professionals; encouraging government agencies to investigate pesticide complaints and provide easy-to-read reports of investigation findings; fostering public health reporting from electronic medical records, poison control centers (PCCs), and WC; expanding and strengthening AOPI state-based surveillance programs; and developing interagency agreements to outline the roles and responsibilities of each state agency involved with pesticide safety. |
Job characteristics associated with self-rated fair or poor health among U.S. workers
Luckhaupt SE , Alterman T , Li J , Calvert GM . Am J Prev Med 2017 53 (2) 216-224 INTRODUCTION: Approximately 60% of the U.S. adult population is employed. Many aspects of a person's job may influence health, but it is unclear which job characteristics are most strongly associated with health at a population level. The purpose of this study was to identify important associations between job characteristics and workers' self-rated health in a nationally representative survey of U.S. workers. METHODS: Data from the 2010 National Health Interview Survey were used to calculate weighted prevalence rates for self-reported fair/poor health for five categories of job characteristics: occupation; pay/benefits (economic); work organization; chemical/environmental hazards; and psychosocial factors. Backward elimination methods were used to build a regression model for self-reported health with the significant job characteristics, adjusting for sociodemographic variables and health behaviors. Data were collected in 2010 and analyzed in 2012-2016. RESULTS: After adjusting for covariates, workers were more likely to have fair/poor health if they were employed in business operations occupations (e.g., buyers, human resources workers, event planners, marketing specialists; adjusted prevalence ratio [APR]=1.85, 95% CI=1.19, 2.88); had no paid sick leave (APR=1.35, 95% CI=1.11, 1.63); worried about becoming unemployed (APR=1.43, 95% CI=1.22, 1.69); had difficulty combining work and family (APR=1.23, 95% CI=1.01, 1.49); or had been bullied/threatened on the job (APR=1.82, 95% CI=1.44, 2.29). CONCLUSIONS: Occupation, lack of paid sick leave, and multiple psychosocial factors were associated with fair/poor health among U.S. workers at the population level in 2010. Public health professionals and employers should consider these factors when developing interventions to improve worker health. |
Acute nonoccupational pesticide-related illness and injury - United States, 2007-2011
Namulanda G , Monti MM , Mulay P , Higgins S , Lackovic M , Schwartz A , Prado JB , Waltz J , Mitchell Y , Calvert GM . MMWR Morb Mortal Wkly Rep 2016 63 (55) 5-10 CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on acute pesticide-related illness and injury reported by 12 states (California, Florida, Iowa, Louisiana, Michigan, North Carolina, Nebraska, New Mexico, New York, Oregon, Texas, and Washington). This report summarizes the data on illnesses and injuries arising from nonoccupational exposure to conventional pesticides that were reported during 2007-2011. Conventional pesticides include insecticides, herbicides, fungicides, and fumigants. They exclude disinfectants (e.g., chlorine and hypochlorites) and biological pesticides. This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016. The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases. In a separate report, data on illnesses and injuries from occupational exposure to conventional pesticides during 2007-2011 are summarized. |
Acute occupational pesticide-related illness and injury -United States, 2007-2011
Calvert GM , Beckman J , Prado JB , Bojes H , Schwartz A , Mulay P , Leinenkugel K , Higgins S , Lackovic M , Waltz J , Stover D , Moraga-McHaley S . MMWR Morb Mortal Wkly Rep 2016 63 (55) 11-16 CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on acute pesticide-related illness and injury reported by 12 states (California, Florida, Iowa, Louisiana, Michigan, Nebraska, North Carolina, New Mexico, New York, Oregon, Texas, and Washington). This report summarizes the data on illnesses and injuries arising from occupational exposure to conventional pesticides from 2007 through 2011. This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016. The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases. In a separate report, data on illnesses and injuries from nonoccupational exposure to pesticides during 2007-2011 are summarized. |
Sleep-related problems in the US working population: Prevalence and association with shiftwork status
Yong LC , Li J , Calvert GM . Occup Environ Med 2016 74 (2) 93-104 OBJECTIVE: To estimate the prevalence of a comprehensive set of self-reported sleep problems by job characteristics, including shiftwork status, among a representative sample of US workers. METHODS: Data for 6338 workers aged ≥18 years were obtained from the National Health and Nutrition Examination Survey. Short sleep duration was defined as <7 hours per weekday/workday. Sleep quality was categorised as good, moderate and poor based on the frequency of 6 sleep-related symptoms. A sleep-related activities of daily living (ADL) score ≥2 was defined as impaired. Insomnia was defined as having poor sleep quality and impaired ADL. Shiftwork status was categorised as daytime, night, evening, rotating or another schedule. Prevalence rates were calculated and multivariate logistic regression analyses were used. RESULTS: The prevalence of short sleep duration (37.6% overall) was highest among night shift workers (61.8%; p<0.001). The prevalence of poor sleep quality was 19.2% among all workers, with the highest prevalence among night shift workers (30.7%, p=0.004). The prevalence of impaired ADL score (24.8% overall) and insomnia (8.8% overall) was also highest for night shift workers (36.2%, p=0.001 and 18.5%, p=0.013, respectively). In multivariate analysis, night shift workers had the highest likelihood of these sleep problems. CONCLUSIONS: Self-reported short sleep duration, poor sleep quality, impaired ADL score and insomnia are common among US workers especially among night shift workers. Although these findings should be confirmed with objective sleep measures, they support the need for intervention programmes to improve sleep quantity and quality among night shift workers. |
Notes from the field: Acute sulfuryl fluoride poisoning in a family - Florida, August 2015
Mulay PR , Clark G , Jackson WL , Calvert GM . MMWR Morb Mortal Wkly Rep 2016 65 (27) 698-9 On August 19, 2015, the Florida Department of Health (FDOH) was notified by the Florida Poison Information Center Network and a local hospital of possible sulfuryl fluoride poisonings affecting a family in Martin County, in southeastern Florida. Sulfuryl fluoride is a highly toxic (toxicity category I) gas fumigant used for termite control of homes and buildings. FDOH personnel in Martin County commenced an investigation and identified a family of five (a grandmother, mother, father, son, and daughter) exposed to sulfuryl fluoride after their house was fumigated. The Florida Department of Agriculture and Consumer Services (FDACS), and the U.S. Environmental Protection Agency (EPA) Criminal Investigation Division also conducted an investigation after being notified by FDOH. Medical records were reviewed, and the father was interviewed by FDOH. |
Acute illness associated with exposure to a new soil fumigant containing dimethyl disulfide - Hillsborough County, Florida, 2014
Mulay PR , Cavicchia P , Watkins SM , Tovar-Aguilar A , Wiese M , Calvert GM . J Agromedicine 2016 21 (4) 373-9 Dimethyl disulfide (DMDS) is a new soil fumigant that is considered a replacement for methyl bromide. In 2014, the Florida Department of Health (FDOH) received several complaints of illness following a strong DMDS odor in Hillsborough County. Public health investigation of DMDS-related illness was conducted to assess illness and identify areas to target for prevention activities. This investigation included surveillance, interviews, review of medical records, review of supporting documentation, and determination of pesticide-related illness and injury case status. FDOH interviewed 66 people complaining of illness related to DMDS. Thirty-two were classified as possible and 11 as suspicious cases of DMDS-related illness. Among cases, the mean age was 48 years (range: 3-71 years). The majority were non-Hispanic (n=43, 100%), white (n=40, 93%), and female (n=23, 53.5%). The most common signs and symptoms reported by exposed people included eye pain, throat irritation, nausea, dizziness, headache, and fatigue. There were 88% of cases classified as having low severity of illness and 12% classified as having moderate severity. The average distance from an application site among individuals who reported being exposed at or near their home was 0.74 miles for those classified as cases (n=36) and 2.84 miles for those not classified as cases (n=21, p<0.05). This is the first known comprehensive report of DMDS-related illness in humans. Even though illnesses associated with DMDS in this investigation were generally of low severity, it is important to identify better ways to prevent off-target movement of DMDS and to improve notification to communities when nearby DMDS applications are planned. |
Hearing difficulty and tinnitus among U.S. workers and non-workers in 2007
Masterson EA , Themann CL , Luckhaupt SE , Li J , Calvert GM . Am J Ind Med 2016 59 (4) 290-300 BACKGROUND: Hearing loss and tinnitus are two potentially debilitating physical conditions affecting many people in the United States. The purpose of this study was to estimate the prevalence of hearing difficulty, tinnitus, and their co-occurrence within U.S. POPULATIONS: METHODS: Data from the 2007 National Health Interview Survey (NHIS) were examined. Weighted prevalence and adjusted prevalence ratios for self-reported hearing difficulty, tinnitus, and their co-occurrence were estimated and compared by demographic, among workers with and without occupational noise exposure, and across industries and occupations. RESULTS: Seven percent of U.S. workers never exposed to occupational noise had hearing difficulty, 5% had tinnitus and 2% had both conditions. However, among workers who had ever been exposed to occupational noise, the prevalence was 23%, 15%, and 9%, respectively (P < 0.0001). CONCLUSIONS: Hearing difficulty and tinnitus are prevalent in the U.S.; especially among noise-exposed workers. Improved strategies for hearing conservation or better implementation are needed. Am. J. Ind. Med. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. |
Magnitude and characteristics of acute paraquat- and diquat-related illnesses in the US: 1998-2013
Fortenberry GZ , Beckman J , Schwartz A , Prado JB , Graham LS , Higgins S , Lackovic M , Mulay P , Bojes H , Waltz J , Mitchell Y , Leinenkugel K , Oriel MS , Evans E , Calvert GM . Environ Res 2016 146 191-199 BACKGROUND: Paraquat and diquat are among the most commonly used herbicides in the world. OBJECTIVES: Determine the magnitude, characteristics, and root causes for acute paraquat- and diquat-related illnesses in the US. METHODS: Illnesses associated with paraquat or diquat exposure occurring from 1998 through 2011 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program, the California Department of Pesticide Regulation (CDPR) Pesticide Illness Surveillance Program (PISP), and the Incident Data System (IDS). Cases identified by the National Poison Data System (NPDS) were reviewed for the years 1998-2003 and 2006-2013. RESULTS: A total of 300 paraquat- and 144 diquat-related acute illnesses were identified by SENSOR, PISP, and IDS. NPDS identified 693 paraquat- and 2128 diquat-related acute illnesses. In SENSOR/PISP/IDS, illnesses were commonly low severity (paraquat=41%; diquat=81%); however, SENSOR/PISP/IDS identified 24 deaths caused by paraquat and 5 deaths associated with diquat. Nineteen paraquat-related deaths were due to ingestion, seven of which were unintentional, often due to improper storage in beverage bottles. In SENSOR/PISP/IDS, paraquat and diquat-related acute illnesses were work-related in 68% (n=203) and 29% (n=42) of cases, respectively. When herbicide application site was known, the vast majority of acute paraquat-related illnesses (81%) arose from agricultural applications. Common root causes of illness were failure to use adequate personal protective equipment (PPE), application equipment failure, and spill/splash of herbicide. CONCLUSIONS: Although the magnitude of acute paraquat/diquat-related illnesses was relatively low, several fatalities were identified. Many illnesses could be prevented through stricter compliance with label requirements (e.g. ensuring proper herbicide storage and PPE use), and through enhanced training of certified applicators. |
Agricultural pesticide exposure and chronic kidney disease: new findings and more questions
Calvert GM . Occup Environ Med 2016 73 (1) 1-2 The vital importance of agriculture is well-recognised, as is the usefulness of pesticides in increasing agricultural yields and reducing spoilage rates. The usefulness of pesticides in mitigating disease-carrying pests (eg, mosquitos) is also well known. However, there are also risks associated with pesticide use. In addition to causing acute poisoning,1 they are also associated with increased cancer risks,2 among other diseases. A paper by Lebov and colleagues3 provides evidence for another potential risk associated with pesticides, that is, end-stage renal disease (ESRD). To our knowledge, this is the first report using the United States Renal Data System (USRDS) to assess the association between pesticide exposure and ESRD. | Currently, there is little literature available on the nephrotoxic effects of pesticides. The little research that does exist comes from animal studies and case reports of pesticide-poisoned individuals. Fortunately, our understanding of the role of occupational exposures, including pesticides, on ESRD development in humans is growing. An important tool supporting the growth of this understanding is the USRDS.4 Since the US government provides healthcare coverage, under Medicare, for all patients with ESRD and because these ESRD claims data are comprehensively captured by USRDS, USRDS represents a nearly complete national disease registry in the USA. Furthermore, because there is no other medical condition so covered by the US government, there is no other disease or injury in the USA that has such a nearly complete national registry. From the first use of USRDS to identify occupational exposures associated with ESRD, which in that initial case involved an exploration of silica exposure,5 it has been used to identify ESRD associations with several other occupational exposures, including perchloroethylene,6 lead7 and 1,1,1-trichloroethane.8 With the paper in this issue of OEM, USRDS has now been used to assess the association between pesticide exposure and ESRD.3 Lebov et al matched data from the Agricultural Health Study (AHS), a very large prospective study of licensed pesticide applicators, with data from USRDS to identify cohort members with ESRD and to determine if the observed cases exceeded population rates. Although these authors provided reassuring findings of no increased ESRD risk in the overall cohort, they did find significantly increased ESRD risks and positive exposure-response trends, among pesticide applicators who mixed or applied one or more of six specific pesticides. These pesticides included five herbicides (alachlor, atrazine, metolachor, paraquat and pendimethalin) and the insecticide permethrin. |
Summary of notifiable noninfectious conditions and disease outbreaks: acute occupational pesticide-related illness and injury - United States, 2007-2010
Calvert GM , Beckman J , Prado JB , Bojes H , Mulay P , Lackovic M , Waltz J , Schwartz A , Mitchell Y , Moraga-McHaley S , Leinenkugel K , Higgins S . MMWR Morb Mortal Wkly Rep 2015 62 (54) 5-10 CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on acute pesticide-related illnesses and injuries reported by 11 states (California, Florida, Iowa, Louisiana, Michigan, North Carolina, New Mexico [2007–2008 only], New York, Oregon, Texas, and Washington). This report summarizes data on illnesses and injuries arising from occupational exposure to conventional pesticides during 2007–2010. This report is a part of the first-ever Summary of Notifiable Noninfectious Conditions and Disease Outbreaks, which encompasses various surveillance years but is being published in 2015 (1). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases (2). | Background | Pesticides are substances or mixtures of substances intended to prevent, destroy, repel, or mitigate pests (e.g., insects, rodents, fungi, and weeds). In 2007, the year with the most currently available data, an estimated 2.1 billion pounds of conventional pesticides were used in the United States (3), which represents approximately 22% of the entire worldwide use of these pesticides. Conventional pesticides include insecticides, herbicides, fungicides, and fumigants and exclude chlorine, hypochlorites, and biocides. | The toxicity of pesticides continues to raise public concern and is the focus of much media attention. The benefits of pesticides are well recognized and primarily include their role in protecting the food supply and in controlling disease vectors (4). However, no form of pest control is perfectly safe. Tracking the associated health effects of pesticides can help ensure that no pesticides pose an unreasonable burden (5). As such, public health surveillance of acute pesticide-related illness and injury serves a vital societal role by assessing the magnitude and characteristics of this condition. Surveillance of acute pesticide-related illness and injury has been endorsed by several professional organizations and federal agencies including the American Medical Association (6), the Council of State and Territorial Epidemiologists (7), NIOSH (8), and the U.S. Government Accountability Office (9). To address the need for public health surveillance of acute pesticide-related illness and injury, NIOSH established such a surveillance program in 1987. | Pesticide products must pass an extensive battery of testing prior to being registered by the U.S. Environmental Protection Agency (EPA). This testing forms the basis for the human health and environmental risk assessments conducted by EPA that guide identification of the conditions under which a pesticide can be used. These conditions of use are reflected in pesticide product labeling. Compliance with these use conditions are expected to prevent unreasonable adverse effects to human health and the environment. To verify the real-world effectiveness of pesticide product labeling in preventing adverse human health effects, findings from acute pesticide-related illness and injury surveillance systems are reviewed. These surveillance data assist EPA to determine whether labeling is effective or if labeling improvements are needed. When adverse health effects occur despite adherence to label instructions, and if EPA determines the magnitude to be unreasonable, EPA requires that interventions be instituted that involve changing pesticide use practices and/or modifying regulatory measures (10). Acute pesticide-related illness and injury also can occur because of a lack of compliance with existing pesticide regulations. The appropriate interventions for these cases include enhanced education and enforcement. |
Cluster of Ebola virus disease, Bong and Montserrado counties, Liberia
Nyenswah TG , Fallah M , Calvert GM , Duwor S , Hamilton ED , Mokashi V , Arzoaquoi S , Dweh E , Burbach R , Dlouhy D , Oeltmann JE , Moonan PK . Emerg Infect Dis 2015 21 (7) 1253-6 Lack of trust in government-supported services after the death of a health care worker with symptoms of Ebola resulted in ongoing Ebola transmission in 2 Liberia counties. Ebola transmission was facilitated by attempts to avoid cremation of the deceased patient and delays in identifying and monitoring contacts. |
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