Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Wang ML[original query] |
---|
Longitudinal and cross-sectional analyses of lung function in toluene diisocyanate production workers
Wang ML , Storey E , Cassidy LD , Doney B , Conner PR , Collins JJ , Carson M , Molenaar D . J Occup Environ Med 2017 59 Suppl 12 S28-s35 OBJECTIVE: The aim of this study was to investigate lung function among toluene diisocyanate (TDI) production workers. METHODS: One hundred ninety-seven U.S workers performed spirometry from 2006 through 2012. Results were compared within the study cohort and with U.S. population measures. A mixed-effects model assessed factors affecting repeated forced expiratory volume in 1 second (FEV1) measurements. RESULTS: The cohort's mean FEV1 and forced vital capacity (FVC) percent reference values, although greater than 90%, were significantly lower and the prevalence of abnormal spirometry (predominantly restrictive pattern) was significantly higher than in the U.S. POPULATION: Differences in lung function among workers with higher cumulative TDI exposure were in the direction of an exposure effect, but not significant. CONCLUSION: We found little evidence of an adverse effect of TDI exposure on longitudinal spirometry in these workers. The association between TDI exposure and the increasing prevalence of a restrictive pattern needs further exploration. |
Medical monitoring for occupational asthma among toluene diisocyanate production workers in the United States
Cassidy LD , Doney B , Wang ML , Kurth L , Conner PR , Collins JJ , Carson M , Molenaar D , Redlich CA , Storey E . J Occup Environ Med 2017 59 Suppl 12 S13-s21 OBJECTIVE: The aim of this study was to describe a study of medical monitoring methods and lessons learned in detecting health outcomes in U.S. plants producing toluene diisocyanate (TDI). METHODS: A multidisciplinary team implemented a medical and environmental monitoring program in three TDI plants. RESULTS: Of 269 eligible workers, 197 (73%) participated and 42 (21%) met symptom and/or lung function criteria that would trigger evaluation for possible asthma over 5 years of data collection. Subsequent evaluation was delayed for most, and a web-based data collection system improved timeliness. CONCLUSION: Medical monitoring of TDI workers identified workers triggering further assessment per study protocol. Systems and/or personnel to ensure rapid follow-up are needed to highlight when triggering events represent potential cases of asthma needing further evaluation. Implementation of a research protocol requires resources and oversight beyond an occupational health program. |
Incidence of occupational asthma and exposure to toluene diisocyanate in the United States toluene diisocyanate production industry
Collins JJ , Anteau S , Conner PR , Cassidy LD , Doney B , Wang ML , Kurth L , Carson M , Molenaar D , Redlich CA , Storey E . J Occup Environ Med 2017 59 Suppl 12 S22-s27 OBJECTIVE: This study examines asthma risk in facilities producing toluene diisocyanate (TDI). METHODS: A total of 197 workers were monitored from 2007 to 2012. TDI air concentrations were used to estimate exposures. RESULTS: The incidence of cases consistent with TDI-induced asthma was 0.009 per person-years (seven cases) or consistent with TDI-induced asthma or asthma indeterminate regarding work-relatedness was 0.012 (nine cases). Increased risk of cases consistent with TDI asthma was observed for cumulative (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.07 to 4.05) per logarithm parts per billion-years and peak TDI exposures (OR = 1.18, 95% CI 1.06 to 1.32) (logarithm parts per billion). There was a weak association with cumulative and peak exposures for decline of short-term forced expiratory volume in one second (FEV1). Asthma symptoms were associated with workers noticing an odor of TDI (OR 6.02; 95% CI 1.36 to 26.68). CONCLUSIONS: There is evidence that cumulative and peak exposures are associated with TDI-induced asthma. |
Small airway dysfunction and abnormal exercise responses. A study in coal miners
Petsonk EL , Stansbury RC , Beeckman-Wagner LA , Long JL , Wang ML . Ann Am Thorac Soc 2016 13 (7) 1076-80 RATIONALE: Coal mine dust exposure can cause symptoms and loss of lung function from multiple mechanisms, but the roles of each disease process are not fully understood. OBJECTIVES: We investigated the implications of small airway dysfunction for exercise physiology among a group of workers exposed to coal mine dust. METHODS: Twenty coal miners performed spirometry, first breathing air and then helium-oxygen, single-breath diffusing capacity, and computerized chest tomography, and then completed cardiopulmonary exercise testing. MEASUREMENTS AND MAIN RESULTS: Six participants meeting criteria for small airway dysfunction were compared with 14 coal miners who did not. At submaximal workload, miners with small airway dysfunction used a higher proportion of their maximum voluntary ventilation and had higher ventilatory equivalents for both O2 and CO2. Regression modeling indicated that inefficient ventilation was significantly related to small airway dysfunction but not to FEV1 or diffusing capacity. At the end of exercise, miners with small airway dysfunction had 27% lower O2 consumption. CONCLUSIONS: Small airway abnormalities may be associated with important inefficiency of exercise ventilation. In dust-exposed individuals with only mild abnormalities on resting lung function tests or chest radiographs, cardiopulmonary exercise testing may be important in defining causes of exercise intolerance. |
Small mine size is associated with lung function abnormality and pneumoconiosis among underground coal miners in Kentucky, Virginia and West Virginia
Blackley DJ , Halldin CN , Wang ML , Laney AS . Occup Environ Med 2014 71 (10) 690-4 OBJECTIVES: To describe the prevalence of lung function abnormality and coal workers' pneumoconiosis (CWP) by mine size among underground coal miners in Kentucky, Virginia and West Virginia. METHODS: During 2005-2012, 4491 miners completed spirometry and chest radiography as part of a health surveillance programme. Spirometry was interpreted according to American Thoracic Society and European Respiratory Society guidelines, and radiography per International Labour Office standards. Prevalence ratios (PR) were calculated for abnormal spirometry (obstructive, restrictive or mixed pattern using lower limits of normal derived from National Health and Nutrition Examination Survey (NHANES) III) and CWP among workers from small mines (≤50 miners) compared with those from large mines. RESULTS: Among 3771 eligible miners, those from small mines were more likely to have abnormal spirometry (18.5% vs 13.8%, p<0.01), CWP (10.8% vs 5.2%, p<0.01) and progressive massive fibrosis (2.4% vs 1.1%, p<0.01). In regression analysis, working in a small mine was associated with 37% higher prevalence of abnormal spirometry (PR 1.37, 95% CI 1.16 to 1.61) and 2.1 times higher prevalence of CWP (95% CI 1.68 to 2.70). CONCLUSIONS: More than one in four of these miners had evidence of CWP, abnormal lung function or both. Although 96% of miners in the study have worked exclusively under dust regulations implemented following the 1969 Federal Coal Mine Safety and Health Act, we observed high rates of respiratory disease including severe cases. The current approach to dust control and provision of safe work conditions for central Appalachian underground coal miners is not adequate to protect them from adverse respiratory health effects. |
Rapid decline in lung function in coal miners: evidence of disease in small airways
Stansbury RC , Beeckman-Wagner LA , Wang ML , Hogg JP , Petsonk EL . Am J Ind Med 2013 56 (9) 1107-12 BACKGROUND: Coal mine dust exposure can cause both pneumoconiosis and chronic airflow limitation. The contributions of various pathophysiologic mechanisms to dust-related lung function decrements remain unclear. METHODS: Clinical and physiological findings were assessed for 15 underground coal miners who had demonstrated accelerated FEV1 losses (decliners) over 6-18 years. Decliners' findings were evaluated in comparison to a group of 11 miners who had shown relatively stable lung function (referents) during the same period. RESULTS: At follow-up examination, the decliners showed significantly greater mean airway resistance (10.47 vs. 6.78 cmH2 O/L/s; P = 0.05) and more air trapping (RV/TLC = 37.5 vs. 29.1%; P < 0.01) compared to the referents. Decliners also demonstrated more evidence of small airways dysfunction and tended to have more bronchospasm than the referent group. Total lung capacity, lung compliance, diffusing capacity, and chest radiography did not differ significantly between the two groups. After cessation of mine dust exposures, the decliners' mean rate of FEV1 loss normalized. CONCLUSION: In a series of working coal miners, accelerated lung function declines were associated with air trapping and evidence of small airways dysfunction. A preventive benefit from controlling dust exposures was suggested. |
Lung-function impairment among US underground coal miners, 2005 to 2009: geographic patterns and association with coal workers' pneumoconiosis
Wang ML , Beeckman-Wagner LA , Wolfe AL , Syamlal G , Petsonk EL . J Occup Environ Med 2013 55 (7) 846-50 OBJECTIVE: To investigate contemporary geographic distributions of lung-function impairment and radiographic evidence of coal workers' pneumoconiosis (CWP) and their associations. METHODS: From 2005 to 2009, 6373 underground coal miners completed a health survey, including spirometry testing and chest radiography. Coal workers' pneumoconiosis and progressive massive fibrosis were determined by NIOSH B readers, using the International Labour Office classification. Prevalences of CWP and spirometry less than lower normal limits were mapped by county, and their association assessed. RESULTS: The prevalences of abnormal spirometry results and CWP were 13.1% and 4.0%, respectively. Counties with elevated prevalences for both the outcomes were located in contiguous areas of southeastern Kentucky, western Virginia, southern West Virginia, and eastern Pennsylvania. Prevalence of abnormal spirometry results increases with increasing category of simple CWP and progressive massive fibrosis. CONCLUSIONS: Abnormal spirometry in coal miners is associated with CWP; these two health outcomes have similar geographic distributions. |
Self-reported hand symptoms: a role in monitoring health care workers for latex sensitization?
Wang ML , Kelly KJ , Klancnik M , Petsonk EL . Ann Allergy Asthma Immunol 2012 109 (5) 314-8 BACKGROUND: The use of powdered natural rubber latex (NRL) gloves increased greatly in the 1980s because of concerns about transmission of blood-borne infections and the subsequent implementation of universal precautions. The most common clinical reactions to glove use are irritant and T-cell-mediated contact dermatitis. However, IgE-mediated immediate reactions to latex have become a serious concern for health care workers (HCWs). The diagnosis of latex allergy requires a comprehensive medical history and diagnostic tests. The skin prick test is the preferred diagnostic method, although it can be time-consuming. OBJECTIVE: To determine the role of hand symptoms reported on questionnaires in monitoring HCWs for latex sensitization. METHODS: Questionnaires were completed by 804 HCWs at 2 hospitals. Using a positive skin prick test (SPT) result as a criterion standard of latex sensitization, the diagnostic performance of hand symptoms was evaluated. RESULTS: Increasing latex glove use was strongly related to increasing reports of hand symptoms. Hand symptoms were highly associated with glove-related respiratory and systemic symptoms. A positive SPT result was seen in 5% of HCWs and increased with the number of hand symptoms: 0 (1.6%), 1 to 2 (3.4%), and 3 to 7 (19.0%). Participants reporting more than 2 hand symptoms were 11 times more likely to have positive SPT results compared with those with 2 or fewer hand symptoms. CONCLUSION: Hand symptoms are closely associated with latex sensitization. Questionnaires should be useful in health monitoring for HCWs who use latex gloves. |
Analysis of available diagnostic tests for latex sensitization in an at-risk population
Accetta Pedersen DJ , Klancnik M , Elms N , Wang ML , Hoffmann RG , Kurup VP , Kelly KJ . Ann Allergy Asthma Immunol 2012 108 (2) 94-7 BACKGROUND: Lack of a Food and Drug Administration (FDA)-approved skin testing reagent for latex allergy in the United States requires reliance on patient history and serologic assays for diagnosis. OBJECTIVE: To determine the diagnostic sensitivity, specificity, and predictive values of an FDA-cleared antilatex IgE serology test and an enzyme-linked immunosorbent assay (ELISA) with various sources of latex protein antigens in an at-risk but unselected population of health care workers. METHODS: Health care workers underwent duplicate latex and serologic testing for latex specific IgE with the CAP assay and ELISA from June 1, 1998, through December 31, 2002. Logistic regression with receiver operating characteristic curve analysis determined the values, resulting in 98% and 99% specificity for the CAP assay and ELISA, respectively. RESULTS: Results of paired skin and serologic tests were available for 792 participants. Forty duplicate skin test results (5%) were positive. For the CAP assay, sensitivity was 35%; specificity, 98%; positive predictive value, 48.3%; and negative predictive value, 96.6%. ELISA demonstrated similar results. Multivariable logistic regression yielding a 98% or 99% specificity for the various ELISAs demonstrated that the adjusted odds of a positive skin test result significantly increased with positive CAP assay and ELISA results using a powdered glove extract. CONCLUSIONS: The performance of the FDA-cleared antilatex IgE serologic test for latex allergy has much lower sensitivity than previously reported. This finding confirms that this serologic test should be used only for patients with a history of latex allergy and not for screening the population with a low prevalence of latex sensitization. |
Comparison of digital direct readout radiography with conventional film-screen radiography for the recognition of pneumoconiosis in dust-exposed Chinese workers
Mao L , Laney AS , Wang ML , Sun X , Zhou S , Shi J , Shi H . J Occup Health 2011 53 (5) 320-6 OBJECTIVES: Pneumoconiosis in China remains a disease with substantial public health significance. Diagnostic standards for the pneumoconioses are based on traditional film-screen radiography (FSR). However, FSR is increasingly being replaced with digital radiographic imaging, which has become the predominant technology available in Chinese clinical practice. To evaluate the applicability of digital direct readout radiography (DR) images in the recognition of pneumoconioses, we compared the profusion of small opacities and large opacities between FSR and DR radiographs. METHODS: We enrolled 161 pneumoconioses patients and 31 dust-exposed workers during the course of the study, with FSR and DR images obtained from all participants. Each chest film was interpreted by five readers using the Chinese Diagnostic Criteria classification of radiographs of pneumoconiosis, as were DR images displayed on medical-grade computer monitors. RESULTS: No statistically significant differences were observed when the data were analyzed by small opacity profusion subcategory except for 1/1. The overall intermodality agreement of small opacities was good, with a weighted kappa (kappa) of 0.77. CONCLUSIONS: DR images with soft copy display are equivalent with respect to image quality and the recognition and classification of small parenchymal lung opacities. Additionally, we observed likeness between modalities with respect to the classification of large opacities. Overall, our study findings demonstrate that in a population of Chinese workers with pneumoconiosis, direct readout digital systems are equivalent to traditional film-screen radiography in the recognition and classification of small pneumoconiotic opacities. |
Prevention of IgE sensitization to latex in health care workers after reduction of antigen exposures
Kelly KJ , Wang ML , Klancnik M , Petsonk EL . J Occup Environ Med 2011 53 (8) 934-40 OBJECTIVE: To investigate occupational latex allergy in health care workers (HCWs) before and after an intervention designed to reduce latex allergen exposure from gloves. METHODS: Latex antigen concentrations in work area air ducts were measured before the intervention. Symptoms and latex sensitization were monitored annually before and after the intervention in 805 HCWs, using questionnaires and skin prick testing. RESULTS: The prevalence of latex sensitization before the intervention correlated with air duct latex antigen measurements, for HCWs exposed to low (9/413, 2%), intermediate (23/292, 8%), and high (11/67, 16%) antigen levels, P < 0.0001. After the intervention, new latex sensitization rates declined 16-fold, and 25% of previously sensitized employees reverted to negative skin tests. CONCLUSION: Airborne antigen exposure is a major source of latex sensitization among HCWs. Use of powder-free latex gloves markedly reduces the risk of sensitization. |
Interpreting screening questionnaires: specific respiratory symptoms and their relationship to objective test results
Petsonk EL , Wang ML . J Occup Environ Med 2010 52 (12) 1225-9 OBJECTIVE: To better delineate the relationship between responses to screening respiratory symptom questionnaires and various pulmonary function test results. METHODS: Spirometry, methacholine challenge, standardized questionnaires, smoking, medical, and work histories were recorded at initial and 5-year follow-up surveys among 411 participants. Percent-predicted forced expiratory volume in 1 second (ppFEV1), 5-year FEV1 decline, and proportion of methacholine responders (% hyper-responders) were compared with questionnaire responses utilizing generalized estimating equations modeling and analysis of variance. RESULTS: Significant associations were found between ppFEV1 and cough, phlegm, dyspnea, or ever wheezing; between greater percentage of hyper-responders and dyspnea with wheezing, ever/persistent wheezing, or history of asthma/hay fever; and between accelerated FEV1 decline and new onset dyspnea with wheezing, phlegm, or persistent wheeze. CONCLUSIONS: Particular respiratory symptoms reported on screening questionnaires are associated with specific physiologic abnormalities, enhancing questionnaire utility in workplace health surveillance. |
Comparing film and digital radiographs for reliability of pneumoconiosis classifications: a modeling approach
Sen A , Lee SY , Gillespie BW , Kazerooni EA , Goodsitt MM , Rosenman KD , Lockey JE , Meyer CA , Petsonk EL , Wang ML , Franzblau A . Acad Radiol 2010 17 (4) 511-9 RATIONALE AND OBJECTIVES: The International Labour Office (ILO) system for classifying chest radiographic changes related to inhalation of pathogenic dusts is predicated on film-screen radiography. Digital radiography has replaced film in many centers. Digital images can be printed on film ("hard copy") or can be viewed at a computer workstation ("soft copy"). The goal of the present investigation was to compare the inter-reader and intra-reader agreement of ILO classifications for pneumoconiosis across image formats. MATERIALS AND METHODS: Traditional film radiographs, hard copy digital images, and soft copy digital images from 107 subjects were read by six B readers. A multiple reader version of the inter-reader kappa statistic was compared across image formats. Intra-reader kappa comparisons were carried out using an iterative least-squares approach (unadjusted analysis) as well as a two-stage regression model adjusting for readers and subject-level covariates. RESULTS: There were few significant differences in the inter-reader and intra-reader agreement across formats. For parenchymal abnormalities, inter-reader and intra-reader kappa values ranged from 0.536 to 0.646, and 0.65 to 0.77, respectively. In the covariate-adjusted analysis film-screen radiography was generally associated with a numerically greater reliability (ie, higher kappa values) than the other image formats, although differences were rarely statistically significant. CONCLUSION: Film-screen radiographs, hard copy digital images, and soft copy digital images yielded similar reliability measures. These findings provide further support to the recommendation that soft copy digital images can be used for the recognition and classification of dust-related parenchymal abnormalities using the ILO system. |
Excessive longitudinal FEV1 decline and risks to future health: A case-control study
Wang ML , Avashia BH , Wood J , Petsonk EL . Am J Ind Med 2009 52 (12) 909-15 BACKGROUND: Accelerated loss of forced expiratory volume in 1 s (FEV(1)) in an individual is considered an indicator of developing lung disease. METHODS: We investigated longitudinal FEV(1) slopes, calculated by simple linear regression, and adverse health outcomes after 10-30 years, among 1,428 chemical plant workers. Cases were defined by FEV(1) slopes below 5th percentile values for the cohort. Cases were matched with controls (107 pairs) for race, gender, smoking status, year of birth, age, height, and calendar year at first test. Matched pair statistics were used for comparisons. RESULTS: Cases had a higher proportion, compared to controls, of diagnosis of COPD or emphysema (17.8% vs. 1.9%, P = 0.0002), medication use for respiratory diseases (24.3% vs. 4.7%, P < 0.0001), dyspnea (15% vs. 3.7%, P = 0.0042), and wheezing or rhonchi on examination (10.3% vs. 1.9%, P = 0.0225). CONCLUSIONS: Chemical plant workers who experienced accelerated FEV(1) declines experienced four to nine times as many adverse health conditions over 10-30 years. Am. J. Ind. Med. (c) 2009 Wiley-Liss, Inc. |
Interpreting longitudinal spirometry: weight gain and other factors affecting the recognition of excessive FEV(1) decline
Wang ML , Avashia BH , Petsonk EL . Am J Ind Med 2009 52 (10) 782-9 BACKGROUND: Excessive FEV(1) loss in an individual or a group can reflect hazardous exposures and development of lung disease. However, multiple factors may affect FEV(1) measurements. METHODS: Using medical screening data collected in 1884 chemical plant workers between 1973 and 2003, the influence of multiple factors on repeated measurements of FEV(1) was examined. RESULTS: The FEV(1) level was associated with age, height, race, sex, cigarette smoking, changes in body weight, and spirometer model. After controlling for these factors, longitudinal FEV(1) decline averaged 23.8 ml/year for white males; an additional loss of 8.3 ml was associated with one pack-year smoking and 5.4 ml with a one pound weight gain. Depending on the spirometer model, FEV(1) differed by up to 95 ml. CONCLUSIONS: The study results provide quantitative estimates of the effect of specific factors on FEV(1), and should be useful to health professionals in the evaluation of accelerated lung function declines. Am. J. Ind. Med. (c) 2009 Wiley-Liss, Inc. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 06, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure