Results of an Educational Intervention to Improve the Health Knowledge, Attitudes and Self-Reported Behaviors of Swine Confinement Workers

ABSTRACT: Swine confinement workers participated in an educational intervention designed to improve knowledge, attitudes, and behaviors related to respiratory disease. The desired changes were (1) improvement in knowledge about recommended gas and dust levels in buildings and benefits of using properly fitted masks; (2) improvement of attitudes about wearing dust masks, taking safety precautions, and inspecting the ventilation and heating systems; and (3) improvement in behaviors such as regular inspection of buildings and wearing an appropriate dust mask or respirator. The health risks of failing to practice these behaviors include chronic bronchitis, occupational asthma, organic dust toxic syndrome, chronic sinusitis, and even death from acute toxicity related to hydrogen sulfide. An intervention group and a nonintervention group of swine confinement workers were assessed at the beginning of the project and one year later to determine changes brought about by an educational intervention. During that year, swine producers in the intervention group were mailed a series of six educational home-study modules and reference materials on confinement topics. Analysis of covariance and categorical repeated measures analysis were used to determine changes over time in the percentage of people who answered correctly in each group. Significant changes in knowledge scores, attitude scores, and reported behavior scores all favored the intervention group. The 14 statistically significant changes in knowledge items were related to dust mask use, manure pit safety, liquid manure agitation, building gas and dust norms, and recommended gas levels. The four attitudinal items that improved significantly concerned the importance of regular cleaning and upkeep, improving health and safety, knowing ways to keep buildings safer, and recognizing the benefits of wearing a dust mask. The four items about self-reported behavior changes included inspecting and servicing of building heaters, measuring building gases, and wearing a mask while working. Thus, important changes in the intervention group occurred in all three targeted areas—knowledge, attitudes, and behaviors. The results lead to three conclusions: the educational materials were effective; swine producers are educable through a low-cost intervention; and educational intervention acan improve many factors related to the safety and health of confinement workers.     

Respiratory protection: associated factors and effectiveness of respirator use among underground coal miners

BACKGROUND: We investigated factors associated with the use of respiratory protection and explored the effectiveness of respirators among coal miners. METHODS: Between 1987 and 1992, respiratory symptoms, smoking, lung function, and dust exposures were assessed longitudinally among 185 underground bituminous coal miners. Self-reported use of respiratory protection was expressed as mean percent time wearing a respirator. RESULTS: Miners' respirator use increased with mean dust concentration, but decreased with tobacco consumption. Increasing age was associated with greater respirator use. Miners who had respiratory symptoms at the initial survey subsequently reported greater use of respirators. A significant protective association was found between the miners' respirator use and FEV(1) levels at both the initial and follow-up surveys. CONCLUSIONS: These results provide additional evidence that respirator use is protective of lung health. When respiratory protection programs are developed, factors that may affect respirator use behavior, such as age, smoking, and respiratory symptoms, should be considered. Future studies of respiratory health will need to consider workers' use of respiratory protection.     

烟台市室内装修工人粉尘防护现状及影响因素分析

目的 调查烟台市室内装修工人粉尘防护现状,分析其主要影响因素,为加强职业保护提供资料和思路。
方法 对烟台市六区200名室内装修工人进行面对面问卷调查,了解工人防尘知识掌握情况、防护态度和行为,以及工人健康管理情况,并对工人粉尘防护知识掌握情况及防尘口罩佩戴情况的影响因素进行分析。
结果 粉尘防护知识掌握分级为“好”的工人占18.23%,39.58%的工人在接尘时能正确佩戴防尘口罩。不同来源工人参加工伤社会保险率、定期体检率差异均有统计学意义（P < 0.05）,其情况均以企业工人最好,个体户最差。多因素logistic回归分析结果表明:相比个体户,企业工人和包工头招揽的工人掌握好粉尘防护知识的可能性较高（OR=24.767、19.244,P < 0.01）;相比≤ 30岁工人,41~50岁工人正确佩戴防尘口罩的可能性较低（OR=0.404,P < 0.05）;分别相比认为作业时不需要佩戴防尘口罩、认为粉尘防护措施不重要的工人,认为作业时需要佩戴防尘口罩、认为粉尘防护措施重要的工人正确佩戴口罩的可能性更高（OR=2.884、3.139,P < 0.05）。
结论 烟台市室内装修工人防尘知识水平及防尘行为有待改进。开展有效的工作场所健康促进活动,重点关注流动性较大工人的健康教育工作,是今后加强室内装修工人粉尘防护的主要措施。
     

Respiratory effects and dust exposures in hog confinement farming

Fifty-three hog confinement farmers and 43 control farmers were studied. Pulmonary function, total and respirable personal dust levels, and responses to a health status questionnaire were obtained for all farmers. The hog farmers' total and respirable personal dust exposures were significantly higher than the respective levels of the control farmers. Higher dust levels were associated with the use of floor (scatter) feeding, indoor feed grinding, and the use of high moisture corn feed. Pork producers reported respiratory symptoms significantly more often than controls. Lung function did not differ between the two groups of farmers, nor could dust exposure levels be related to lung function.     

Occupational exposure and lung function measurements among workers in swine confinement buildings

Previous studies have demonstrated that air in swine confinement buildings contains large amounts of dusts, highly contaminated with microorganisms and bacterial endotoxin. A study was undertaken to investigate the respiratory function of workers before and after the work shift in swine confinement buildings. Questionnaires were mailed to workers on swine farms. Dust levels were measured by personal sampling, and the micro-flora in the dust was determined. Work-related symptoms from the lung were frequent. Several workers who were smokers had forced expiratory volume in 1 second (FEV1) values lower than expected when they started work. Among a group of life-long nonsmoking workers the baseline forced vital capacity and FEV1 were not decreased. Changes in the FEV1 over the working shift were generally not found. It is suggested that exposure to dust in swine confinement buildings may lead to respiratory impairment but further studies on larger population samples and different exposure conditions are required.     

Metal dust exposure and lung function deterioration among steel workers: an exposure-response relationship

Background: Metallic dust is a heterogeneous substance with respiratory sensitizing properties. Its long term exposure adversely affected lung function, thus may cause acute or chronic respiratory diseases.

Methods: A cross-sectional study was conducted in a steel factory in Terengganu, Malaysia to assess the metal dust exposure and its relationship to lung function values among 184 workers. Metal dust concentrations values (Co, Cr, and Ni) for each worker were collected using air personal sampling. Lung function values (FEV₁, FVC, and %FEV₁/FVC) were determined using spirometer.

Results: Exposure to cobalt and chromium were 1–3 times higher than permissible exposure limit (PEL) while nickel was not exceeding the PEL. Cumulative of chromium was the predictor to all lung function values (FEV₁, FVC, and %FEV₁/FVC). Frequency of using mask was positively associated with FVC (Adj b = 0.263, P = 0.011) while past respiratory illnesses were negatively associated with %FEV₁/FVC (Adj b = –1.452, P = 0.026). Only few workers (36.4%) were found to wear their masks all times during the working hours.

Conclusions: There was an exposure-response relationship of cumulative metal dust exposure with the deterioration of lung function values. Improvement of control measures as well as proper and efficient use or personal protection equipment while at work could help to protect the respiratory health of workers.     

Lung function and respiratory symptoms in pig farmers

In a pilot study to investigate the health effects of swine confinement work on the respiratory tract pulmonary function tests and a questionnaire for respiratory symptoms were used. Complete data, including qualitative exposure information, were gathered for 132 owners of fattening, breeding, or closed pig farms. All measured pulmonary function values, except the FVC, were on average lower than the reference values of the European Committee for Coal and Steel. There were no significant associations between duration of exposure and pulmonary function. About 28% of the farmers had respiratory or flu-like symptoms during or shortly after confinement work; 14% reported symptoms four to eight hours after work. For the fattening farm the following elements of confinement management were negatively correlated with pulmonary function: fully slatted floor, an automatic feeding system, natural ventilation, and the use of dust masks. A significant association between lung disease of the pigs and pulmonary function of the pig farmers was observed.     

An environmental and respiratory health survey of workers in a grain mill in the Johannesburg area,South Africa

A respiratory health survey was conducted in a grain mill and the relationship of health indicators to quantitative measures of airborne dust, fungal, and bacterial contamination was examined. Respiratory symptoms were more prevalent in the high dust exposure categories; lung function levels were also higher in the high dust exposure categories, consistent with a “healthy” worker effect. Workers in the three higher dust exposure categories showed either no change or a decrease in lung function over the working week, while workers in the low exposure category demonstrated an improvement in lung function over the working week. Total dust and microbiological (fungal and bacterial) load were found to be significantly related to each other, and the relationship of microbiological load to lung function level and changes over the working week were similar to those found for total dust © 1993 Wiley-Liss, Inc.     

Lung function and respiratory symptoms in pig farmers.

In a pilot study to investigate the health effects of swine confinement work on the respiratory tract pulmonary function tests and a questionnaire for respiratory symptoms were used. Complete data, including qualitative exposure information, were gathered for 132 owners of fattening, breeding, or closed pig farms. All measured pulmonary function values, except the FVC, were on average lower than the reference values of the European Committee for Coal and Steel. There were no significant associations between duration of exposure and pulmonary function. About 28% of the farmers had respiratory or flu-like symptoms during or shortly after confinement work; 14% reported symptoms four to eight hours after work. For the fattening farm the following elements of confinement management were negatively correlated with pulmonary function: fully slatted floor, an automatic feeding system, natural ventilation, and the use of dust masks. A significant association between lung disease of the pigs and pulmonary function of the pig farmers was observed.     

Dust exposure and respiratory symptoms among cement factory workers in the United Arab Emirates

This study was conducted in a cement factory in the United Arab Emirates to assess cement dust exposure and its relationship to respiratory symptoms among workers. A total of 149 exposed and 78 unexposed workers participated in this cross-sectional study. Information on demographic and respiratory symptoms was collected by questionnaire. Personal total dust levels were determined by the gravimetric method. Concentration of the total dust ranged between 4.20 mg/m(3) in the crushers and 15.20 mg/m(3) in the packaging areas, and exceeded the exposure limit in the packaging and raw mill areas. The prevalence of respiratory symptoms was higher among the exposed workers, but the difference from that of unexposed workers was statistically significant only for cough (19.5%; OR=4.5; 95%CI=1.5-13.2), and phlegm (14.8%; OR=13.3; 95%CI=1.8-100.9). Cough and phlegm were found to be related to exposure to dust, cumulative dust and smoking habit, while chronic bronchitis was related to smoking habit. The few factory workers (19.5%) who used masks all the time had a lower prevalence rate of respiratory symptoms than those not using them. High dust level was the only variable that influenced the workers to use the mask all the time. It is recommended that control measures be adopted to reduce the dust and workers should be encouraged to use respiratory protection devices during their working time.     

Chronic respiratory disorders related to farming and exposure to grain dust in a rural adult community

In a survey of chronic respiratory symptoms and airflow obstruction of a rural population aged 20-65 years, the effects of both farming and, in particular, the exposure to grain dust on the respiratory health of the people was examined. Of the 1,892 subjects (82% of the eligible population) studied, 924 were males and 968 females, with half living in the town. Three groups were identified: current, former, and never farmers. Almost all current farmers were exposed to grain for, on average, 2 months a year. There was no difference in atopic status between the groups. While there was a strong association between most symptoms and smoking, there was no association between symptoms and exposure to grain and farming category once age and smoking had been taken into account. Results of this study suggest that farmers do not have chronic respiratory symptoms or impairment of lung function because of their exposure to grain dust. Lung function of former farmers might have been affected by farming, and this may reflect more involvement with livestock in the past.     

Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of multiple surgical masks

Guidelines issued by the Centers for Disease Control and Prevention and the World Health Organisation state that healthcare workers should wear N95 masks or higher-level protection during all contact with suspected severe acute respiratory syndrome (SARS). In areas where N95 masks are not available, multiple layers of surgical masks have been tried to prevent transmission of SARS. The in vivo filtration capacity of a single surgical mask is known to be poor. However, the filtration capacity of a combination of masks is unknown. This was a crossover trial of one, two, three and five surgical masks in six volunteers to determine the in vivo filtration efficiency of wearing more than one surgical mask. We used a Portacount to measure the difference in ambient particle counts inside and outside the masks. The best combination of five surgical masks scored a fit factor of 13.7, which is well below the minimum level of 100 required for a half face respirator. Multiple surgical masks filter ambient particles poorly. They should not be used as a substitute for N95 masks unless there is no alternative.     

Relation between dust exposure and lung function in miners and ex-miners

A sample of men working in the British coal industry in the 1950s has been followed up and examined 22 years later. The relations between lung function and individual cumulative exposure to respirable dust have been studied in 1867 men who were still working in the industry at the time of follow up and 2192 men who had left. Levels of forced expired volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio at follow up were found to be inversely related to exposure to respirable dust after allowing for other factors, even in men without pneumoconiosis. The magnitude of this estimated effect was equivalent to a loss of 228 ml FEV1 in response to an exposure of 300 gh/m3, a moderately high exposure for this group. Ex-miners aged under 65 had worse lung function than miners on average, suggesting that ill health had encouraged some of these men to leave the industry. Whereas a more severe response to dust exposure among ex-miners under 65 was suggested, this difference could easily have arisen by chance. The presence of symptoms of chronic bronchitis was associated with reduced levels of lung function, however, and, additionally, ex-miners under 65 with chronic bronchitis showed a more severe response of the FVC to dust exposure than miners without these symptoms. Among these ex-miners with chronic bronchitis a small group of men who had taken other jobs showed a much more severe effect of dust exposure on their lung function than the average, likely in heavily exposed men to contribute importantly to disability. Men in this group who had given up smoking showed and even more severe effect of dust exposure, equivalent to a loss of 940 ml FEV1 in response to an exposure of 300 gh/m3. These results indicate that exposure to respirable dust can occasionally cause severe respiratory impairment in the absence of progressive massive fibrosis. Dust exposure was related to a parallel reduction of FEV1 and FVC, implying that the pathology of dust induced lung damage differs form that induced by smoking. This pattern of abnormality was shown by some non-smokers, whereas smokers and ex-smokers apparently severely affected by dust showed a classic obstructive pattern of abnormality with pronounced reduction of the FEV1/FVC ratio.     

Relation between dust exposure and lung function in miners and ex-miners.

A sample of men working in the British coal industry in the 1950s has been followed up and examined 22 years later. The relations between lung function and individual cumulative exposure to respirable dust have been studied in 1867 men who were still working in the industry at the time of follow up and 2192 men who had left. Levels of forced expired volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio at follow up were found to be inversely related to exposure to respirable dust after allowing for other factors, even in men without pneumoconiosis. The magnitude of this estimated effect was equivalent to a loss of 228 ml FEV1 in response to an exposure of 300 gh/m3, a moderately high exposure for this group. Ex-miners aged under 65 had worse lung function than miners on average, suggesting that ill health had encouraged some of these men to leave the industry. Whereas a more severe response to dust exposure among ex-miners under 65 was suggested, this difference could easily have arisen by chance. The presence of symptoms of chronic bronchitis was associated with reduced levels of lung function, however, and, additionally, ex-miners under 65 with chronic bronchitis showed a more severe response of the FVC to dust exposure than miners without these symptoms. Among these ex-miners with chronic bronchitis a small group of men who had taken other jobs showed a much more severe effect of dust exposure on their lung function than the average, likely in heavily exposed men to contribute importantly to disability. Men in this group who had given up smoking showed and even more severe effect of dust exposure, equivalent to a loss of 940 ml FEV1 in response to an exposure of 300 gh/m3. These results indicate that exposure to respirable dust can occasionally cause severe respiratory impairment in the absence of progressive massive fibrosis. Dust exposure was related to a parallel reduction of FEV1 and FVC, implying that the pathology of dust induced lung damage differs form that induced by smoking. This pattern of abnormality was shown by some non-smokers, whereas smokers and ex-smokers apparently severely affected by dust showed a classic obstructive pattern of abnormality with pronounced reduction of the FEV1/FVC ratio.     

Airways inflammation after exposure in a swine confinement building during cleaning procedure

BACKGROUND: Healthy volunteers exposed for 3 hr during weighing of pigs develop an airway inflammation characterized by a massive influx of neutrophilic granulocytes in the upper and lower airways and increased bronchial responsiveness to methacholine. The purpose of the present study was to investigate health effects from exposure during cleaning of the swine confinement building and to evaluate the effect of a respiratory protection device. METHODS: Sixteen subjects were exposed for 3 hr during cleaning of a swine confinement room with a high-pressure cleaner. Seven out of sixteen subjects were equipped with a mask during exposure. RESULTS: The bronchial responsiveness increased in all subjects following exposure, significantly more in the group exposed without a mask (P < 0.05). The cell concentration (mainly neutrophilic granulocytes) in nasal lavage fluid as well as the concentration of interleukin-8, increased significantly only in those subjects exposed without a respiratory protection device. In peripheral blood, an increase of neutrophilic granulocytes was observed in both groups, although it was significantly higher in the group without mask (P < 0.05). The inhalable dust level was 0.94 (0.74 - 1.55) mg/m(3) and respirable dust 0.56 (0.51-0.63) mg/m(3). CONCLUSION: Exposure to dust aerosols during the cleaning of the interior of a swine confinement building induces increased bronchial responsiveness and an acute inflammatory reaction in the upper airways. The use of a mask attenuated but did not abolish the inflammatory response. This suggests that gases and/or ultrafine particles in this environment could be important factors in the development of increased bronchial responsiveness.     

Lung function and work-related exposure in pig farmers with respiratory symptoms

The present study was conducted to evaluate characteristics of pig houses that are associated with the development of respiratory morbidity in 100 swine producers with work-related respiratory symptoms. A standardized questionnaire for farm characteristics was used, and lung function was assessed immediately before and after feeding the pigs. Exposure to dust and endotoxin was determined by personal sampling. Among these farmers, baseline lung function results were shown to be negatively associated with duration of employment, number of pigs on the farm, manual feeding, and ventilation. The decrease in forced vital capacity and forced expiratory volume in 1 second over the feeding period was negatively correlated with air velocity, whereas respirable dust concentrations were shown to be significant predictors of maximal midexpiratory flow (MMEF25/75) decline. In conclusion, among symptomatic pig farmers, those with higher numbers of pigs and longer duration of employment are at highest risk for developing functional impairment.     

Follow-up study of respiratory health of newly-hired female cotton textile workers

BACKGROUND: Numerous studies have investigated adverse effects of exposure to cotton dust on respiratory health, but very limited longitudinal data are available with regard to the early pulmonary response to cotton dust. Moreover, the adverse effects of occupational exposure to cotton dust have been difficult to separate from the confounding effects of smoking. This setting provided a unique opportunity to evaluate early respiratory effects in newly hired and non-smoking female textile workers. METHODS: To identify early pulmonary responses to cotton dust exposure and associated gram-negative bacterial endotoxin, respiratory symptoms and pulmonary function in 225 newly-hired textile workers were assessed at work initiation, and at three and twelve months later. RESULTS: All the workers were females and nonsmokers, with an average age of 18 years. Symptom incidence at three months was 3.6% for usual cough with phlegm, and 6.7% for usual dry cough. Lung function changes were detectable at one year: FEV1 declined by 70 ml and FVC by 124 ml over the year, and workers reporting respiratory symptoms at three months showed a significantly greater cross-shift drop in FEV1 (- 2.3%) than those without the symptoms (- 0.7%). CONCLUSIONS: These results suggest that the occurrence of respiratory symptoms represents the earliest response to cotton dust exposure, followed by lung function changes. Early respiratory symptoms may be a risk factor for subsequent loss of pulmonary function in cotton textile workers.     

Lung Function and Respiratory Symptoms in Male Palestinian Farmers

ABSTRACT

In a cross-sectional study of 250 farmers aged 22 to 77 years, of whom 36.4% are smokers, the authors aimed at describing lung function and respiratory symptoms and to estimate associations with exposures to pesticides and dust. Lung function was measured using a spirometer. Respiratory symptoms and exposure levels were self-reported based on a modified standardized questionnaire. Mean forced vital capacity (FVC) was 4.20 L (SD = 0.93 L), 95.51% of predicted as compared to European standards. Mean forced expiratory volume in one second (FEV₁) was 3.28 L (SD = 0.80 L), 91.05% of predicted. The authors found high symptom prevalences: 14.0% for chronic cough; 26.4% for wheeze; and 55.2% for breathlessness. There was no clear association between exposure to pesticides or dust and lung function or between such exposures and respiratory symptoms. However, a significant association was found between smoking and respiratory symptoms such as chronic cough, cough with phlegm, and wheezes. The lack of farm exposure associations could be due to improvement in farmers’ awareness to pesticides hazards as well as regulations of pesticide import, or because of inherent problems with the experimental design. Farmers who kept animals and poultry seem to have less respiratory symptoms and better lung function.     

Face masks in the general healthy population. Scientific and ethical issues

In most European countries, facemasks use is recommended or mandatory in enclosed spaces where physical distancing is not possible. In Spain, this measure was first extended to open public spaces and later made mandatory regardless of whether or not the interpersonal safety distance can be kept. At present, there is no evidence on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2. The mandatory use of masks poses some ethical questions. Firstly, it entails a paternalistic action. Secondly, application of the principle of precaution becomes questionable when there is no clear benefit-risk relationship. Thirdly, compulsoriness can interfere with equity of public health actions. Fourthly, it can result in social stigma and discrimination against those who do not wear one, even though they well may have good reasons for doing so. Lastly, this measure may generate confusion in the population, along with an altered perception of the risk. The World Health Organization recommends its use in public places with a high potential risk of transmission and where other prevention measures, such as physical distancing, are not possible. Mandatory use of masks in public open spaces, regardless of the risk of transmission or of whether or not the interpersonal safety distance can be kept, is an intrusive measure that restricts individual freedoms, and would not appear to be justified on the basis of available scientific evidence. What we need are recommendations explaining where, when, how and what type of mask to wear.     

Protecting staff against airborne viral particles: in vivo efficiency of laser masks

Laser masks are used to prevent inhalation of viral particles during laser surgery. A crossover trial was performed in eight volunteers to compare the ability of a surgical mask and a laser mask with that of an FFP2 respirator to filter airborne dust particles. The surgical and laser masks were tested when worn normally and when they were taped to the face. The mean reductions in particle counts were 3.0 fold [95% confidence interval (95% CI) 1.8-4.2] for the untaped surgical mask, 3.8 fold (95% CI 2.9-4.6) for the untaped laser mask, 7.5 fold (95% CI 6.5-8.5) for the taped surgical mask, 15.6 fold (95% CI 13.5-17.8) for the taped laser mask, and 102.6 fold (95% CI 41.2-164.1) for the FFP2 half-face respirator. The laser mask provided significantly less protection than the FFP2 respirator (P=0.02), and only marginally more protection than the surgical mask. The continued use of laser masks for respiratory protection is questionable. Taping masks to the face only provided a small improvement in protection.