Respirator Use and Practices in Agricultural Crop Production Establishments

ABSTRACT

The risk of developing respiratory diseases can be reduced by either wearing respiratory protection under the guidance of an effective respiratory protection program or using controls. In 2001, the Survey of Respirator Use and Practices gathered information on the types of respirators used, respirator use practices, and the respirator program characteristics from 40,002 randomly selected US establishments. This report presents findings of the Survey of Respirator Use and Practices for the Agricultural Production—Crops industry and compares them with National Institute for Occupational Safety and Health (NIOSH) recommendations. Approximately one third of all Agricultural Production—Crops establishments required respirator use. Of the Agricultural Production—Crops establishments that required respirator use, (1) a written program to determine what type of respirator to use was not adopted by management in 73% of the establishments; (2) 21% did not know whether air sampling was conducted for substances for which employees were required to use respirators; (3) 29.5% did not provide respirator training for employees; (4) employees were not assessed for medical fitness to wear a respirator or it was not known whether the employees were assessed, in 49.4%; and (5) the program administrator had received no respirator training in 29.5%. Of the Agricultural Production—Crops establishments that required respirator use, 69.5% had at least 3 indicators of a potentially inadequate respiratory protection program. The high rates of indicators of potential inadequacies suggest widespread problems with respiratory protection programs in the Agricultural Production—Crops industry, indicating a potential for improvement.     

住院患者呼吸系统疾病死亡与环境风险因素分析

目的通过分析呼吸系统疾病在所有住院死亡疾病中的构成与顺位,探讨其与环境风险因素的关系。方法对766名因呼吸系统疾病死亡的患者进行统计、分析。结果在所有住院死亡的疾病中,呼吸系统疾病死亡患者最多。结论呼吸系统疾病的高病死率可能与环境风险因素密切相关。     

Neonatal Morbidity and Mortality in Tribal and Rural Communities in Central India

Background and Objectives:

Little is known about the natural history of neonates born in the rural and tribal areas in India. The Neonatal Disease Surveillance Study (NDSS) measures the incidence of high-priority neonatal diseases, neonatal health events and associated risk factors to plan appropriate and effective actions.

Materials and Methods:

The NDSS is being conducted in Ramtek Revenue Block, Nagpur district, Maharashtra state, given its considerably high level of neonatal mortality. All households from five selected primary health centers were screened. Both active and passive surveillance systems were used for systematic collection of mother''s health during pregnancy and of baby''s health from birth to 4 months after birth. First-year results from November 2006 to October 2007 are presented.

Results:

Pregnancy outcomes were available for 1,136 women, with an overall neonatal mortality of 73 per 1,000 live births. The pregnancy outcomes varied by gestational age of the baby; miscarriages and abortions were higher in tribal than in non-tribal women, and tribal women had higher rates of low-birth weight (LBW) neonates than non-tribal women. The main cause of neonatal mortality was LBW, followed by sepsis and respiratory illness. The mortality of non-tribal babies was most strongly associated with pre term. For tribal babies, mortality was also associated with maternal morbidity and delay in the initiation of breastfeeding.

Interpretation and Conclusions:

The NDSS provides valuable information on the potentially modifiable factors associated with increased likelihood of neonatal mortality and morbidity. The Neonatal Health Research Initiative is now developing community-based interventions to reduce the high rate of neonatal mortality and morbidity in the rural areas of India.     

Influence of Socioeconomic Status on In-Hospital Mortality and Morbidity after Stroke in India: Retrospective Hospital-Based Cohort Study

Objectives:

To determine an association between socioeconomic status and in-hospital outcome in Indian patients with stroke.

Materials and Methods:

Retrospective hospital-based cohort study. The hospital stroke register was used for this study. The independent variables were demographic job status, education, cardiovascular risk factors, comorbidities and the score on the Glasgow Coma Scale (GCS). The outcome variables were mortality and Barthel′s index (BI) score at discharge.

Results:

Data of 599 consecutive patients comprising 370 men (54.3%) and 229 women (33.6%) was available for analysis. Their mean age was 55.63±15.36 years. Age, diagnosis (ischemic or hemorrhagic), midline shift, smoking and GCS were significantly associated with mortality and BI score (P<0.05). There was a statistically significant association between employment status and BI at discharge (P=0.03) in univariate analysis. In multivariate analysis, joblessness was associated with lower BI at discharge (P=0.02) after adjustment for GCS motor score and stroke subtype.

Conclusion:

Our study shows that in patients with stroke, lower employment status is associated with poor outcome at discharge from the hospital. The association is independent of other prognostic factors.     

Respiratory Morbidity among Children Following Renovation of a Water-Damaged School

The authors sought to determine whether exposure to molds, resulting from moisture damage in a school, was associated with increased respiratory symptoms and morbidity among schoolchildren and whether the renovation of this building resulted in a decrease in prevalence of respiratory symptoms and morbidity. The study was a follow-up (1-y interval) of children between the ages of 7 and 12 y from two elementary schools in a Finnish suburb. In addition to a questionnaire completed by the parents, the authors assessed the respiratory health of children by examining the health records of a local health center. In the cross-sectional study, the prevalence of symptoms and infections were higher in the exposed group, as were visits to a physician and use of antibiotics. The school was renovated, after which all prevalence decreased and no significant differences remained, except for visits to a physician (according to questionnaire responses). Therefore, moisture damage and exposure to molds increased the indoor air problems of schools and affected the respiratory health of children.     

Ambient Air Pollution and Chronic Respiratory Morbidity in Delhi

The authors conducted a cross-sectional study among residents of Delhi to determine the role of ambient air pollution in chronic respiratory morbidity in Delhi. The authors selected a random, stratified sample (N = 4,171) of permanent residents who were 18+ y of age and who lived near 1 of the 9 permanent air quality monitoring stations in the city. Air-quality data for the past 10 y were obtained; data were based on the differences in total suspended particulates, and the study areas were categorized into lower- and higher-pollution zones. A standardized questionnaire was administered, clinical examination was carried out, and spirometry followed. The authors assessed chronic respiratory morbidity by (a) prevalence of chronic respiratory symptoms (i.e., chronic cough, phlegm, breathlessness, and wheezing) and airway diseases (i.e., chronic obstructive pulmonary disease/chronic bronchitis and bronchial asthma); and (b) lung function results in asymptomatic nonsmoking subjects in the two pollution zones. A multiple logistic regression identified the determinants of chronic symptoms. Smoking, male sex, increasing age, and lower socioeconomic status were strong independent risk factors for occurrence of chronic respiratory symptoms. In the comparison of nonsmoking residents of lower- and higher-pollution zones—stratified according to socioeconomic levels and sex—chronic cough, chronic phlegm, and dyspnea (but not wheezing) were significantly more common in the higher-pollution zone in only some of the strata. Furthermore, prevalence rates of bronchial asthma, chronic obstructive pulmonary disease, and chronic bronchitis among residents in the two pollution zones were not significantly different. Nonetheless, lung function of asymptomatic nonsmokers was consistently and significantly better among both male and female residents of the lower-pollution zone.     

Association of Outdoor Air Pollution with Chronic Respiratory Morbidity in an Industrial Town in Northern India

A cross-sectional study was performed in one industrial (study) and one non-industrial (reference) town in Punjab State, northern India. Ambient air quality samples were collected and analyzed each week for 2 yr. Subjects were 3,603 individuals <15 yr old who were interviewed and whose lung functions were measured spirometrically. Their biomarkers were categorized in terms of obstructive or restrictive defects. Levels of total suspended particulates, nitrogen oxides, sulfur oxides, carbon monoxide, and ozone were significantly higher in the study town than in the reference town. The prevalence of chronic respiratory symptoms (cough, phlegm, breathlessness, or wheezing) was 27.9 and 20.3% in the study and reference towns, respectively (p < 0.05). That of obstructive ventilatory defect was 24.9 and 11.8% (p < 0.05), respectively. Logistic regression analysis showed that residence in the study town was independently associated with chronic respiratory symptoms (odds ratio [OR] = 1.5; 95% confidence interval [Cl] = 1.2, 1.8; p < 0.001) and spirometric ventilatory defect (OR = 2.4; 95% Cl = 2.0, 2.9; p < 0.001) after controlling for other demographic effects.     

Invasive Pneumococcal Disease and Long-Term Mortality Rates in Adults,Alberta, Canada

The relationship between increased short-term mortality rates after invasive pneumococcal disease (IPD) has been frequently studied. However, the relationship between IPD and long-term mortality rates is unknown. IPD patients in Alberta, Canada, had clinical data collected that were linked to administrative databases. We used Cox proportional hazards modeling, and the primary outcome was time to all-cause deaths. First IPD events were identified in 4,522 patients, who had a median follow-up of 3.2 years (interquartile range 0.8‒9.1 years). Overall all-cause mortality rates were consistently higher among cases than controls at 30 days (adjusted hazard ratio [aHR] 3.75, 95% CI 3.29–4.28), 30‒90 days (aHR 1.56, 95% CI 1.27‒1.93), and >90 days (aHR 1.43, 95% CI 1.33–1.54). IPD increases risk for short, intermediate, and long-term mortality rates regardless of age, sex, or concurrent conditions. These findings can help clinicians focus on postdischarge patient plans to limit long-term effects after acute IPD infection.     

Agricultural Work Exposures and Pulmonary Function Among Hired Farm Workers in California (The MICASA Study)

Despite California’s dependence on hired farm labor, scarce research has been conducted on the respiratory health of hired farm workers. Agricultural exposures to inorganic and organic dusts can adversely affect an individual’s respiratory health and differ by farm type and job task. The purpose of the present analysis was to examine associations between agricultural work exposures and pulmonary function among 450 California farm workers. Data were collected as part of the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) study, a prospective cohort study examining occupational risk factors and health of hired farm worker families in Mendota, California. Time-weighted self-reported average (TWSRA) dust scores were calculated from assessments of past-12-month agricultural work history. Other dust exposure indicator variables included months worked in agriculture in the past 12 months and years worked in agriculture. Multiple linear regression modeled FEV₁ (forced expiratory volume in 1 second), FEF_25–75% (forced midexpiratory flow rate), FVC (forced vital capacity), FEV₆, FEV₁/FVC, and FEV₁/FEV₆ separately. Seventy-six percent of participants had worked in agriculture in the past year. In models conducted for crops and tasks separately, high TWSRA dust score was associated with better FEV₆. Crop and task models showed associations between greater months worked in agriculture in the past year and better FEV₁, FEF_25–75%, and FEV₆. Both models also found greater years worked in agriculture to be associated with worse FEV₁/FEV₆. Results were generally in the opposite direction as expected given past research but not uncommon. Future research should investigate relationships between pulmonary function and agricultural dust exposure over a lifetime and changes in pulmonary function over time.     

Morbidity Measures Predicting Mortality in Inpatients: A Systematic Review

ObjectivesMorbidity is an important risk factor for mortality and a variety of morbidity measures have been developed to predict patients' health outcomes. The objective of this systematic review was to compare the capacity of morbidity measures in predicting mortality among inpatients admitted to internal medicine, geriatric, or all hospital wards.DesignA systematic literature search was conducted from inception to March 6, 2019 using 4 databases: Medline, Embase, Cochrane, and CINAHL. Articles were included if morbidity measures were used to predict mortality (registration CRD42019126674).Setting and ParticipantsInpatients with a mean or median age ≥65 years.MeasurementsMorbidity measures predicting mortality.ResultsOf the 12,800 articles retrieved from the databases, a total of 34 articles were included reporting on inpatients admitted to internal medicine, geriatric, or all hospital wards. The Charlson Comorbidity Index (CCI) was reported most frequently and a higher CCI score was associated with greater mortality risk, primarily at longer follow-up periods. Articles comparing morbidity measures revealed that the Geriatric Index of Comorbidity was better predicting mortality risk than the CCI, Cumulative Illness Rating Scale, Index of Coexistent Disease, and disease count.Conclusions and ImplicationsHigher morbidity measure scores are better in predicting mortality at longer follow-up period. The Geriatric Index of Comorbidity was best in predicting mortality and should be used more often in clinical practice to assist clinical decision making.     

Mortality and cancer morbidity among workers in the rubber tire industry

A retrospective follow-up study was conducted to evaluate mortality and cancer incidence between 1954 and 1976 among 1,792 white male production workers employed for at least 2 years at a tire manufacturing plant. There were no marked excesses in overall or site-specific cancer deaths or incident cases. Compared to U.S. white males, men employed for at least 10 years experienced small increases in deaths from cancers of the large intestine, pancreas, and lung. Results obtained by comparing observed incident cancer cases to the numbers expected based on age- and calendar time-specific incidence rates of Connecticut males also suggested excesses of these three malignancies. These findings were based on small numbers and therefore do not necessarily indicate causal associations between cancer excesses and employment in the rubber tire industry. However, because the workers studied comprised a relatively young population that may not have experienced the full impact of carcinogenic occupational exposures, further follow-up is warranted.     

柞蚕丝生产环境对工人呼吸系统损害的调查

对２２０名柞蚕丝生产加工工人及３３２名不接触尘毒的对照工人进行了呼吸系统症状的询问调查及肺功能检测。并对经常有呼吸系统症状者进行了胸部正位Ｘ线检查,对各加工工序进行了空气真菌学调查。结果表明：柞蚕丝生产加工工人的呼吸系统症状阳性率和肺功能各项指标的异常率与相应的对照组相比显著提高。Ｘ线胸片有炎症状影者５人,经常发热的工人１５人,且均工作于前纺和后纺工序。各工序空气中的真菌个数较对照现场明显增高,波     

Infectious Disease Mortality Rates,Thailand, 1958–2009

To better define infectious diseases of concern in Thailand, trends in the mortality rate during 1958–2009 were analyzed by using data from public health statistics reports. From 1958 to the mid-1990s, the rate of infectious disease–associated deaths declined 5-fold (from 163.4 deaths/100,000 population in 1958 to 29.5/100,000 in 1997). This average annual reduction of 3.2 deaths/100,000 population was largely attributed to declines in deaths related to malaria, tuberculosis, pneumonia, and gastrointestinal infections. However, during 1998–2003, the mortality rate increased (peak of 70.0 deaths/100,000 population in 2003), coinciding with increases in mortality rate from AIDS, tuberculosis, and pneumonia. During 2004–2009, the rate declined to 41.0 deaths/100,000 population, coinciding with a decrease in AIDS-related deaths. The emergence of AIDS and the increase in tuberculosis- and pneumonia-related deaths in the late twentieth century emphasize the need to direct resources and efforts to the control of emerging and re-emerging infectious diseases.