Occupational Carbon Monoxide Poisoning Associated with Diesel Motor Operation in an Air-raid Shelter in June 2015, Jinan City, China-An Epidemiological Investigation.

Occupational carbon monoxide (CO) poisoning related to diesel motor fumes in an air-raid shelter (ARS) was first identified in Jinan City, China, in June 2015. A total of 17 cases were identified, including 14 possible cases of firemen and 3 confirmed cases of water channel clean-up workers. The overall attack rate (AR) of firemen was 42% (14/33). The firemen had a significantly higher AR with a longer exposure and more protracted time of rescue in the ARS (P < 0.05). All the cases stated that they did not realize the potentially high level of exposure to CO in the ARS. CO poisoning posed a risk to both patients and service providers. Occupational safety and health education should be promoted and enforced in all workplaces where CO sources exist.

Increase in Medical Emergency Calls and Calls for Central Nervous System Symptoms During a Severe Air Pollution Event, January 2013, Jinan City, China.

BACKGROUND: In January 2013, a continuous and severe haze event affected one third of the major cities in China, including Jinan. OBJECTIVES: We investigated whether medical emergency calls (for nonaccidental emergencies) and calls for Central Nervous System (CNS) syndromes increased during this episode compared with the previous winter months (January, February, and December) in 2011 and 2012. METHODS: Daily emergency calls were obtained from Jinan Medical Emergency Center. Sentinel CNS syndromes from nonaccidental emergency calls included seven symptoms: headache, dizziness, syncope, coma, convulsions, paralysis, and epilepsy. Particles with aerodynamic diameter <10 µm (PM10) were used as the indicator of air pollution. A generalized linear model based on quasi-Poisson regression was used to evaluate the effects on nonaccidental emergency calls and calls for CNS syndromes and each symptom, separately, during this episode. RESULTS: Markedly higher mean daily concentration, 332 µg/m of PM10, during this episode versus reference months was found. Obviously increased effects on nonaccidental emergency calls and calls for CNS syndromes were observed during this episode, with relative risk (RR) value 1.3 (95% CI = 1.2, 1.3) and 1.2 (95% CI = 1.1, 1.3). Four of seven CNS symptoms were also increased during this episode: RRs values for dizziness, convulsions, paralysis, and epilepsy were 1.4 (95% CI = 1.2, 1.7), 1.4 (95% CI = 1.1, 1.6), 1.6 (95% CI = 1.2, 2.1), and 1.5 (95% CI = 1.1, 2.0), respectively. CONCLUSIONS: A noticeable increase in medical emergency calls and calls for Central Nervous System syndromes were observed during a severe air pollution episode on January 2013, in a large Chinese city.

Air Pollution in Major Chinese Cities: Some Progress, But Much More to Do.

BACKGROUND: Ambient (outdoor) air pollution has been implicated as a major cause of acute cardiovascular and pulmonary illnesses and increased risk for acute and chronic effects after chronic exposures, including mortality and morbidity. In 2008, due to persistent health concerns about its workforce and their dependents, the US Mission in China began monitoring air quality at the US Embassy in Beijing. Subsequently, monitoring stations were also established at US consulates at Shanghai (2011), Guangzhou (2011), Chengdu (2012), and Shenyang (2013). OBJECTIVES: To determine whether there have been definable trends in air quality in these five Chinese cities. METHODS: Air monitoring results from each locale for accumulated PM2.5 particulate matter were calculated hourly. Accumulated data were organized, culled using a standardized set of heuristics, and analyzed for trends. RESULTS: China's capital city, Beijing, experienced decreased PM2.5 from 2013 through 2015, but no significant long-term downward trend from 2008 through 2015. Shanghai has not shown any definable air quality trend since 2012. Chengdu experienced some improvement in air quality since 2013, but none discernible from 2012 through 2015. Guangzhou had generally better air quality, and a downward trend since 2012. Shenyang experienced increasingly severe air pollution from 2013 through 2015. CONCLUSION: There appear to have been recent tangible, though modest, improvements in air quality in three large Chinese cities: Beijing, Chengdu, and Guangzhou, but no apparent progress in Shanghai, and a worrisome decline in air quality observed in Shenyang. Despite recent progress, there is a long way to go before even the cities which show improvement reach Chinese standards.

A family cluster of nitrite poisoning, Suzhou City, Jiangsu Province, China, 2013.

BACKGROUND: In April 2013, a hospital in Suzhou City notified authorities of a patient with nitrite poisoning with two other family members who had similar toxic symptoms five days prior. We investigated the event to identify the cause, source and possible route of contamination. METHODS: A case was defined as any person living in the Yang Shan Hua Yuan community who had been diagnosed with cyanoderma and food poisoning symptoms from 15 to 25 April 2013. Active case finding was conducted by interviewing community residents and reviewing medical records from local clinics; information was then retrospectively collected on the patient's food history, cooking procedures and food sources. RESULTS: We identified three nitrite poisoning cases, one male and two females, from the same family. The time between dinner and onset of illness was less than an a hour. A retrospective survey showed that a substance presumed to be sugar mixed with asparagus on 17 April and with stir-fried asparagus on 21 April was the suspected contaminant. The presumed sugar came from a clean-up of a neighbouring rental house. Nitrite was detected in a vomitus sample, the sugar substance and two leftover food samples. CONCLUSION: This family cluster of nitrite poisoning resulted from the mistaken use of nitrite as sugar to cook dishes. We recommend that sodium nitrite be dyed a bright colour to prevent such a mistake and that health departments strengthen food hygiene education to alert people about the danger of eating unidentified food from an unknown source.

Renewable energy and occupational health and safety research directions: a white paper from the Energy Summit, Denver Colorado, April 11-13, 2011.

Renewable energy production may offer advantages to human health by way of less pollution and fewer climate-change associated ill-health effects. Limited data suggests that renewable energy will also offer benefits to workers in the form of reduced occupational injury, illness and deaths. However, studies of worker safety and health in the industry are limited. The Mountain and Plains Education and Research Center (MAP ERC) Energy Summit held in April 2011 explored issues concerning worker health and safety in the renewable energy industry. The limited information on hazards of working in the renewable energy industry emphasizes the need for further research. Two basic approaches to guiding both prevention and future research should include: (1) applying lessons learned from other fields of occupational safety and health, particularly the extractive energy industry; and (2) utilizing knowledge of occupational hazards of specific materials and processes used in the renewable energy industry.

Occupational fatalities in Alaska: two decades of progress, 1990-1999 and 2000-2009.

INTRODUCTION: Alaska had the highest work-related fatality rate of any state during 1980-1989. The National Institute for Occupational Safety and Health established the Alaska Field Station (AFS) to address this problem. METHODS: AFS established surveillance systems to provide scientific assessments of occupational hazards. Interventions were developed in collaboration with partners and evaluated. RESULTS: During 2000-2009, Alaska experienced a 42.5% decline in work-related fatalities over the previous decade of 1990-1999. In 2009, the workplace fatality rate for Alaska was 5.6/100,000 workers. Commercial pilot deaths were reduced by 50% and Bering Sea crab fishing death rates were reduced by 60%. Building on this success, AFS established national programs to improve safety in the commercial fishing and oil and gas extraction industries. IMPACT ON INDUSTRY: A focused, epidemiological approach to reducing fatalities in high-risk occupations is effective. Ongoing commitment to this type of approach will assist in continued success in Alaska and elsewhere.

A Family Clustered Nitrite Intoxication Investigation in Gaoxin District, Suzhou, China, 2013.

BACKGROUND: In April, 2013, a Suzhou Hospital reported a nitrite intoxication patient in coma as well as 2 family members with the similar symptom 5 days ahead. We investigated the event to identify the cause, source and possible pollution ways of the contamination. METHODS: We defined case as any person living in YSHY community who has cyanosis and with at least one of the following symptoms: dizziness, headache, fatigue, tachycardia, drowsiness, nausea, vomiting, abdominal pain or diar-rhea during April 15 to April 25, 2013. We searched for case by interviewing community residents and reviewing clinics' medical records; information was then retrospectively collected on the patient's food history, cooking procedures and food sources. RESULTS: We identified 3 nitrite intoxication cases, 1 male and 2 female from a family. The interval time between dinner and onset was < 1 hour. Retrospective survey showed 'sugar stir and mix asparagus' on April 17 and 'scrambled asparagus' on April 21 were suspected foods. Both suspected dishes had 'sugar' added, sourced from a clean-up of a neighboring rental house. Nitrite was detected in a vomitus sample, the 'sugar' and two leftover food samples. CONCLUSION: This family clustered nitrite intoxication was induced by using unidentified nitrite as sugar to cook dishes. We recommend sodium nitrite should be dyed with bright colors to avoid mistaking it for plain salt or sugar, health departments strengthen food hygiene propaganda to improve people's recognition of food safety, and to alert them the dangerous of eating unidentified or unknown source food.

A family cluster of nitrite poisoning, Suzhou City, Jiangsu Province, China, 2013

Background：In April 2013, a hospital in Suzhou City notified authorities of a patient with nitrite poisoning with two other family members who had similar toxic symptoms five days prior. We investigated the event to identify the cause, source and possible route of contamination.Methods：A case was defined as any person living in the Yang Shan Hua Yuan community who had been diagnosed with cyanoderma and food poisoning symptoms from 15 to 25 April 2013. Active case finding was conducted by interviewing community residents and reviewing medical records from local clinics; information was then retrospectively collected on the patient’s food history, cooking procedures and food sources.Results：We identified three nitrite poisoning cases, one male and two females, from the same family. The time between dinner and onset of illness was less than an a hour. A retrospective survey showed that a substance presumed to be sugar mixed with asparagus on 17 April and with stir-fried asparagus on 21 April was the suspected contaminant. The presumed sugar came from a clean-up of a neighbouring rental house. Nitrite was detected in a vomitus sample, the sugar substance and two leftover food samples.Conclusion：This family cluster of nitrite poisoning resulted from the mistaken use of nitrite as sugar to cook dishes. We recommend that sodium nitrite be dyed a bright colour to prevent such a mistake and that health departments strengthen food hygiene education to alert people about the danger of eating unidentified food from an unknown source.

A multifaceted public health approach to statewide aviation safety.

BACKGROUND: During the 1990s, Alaskan pilots had one of the most hazardous occupations in the US. In 2000, a multifaceted public health initiative was launched, focusing on Alaskan air taxi/commuter (AT) operations, including risk factor identification, improved weather information, and the formation of an industry-led safety organization. METHODS: Effectiveness was assessed by comparing rates of crashes using Poisson regression, comparing trends in annual numbers of crashes, and assessing changes in the number and type of controlled flight into terrain (CFIT) events. RESULTS: The greatest improvements were seen in Alaska fatal AT crashes with a 57% decrease in rates between time periods. While the number of AT crashes in the rest of the US steadily declined during 1990-2009, Alaska only showed significant declines after 2000. CFIT crashes declined but remained more deadly than other crashes. CONCLUSIONS: This coordinated effort was successful in reducing crashes in the Alaskan AT industry.

Does the small farm exemption cost lives?

BACKGROUND: Congress has exempted farms with fewer than 11 employees from enforcement of the Occupational Safety and Health Act. Three states (California, Oregon, and Washington) do not observe the exemption. METHODS: We compared rates of fatal occupational injury in agriculture, by year, in 1993-2007, in California, Oregon, and Washington (aggregated), and the remaining states (as two aggregated groups): those with, and those without, state-designed occupational safety and health programs. RESULTS: Fatality rates were approximately 1.6 to 3 times as high in both groups of states observing the small farm exemption as in the group of three states not observing it. Comparisons excluding the agriculture industry showed weaker differences. CONCLUSIONS: The three states' opting out of the small farm exemption may have had substantial direct effects. They may also reflect and/or encourage a generally more effective approach to occupational health and safety. Although alternative explanations must be considered, the stakes are high in terms of injury and loss of life; further investigation seems urgently indicated.

Dealing with pre-ROPS tractors: is a trade-in program the solution?

Tractor overturns are the leading cause of work-related death in an industry with the highest occupational fatality rate. Rollover protective structures (ROPS) and seatbelts are 99% effective in reducing the risk of an overturn fatality. However, kits are not available for 20% of tractors currently lacking ROPS. For these tractor owners, two potential solutions have been discussed: (1) technology for reinforcing tractor axles to accommodate ROPS and (2) a pre-ROPS tractor removal program. The purpose of this study was to conduct preliminary research to assess the feasibility of a tractor trade-in program. Focus groups were conducted with pre-ROPS tractor owners and tractor dealers. The data were analyzed using a concept development analytical approach and results were reviewed in an industry stakeholder's workgroup session. Data from the research indicates that tractor owners and dealers would need persuasive financial incentives to participate in a trade-in program. The workgroup session also indicated that it would be difficult to fund or support a large-scale initiative, and the economics of removing a large group of older tractors from the marketplace may exacerbate financial roadblocks. However, the data from this study could be used to pilot test a small-scale, focused, tractor buy-back program.

A view from above: use of satellite imagery to enhance our understanding of potential impacts of climate change on human health in the Arctic.

OBJECTIVE: Provide an overview and examples of some of the remote sensing technologies presently or potentially available, which could be used to address environmental health problems in the Arctic. STUDY DESIGN: The vulnerability of Arctic populations to health impacts from environmental, weather, and climate-related factors underscores the need for increased applications of technologies such as remote sensing, Geographic Information Systems (GIS), and global positioning systems (GPS) for empowering local health officials and decision-makers to better predict environment-related health problems, decrease vulnerabilities, take preventative measures, and improve community response actions as well as increase community health literacy. METHODS/RESULTS: These increased capabilities for monitoring, risk mapping, information sharing, communications, and surveillance of environmental parameters are powerful tools for addressing such environmentally-related health problems as thermal stress; extreme weather; contaminant transport and deposition into oceans, atmosphere, and ice; air and water quality; built environment impacts; ultraviolet radiation (UV); and infectious and vector-borne diseases. For example, systems are now in place, which can observe ocean parameters, providing information on algal blooms, pollutants and pathogens as well as storm assessments and sea level rise. CONCLUSION: Space-based systems in place can contribute valuable information through monitoring the processes of long-range transport of pollutants to the Arctic, where accumulation in animals and plants can occur. It is well-known that biomagnification up the food chain and ultimate consumption as traditional foods by indigenous peoples have resulted in some of the highest exposures in the world to certain contaminants.

A view from above: use of satellite imagery to enhance our understanding of potential impacts of climate change on human health in the Arctic.

OBJECTIVE: Provide an overview and examples of some of the remote sensing technologies presently or potentially available, which could be used to address environmental health problems in the Arctic. STUDY DESIGN: The vulnerability of Arctic populations to health impacts from environmental, weather, and climate-related factors underscores the need for increased applications of technologies such as remote sensing, Geographic Information Systems (GIS), and global positioning systems (GPS) for empowering local health officials and decision-makers to better predict environment-related health problems, decrease vulnerabilities, take preventative measures, and improve community response actions as well as increase community health literacy. METHODS/RESULTS: These increased capabilities for monitoring, risk mapping, information sharing, communications, and surveillance of environmental parameters are powerful tools for addressing such environmentally-related health problems as thermal stress; extreme weather; contaminant transport and deposition into oceans, atmosphere, and ice; air and water quality; built environment impacts; ultraviolet radiation (UV); and infectious and vector-borne diseases. For example, systems are now in place, which can observe ocean parameters, providing information on algal blooms, pollutants and pathogens as well as storm assessments and sea level rise. CONCLUSION: Space-based systems in place can contribute valuable information through monitoring the processes of long-range transport of pollutants to the Arctic, where accumulation in animals and plants can occur. It is well-known that biomagnification up the food chain and ultimate consumption as traditional foods by indigenous peoples have resulted in some of the highest exposures in the world to certain contaminants.

Unique occupational hazards of Alaska: animal-related injuries.

OBJECTIVE: During 1992-2000, an average of 40 fatal occupational injuries and 12,400 nonfatal occupational injuries and illnesses related to animals were recorded each year in the United States, most involving domestic farm animals. Although Alaska has a relatively small farming industry, it supports several industries that require workers to regularly be in contact with animals. This study examines the pattern and characteristics of animal-related occupational injuries in Alaska. METHODS: Two data sources were accessed: the Alaska Trauma Registry for nonfatal injuries requiring hospitalization and the Alaska Occupational Injury Surveillance System for fatal injuries. The case definition included events in which the source of the injury was an animal or animal product (Occupational Injury and Illness Classification Manual source code 51). RESULTS: In Alaska during 1991-2000, there were 43 animal-related occupational injuries requiring hospitalization and 25 animal-related fatalities. There were only 2 fatal events: 1 bird-strike aircraft accident killing 24 military personnel and 1 bear attack. The majority of the nonfatal injury events were related to marine wildlife (n = 20), with the rest related to either domesticated (n = 11) or nondomesticated (n = 12) mammals. Of events reporting a hospital charge (23 of 43), the average cost was over dollar 9700 per person. CONCLUSIONS: The catastrophic aircraft crash increased bird-control efforts near airports around the state. The nonfatal animal-related injuries have received less notice, although they result in thousands of dollars in hospital costs and lost workdays. Fishing-industry workers in particular should be made aware of potential injuries and educated on how to treat them when away from definitive medical care.

Hospitalized nonfatal injuries in the Alaskan construction industry.

BACKGROUND: Construction industry workers are exposed to many hazards leading to fatal and nonfatal injuries. Information for nonfatal work-related injury surveillance may be vague and come from a variety of sources. METHODS: The Alaska Trauma Registry (ATR) is used as an injury surveillance tool to focus on hospitalized nonfatal injuries in the Alaskan construction industry. RESULTS: During 1991-1999, 717 workers in the Alaskan construction industry were hospitalized due to occupational injuries, with an average annual injury rate of 0.39 injuries/100 workers. Leading causes of injury included falls (48%) and machinery (15%). Thirty-four percent of the falls were from a building or structure, followed by falls from a ladder (24%). A fractured bone was the most common type of injury (57%). CONCLUSIONS: Information on hospitalized patients from the ATR focuses on the more severe and debilitating injuries, and provides valuable information for prioritizing injury prevention efforts in Alaska.

Flight safety in Alaska: comparing attitudes and practices of high- and low-risk air carriers.

INTRODUCTION: Aircraft operations are a vital component of the transportation system in Alaska. Between 1990-2002, a total of 481 people died in Alaska in aviation accidents. The purpose of this study was to examine the practices and attitudes of Alaska commuter and air taxi operators and their pilots as they relate to company fatal accident rates. METHODS: A case-control analysis based on accident statistics was performed, grouping operators and their pilots into cases and controls, based on operator fatal accident rates, during January 1990 to June 2001. Responses from two aviation safety surveys-one of air carrier operators and one of active commercial pilots-were compared between cases and controls. RESULTS: The average case pilot had less career flight experience than control pilots and worked 13 h x d(-1) and 81 h x wk(-10; that is, 1 h x d(-1) and 10 h wk-1 more than controls. Case operators were less likely to consider pilot fatigue a problem when scheduling flights (p = 0.05) and more likely to depend financially on timely delivery of bypass mail (p = 0.04). Case pilots were three times as likely as controls to fly daily into unknown weather conditions. Nearly 90% of case pilots reported that they never flew when so fatigued that they wanted to decline the flight, compared with 64% of control pilots (p = 0.01). CONCLUSIONS: Pilots of high-risk operators differed from those working for the other operators, both in experience and working conditions. The combination of pilot inexperience and longer work hours and workweeks may contribute to Alaska's high aviation crash rate.

Alaska air carrier operator and pilot safety practices and attitudes: a statewide survey.

INTRODUCTION: Aviation crashes are a leading cause of occupational fatalities in Alaska, with Alaskan pilots having nearly 100 times the fatality rate of U.S. workers overall. A survey was designed to study pilot and company practices and attitudes in order to develop intervention strategies that would reduce aviation fatalities. METHODS: Two surveys were administered: one of air carrier operators and one of active commercial pilots. Surveys from 153 air taxi and public-use operators were received at a 79% response rate. RESULTS: There are almost 2000 pilots employed in Alaska during peak season by air taxi operators and public agencies. Surveyed operators and pilots generally agreed that improved weather information and regional hazards training would be effective ways to prevent crashes. Operators were more in favor of operator financial incentives (p < 0.05) and better pre-employment hiring checks on pilots (p < 0.05) compared with pilots' survey responses. There were 48% of pilots of large operators and 73% of pilots of small operators who considered their jobs to be at least as safe as other jobs. CONCLUSIONS: The results of operator-pilot comparisons suggest that financial pressures on operators may influence their views on what measures would be effective in preventing crashes, and that Alaskan pilots underestimate their occupational fatality risk.