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1.
Am J Ind Med ; 66(10): 831-841, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37482966

RESUMO

BACKGROUND: Pneumoconiosis is a group of occupational lung diseases caused by dust and fiber exposure. This study analyzes Medicare claims to estimate the burden of pneumoconiosis among fee-for-service (FFS; Medicare Parts A and B) Medicare beneficiaries during 1999-2019 in the United States. METHODS: Claim and enrollment information from 81 million continuously enrolled FFS Medicare beneficiaries were analyzed. Beneficiaries with any pneumoconiosis and cause-specific pneumoconiosis (e.g., asbestosis, silicosis) were identified using three case definitions (broad, intermediate, and narrow) with varying diagnostic criteria based on claim International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis codes and Healthcare Common Procedure Coding System codes. Results are presented as ranges of values for the three case definitions. RESULTS: The 21-year prevalence range for any pneumoconiosis was 345,383-677,361 (412-833 per 100,000 beneficiaries) using the three case definitions. The highest prevalence was among those ≥75 years of age, males, Whites, and North American Natives. Most claims (70.0%-72.5%) included an ICD-CM diagnosis code for asbestosis. The broad pneumoconiosis prevalence rate increased significantly (p < 0.001) during 2002-2009 by 3%-10% annually and declined significantly by 3%-5% annually starting in 2009. The average annual broad incidence rate declined significantly by 7% annually during 2009-2019. CONCLUSIONS: Despite the decline in rate for any pneumoconiosis among Medicare beneficiaries, which is primarily attributed to a decline in asbestosis, pneumoconiosis is prevalent among FFS Medicare beneficiaries.


Assuntos
Asbestose , Pneumoconiose , Masculino , Humanos , Idoso , Estados Unidos/epidemiologia , Incidência , Medicare , Prevalência , Pneumoconiose/epidemiologia
4.
Health Secur ; 19(6): 582-591, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34757851

RESUMO

An international system should be established to support personal protective equipment (PPE) inventory monitoring, particularly within the healthcare industry. In this article, the authors discuss the development and 15-week deployment of a proof-of-concept prototype that included the use of a Healthcare Trust Data Platform to secure and transmit PPE-related data. Seventy-eight hospitals participated, including 66 large hospital systems, 11 medium-sized hospital systems, and a single hospital. Hospitals reported near-daily inventory information for N95 respirators, surgical masks, and face shields, ultimately providing 159 different PPE model numbers. Researchers cross-checked the data to ensure the PPE could be accurately identified. In cases where the model number was inaccurately reported, researchers corrected the numbers whenever possible. Of the PPE model numbers reported, 74.2% were verified-60.5% of N95 respirators, 40.0% of face shields, and 84.0% of surgical masks. The authors discuss the need to standardize how PPE is reported, possible aspects of a PPE data standard, and standards groups who may assist with this effort. Having such PPE data standards would enable better communication across hospital systems and assist in emergency preparedness efforts during pandemics or natural disasters.


Assuntos
COVID-19 , Equipamento de Proteção Individual , Hospitais , Humanos , Máscaras , Pandemias
5.
MMWR Morb Mortal Wkly Rep ; 68(19): 439-443, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31099768

RESUMO

The 2005 CDC guidelines for preventing Mycobacterium tuberculosis transmission in health care settings include recommendations for baseline tuberculosis (TB) screening of all U.S. health care personnel and annual testing for health care personnel working in medium-risk settings or settings with potential for ongoing transmission (1). Using evidence from a systematic review conducted by a National Tuberculosis Controllers Association (NTCA)-CDC work group, and following methods adapted from the Guide to Community Preventive Services (2,3), the 2005 CDC recommendations for testing U.S. health care personnel have been updated and now include 1) TB screening with an individual risk assessment and symptom evaluation at baseline (preplacement); 2) TB testing with an interferon-gamma release assay (IGRA) or a tuberculin skin test (TST) for persons without documented prior TB disease or latent TB infection (LTBI); 3) no routine serial TB testing at any interval after baseline in the absence of a known exposure or ongoing transmission; 4) encouragement of treatment for all health care personnel with untreated LTBI, unless treatment is contraindicated; 5) annual symptom screening for health care personnel with untreated LTBI; and 6) annual TB education of all health care personnel.


Assuntos
Pessoal de Saúde , Programas de Rastreamento , Mycobacterium tuberculosis , Tuberculose/prevenção & controle , Centers for Disease Control and Prevention, U.S. , Humanos , Testes de Liberação de Interferon-gama , Tuberculose Latente/epidemiologia , Tuberculose Latente/prevenção & controle , Medição de Risco , Revisões Sistemáticas como Assunto , Teste Tuberculínico , Tuberculose/epidemiologia , Tuberculose/transmissão , Estados Unidos/epidemiologia
6.
Am J Ind Med ; 62(3): 183-191, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30658007

RESUMO

INTRODUCTION: Existing epidemiologic information on silicosis relies on mortality data. METHODS: We analyzed health insurance claims and enrollment information from 49 923 987 fee-for-service (FFS) Medicare beneficiaries aged ≥65 from 1999 to 2014. Three different definitions were developed to identify silicosis cases and results are presented as ranges of values for the three definitions. RESULTS: Among FFS beneficiaries, 10 026-19 696 fit the silicosis case definitions (16-year prevalence: 20.1-39.5 per 100 000) with the highest prevalence among North American Natives (87.2-213.6 per 100 000) and those in New Mexico (83.9-203.4 per 100 000). The annual average prevalence had a significant (P < 0.05) 2-5% annual decline from 2005 to 2014. The average annual number of incident cases had a significant 3-16% annual decline from 2007 to 2014. CONCLUSIONS: Silicosis is a prevalent disease among Medicare beneficiaries aged ≥65, with variation across the country. Morbidity data from health insurance claims can provide a more complete picture of silicosis burden.


Assuntos
Medicare/estatística & dados numéricos , Silicose/epidemiologia , Demandas Administrativas em Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Prevalência , Silicose/etnologia , Estados Unidos/epidemiologia
7.
Am J Infect Control ; 45(10): 1133-1138, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28549881

RESUMO

BACKGROUND: Hospital staff expressed health concerns after a surface disinfectant product containing hydrogen peroxide, peracetic acid, and acetic acid was introduced. We sought to determine if this product posed a health hazard. METHODS: An interviewer-administered questionnaire on work and health characteristics was completed by 163 current staff. Symptoms that improved away from work were considered work-related. Forty-nine air samples were taken for hydrogen peroxide, peracetic acid, and acetic acid. Prevalence ratios (PRs) were calculated using Poisson regression, and standardized morbidity ratios (SMRs) were calculated using nationally representative data. RESULTS: Product users reported higher prevalence of work-related wheeze and watery eyes than nonusers (P < .05). Workers in the department with the highest air measurements had significantly higher prevalence of watery eyes (PR, 2.88; 95% confidence interval [CI], 1.18-7.05) than those in departments with lower air measurements, and they also had a >3-fold excess of current asthma (SMR, 3.47; 95% CI, 1.48-8.13) compared with the U.S. CONCLUSIONS: This disinfectant product was associated with mucous membrane and respiratory health effects. Risks of mucous membrane irritation and asthma in health care workers should be considered in development of disinfection protocols to protect patients from hospital-acquired infections. Identification of optimal protocols that reduce worker exposures while maintaining patient safety is needed.


Assuntos
Ácido Acético/efeitos adversos , Ar/análise , Desinfetantes/efeitos adversos , Pessoal de Saúde , Peróxido de Hidrogênio/efeitos adversos , Doenças Profissionais/epidemiologia , Ácido Peracético/efeitos adversos , Ácido Acético/análise , Adolescente , Adulto , Asma/induzido quimicamente , Asma/epidemiologia , Desinfetantes/análise , Oftalmopatias/induzido quimicamente , Oftalmopatias/epidemiologia , Feminino , Hospitais , Humanos , Peróxido de Hidrogênio/análise , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/induzido quimicamente , Ácido Peracético/análise , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
8.
J Agromedicine ; 22(2): 78-88, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28095135

RESUMO

OBJECTIVE: The purpose of this study was to estimate the national prevalence of respirator use among farm operators with farm work-related asthma and factors associated with respirator use. METHODS: The authors examined the 2011 Farm and Ranch Safety Survey, a national survey collected from 11,210 actively farming farm operators in the United States. Adjusted prevalence ratios (aPORs) of respirator use were calculated by demographic characteristics, farm characteristics, asthma characteristics, and selected exposures and hazards. RESULTS: Among the estimated 2.2 million farm operators in 2011, 35.7% reported using a respirator in the past 12 months. Respirator use was significantly (P < .05) associated with age, marital status, sex, smoking status, farm value of sales, farm type, farm acreage, and geographic region. Operators who work with pesticides were 3.5 times more likely to use respirator than those who did not work with pesticides (P < .0001). Among those with current asthma, 60.8% of operators with farm work-related asthma used respirators compared with 44.4% of operators with non-farm work-related asthma (P = .03). Farm operators with farm work-related asthma who had an asthma attack at work were 11.3 times more likely to report respirator use than those who did not have an asthma attack at work (P = .03). CONCLUSIONS: Personal protective equipment, including respirators, is an approach to reducing respiratory exposures in agricultural settings, in particular among those with farm work-related asthma. Education for respirator use and evaluation for respirator tolerance should be considered.


Assuntos
Doenças dos Trabalhadores Agrícolas/prevenção & controle , Asma/prevenção & controle , Fazendas , Máscaras , Exposição Ocupacional/prevenção & controle , Adulto , Doenças dos Trabalhadores Agrícolas/epidemiologia , Asma/epidemiologia , Fazendeiros/estatística & dados numéricos , Fazendas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Praguicidas/toxicidade , Segurança , Estados Unidos/epidemiologia , Recursos Humanos
9.
MMWR Morb Mortal Wkly Rep ; 65(15): 400-1, 2016 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-27100053

RESUMO

In March 2014, a new disinfection product, consisting of hydrogen peroxide, peroxyacetic acid, and acetic acid, was introduced at a Pennsylvania hospital to aid in the control of health care-associated infections. The product is an Environmental Protection Agency-registered non-bleach sporicide advertised as a one-step cleaner, disinfectant, and deodorizer. According to the manufacturer's safety data sheet, the product requires no personal protective equipment when it is diluted with water by an automated dispenser before use. On January 30, 2015, CDC's National Institute for Occupational Health (NIOSH) received a confidential employee request to conduct a health hazard evaluation at the hospital. The request cited concerns about exposure of hospital environmental services staff members to the product and reported symptoms among persons who had used the product that included eye and nasal problems, asthma-like symptoms, shortness of breath, skin problems, wheeze, chest tightness, and cough.


Assuntos
Desinfetantes/efeitos adversos , Doenças Profissionais/induzido quimicamente , Recursos Humanos em Hospital , Doenças Respiratórias/induzido quimicamente , Dermatopatias/induzido quimicamente , Asma/induzido quimicamente , Humanos , Doenças Profissionais/epidemiologia , Pennsylvania/epidemiologia , Prevalência , Doenças Respiratórias/epidemiologia , Dermatopatias/epidemiologia
10.
Prehosp Disaster Med ; 30(6): 625-7, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26507495

RESUMO

INTRODUCTION: Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control. PROBLEM: An ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance. METHODS: A convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed. RESULTS: Many vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a sealant. CONCLUSION: Waterproof separation between the patient compartment and driver cabin may be essential for patient transport vehicles in infectious disease outbreaks, especially when chlorine sprayers are used for decontamination or in resource-limited settings where cleaning supplies may be limited.


Assuntos
Ambulâncias , Líquidos Corporais/virologia , Controle de Doenças Transmissíveis/métodos , Descontaminação/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Ebolavirus , Doença pelo Vírus Ebola/transmissão , Exposição Ocupacional/prevenção & controle , Adulto , Pessoal de Saúde , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Masculino , Serra Leoa
11.
Clin Infect Dis ; 60(11): 1596-602, 2015 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-25722201

RESUMO

BACKGROUND: Healthcare-associated Legionnaires' disease (LD) is a preventable pneumonia with a 30% case fatality rate. The Centers for Disease Control and Prevention guidelines recommend a high index of suspicion for the diagnosis of healthcare-associated LD. We characterized an outbreak and evaluated contributing factors in a hospital using copper-silver ionization for prevention of Legionella growth in water. METHODS: Through medical records review at a large, urban tertiary care hospital in November 2012, we identified patients diagnosed with LD during 2011-2012. Laboratory-confirmed cases were categorized as definite, probable, and not healthcare associated based on time spent in the hospital during the incubation period. We performed an environmental assessment of the hospital, including collection of samples for Legionella culture. Clinical and environmental isolates were compared by genotyping. Copper and silver ion concentrations were measured in 11 water samples. RESULTS: We identified 5 definite and 17 probable healthcare-associated LD cases; 6 case patients died. Of 25 locations (mostly potable water) where environmental samples were obtained for Legionella-specific culture, all but 2 showed Legionella growth; 11 isolates were identical to 3 clinical isolates by sequence-based typing. Mean copper and silver concentrations were at or above the manufacturer's recommended target for Legionella control. Despite this, all samples where copper and silver concentrations were tested showed Legionella growth. CONCLUSIONS: This outbreak was linked to the hospital's potable water system and highlights the importance of maintaining a high index of suspicion for healthcare-associated LD, even in the setting of a long-term disinfection program.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Desinfecção/métodos , Monitoramento Epidemiológico , Doença dos Legionários/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/diagnóstico , Humanos , Controle de Infecções/métodos , Doença dos Legionários/diagnóstico , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Centros de Atenção Terciária
12.
W V Med J ; 110(4): 36-40, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25322586

RESUMO

West Virginia faces health disparities and limited prenatal health resources, especially in at-risk areas. In an effort to augment prenatal smoking cessation resources in at-risk areas of the state, the "Health Education for Prenatal Providers in Appalachia" (HEPPA) based on the ACOG 5As intervention was developed and delivered to healthcare and social service providers in four contiguous counties with limited prenatal care resources to support a consistent message by interprofessional providers. The program evaluation indicated effectiveness in increasing the incorporation of prenatal smoking cessation into providers' interactions with pregnant clients. There is a need for continued and expanded efforts to facilitate access to health resources among various providers working in rural areas of the state.


Assuntos
Educação em Saúde/organização & administração , Pessoal de Saúde , Cuidado Pré-Natal/organização & administração , Abandono do Hábito de Fumar/métodos , Fumar/epidemiologia , Adulto , Região dos Apalaches , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Papel Profissional , Fatores de Risco , Fumar/efeitos adversos , West Virginia
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