How do we conduct a national transfusion related lookback program?

BACKGROUND: Lookback investigations are conducted by blood services when a risk of transmission of infection from a donor to a recipient has been identified. They involve tracing transfusion recipients and offering them testing for the relevant infectious agent. Results are relayed to the recipient to provide reassurance that there has been no transmission or to ensure appropriate treatment and care if required, and blood services are able to learn lessons from the planning, delivery, and outcomes of the investigation. A national lookback exercise was conducted in Scotland following the introduction of a test to identify occult hepatitis B infection, as recommended by the UK Advisory Committee for the Safety of Blood, Tissues and Organs (SaBTO) in 2021. METHODS AND MATERIALS: This paper outlines the development and delivery of a national lookback program. It discusses the logistical, economic, ethical, regulatory, and scientific issues that were considered during the planning and delivery of the lookback exercise. RESULTS: Development and delivery of a national lookback required robust governance, engagement of all relevant stakeholders and a shared understanding of aims, effective communication, systems, resources, limitations, and project management. Outcomes included a high testing uptake, low levels of reported anxiety, and a comprehensive data set. CONCLUSION: Key aspects for delivery of a successful large-scale lookback program include a patient-centered approach, clear and accessible communication, and whole-systems multiagency collaboration. Major challenges include stakeholder engagement and capacity.

Prevalence of Hearing Loss among Noise-Exposed U.S. Workers within the Utilities Sector, 2010-2019.

OBJECTIVE: This study's objective was to estimate hearing loss prevalence for noise-exposed U.S. Utilities workers. METHODS: In this cross-sectional study of a retrospective cohort, audiograms were examined for 1.3 million workers (13,595 within Utilities) from 2010-2019. Hearing loss prevalence, and adjusted risk as compared with a reference industry, were estimated. RESULTS: The hearing loss prevalence for noise-exposed Utilities workers (25%) was higher than for noise-exposed workers in all industries combined (20%). Some sub-sectors surpassed the prevalence for all industries combined and/or had adjusted risks significantly higher than the reference industry. The highest prevalence sub-sectors were Hydroelectric Power Generation (37%) and Steam and Air-Conditioning Supply (29%). CONCLUSIONS: While often overlooked, noise-exposed workers in this sector have among the highest prevalences of hearing loss, and significantly higher risks. Increased attention and better hearing conservation strategies are needed.

Workers' Compensation Costs for Occupational Hearing Loss Claims in the United States, 2009-2013.

This study estimated the average annual number of U.S. workers' compensation (WC) claims for occupational hearing loss (OHL) and their associated cost and identified the industry/occupation classifications with the highest numbers of OHL claims. The most recent U.S. cost estimate ($242 million) was based on data from one state in 1 year (1991). WC data from the National Council on Compensation Insurance, Inc. (35 states) and two additional individual states were examined, incorporating data from 37 states and the District of Columbia. Costs and numbers of claims were estimated for the 13 missing states to develop estimates for the United States. Sensitivity analyses were also performed to develop ranges for the point estimates. The estimated U.S. average annual OHL claim cost fell within the range of $49 to $67 million during 2009-2013, with a point estimate of $60 million (2013 dollars). The estimated average annual number of OHL claims ranged from 4,114 to 5,986, with a point estimate of 4,965 claims. Based on data available from 36 states and DC, 18 of the 40 industry/occupation classifications with ≥50 OHL claims were in the manufacturing sector. WC data underestimate the true burden of OHL. Most OHL cases are not compensated. WC laws, industry composition and other factors vary widely by state, so estimates must employ data for many states. This study incorporated data from most states and utilized sensitivity and comparative analyses to obtain estimates. Workers in a wide range of industry/occupation classifications need special attention to prevent OHL.

Preventing Occupational Hearing Loss: 50 Years of Research and Recommendations from the National Institute for Occupational Safety and Health.

For more than 50 years, the National Institute for Occupational Safety and Health (NIOSH), part of the United States (U.S.) Centers for Disease Control and Prevention (CDC), has been actively working to reduce the effects of noise and ototoxic chemicals on worker hearing. NIOSH has pioneered basic and applied research on occupational hearing risks and preventive measures. The Institute has issued recommendations and promoted effective interventions through mechanisms ranging from formal criteria documents to blogs and social media. NIOSH has conducted surveillance and published statistics to guide policy and target prevention efforts. Over the past five decades, substantial progress has been made in raising awareness of noise as a hazard, reducing the risk of occupational hearing loss, improving the use of hearing protection, and advancing measurement and control technologies. Nevertheless, noise remains a prevalent workplace hazard and occupational hearing loss is still one of the most common work-related conditions. NIOSH continues to work toward preventing the effects of noise and ototoxicants at work and has many resources to assist audiologists in their hearing loss prevention efforts.

Prevalence of hearing protection device non-use among noise-exposed US workers in 2007 and 2014.

BACKGROUND: This study estimated the prevalence of hearing protection device (HPD) non-use among US workers exposed to hazardous workplace noise and provided risk estimates. METHODS: Self-reported data from the National Health Interview Survey in 2007 (15,852 workers) and 2014 (23,656 workers) were examined. Weighted prevalence and adjusted prevalence ratios of HPD non-use (using HPDs half the time or less when exposed to hazardous noise) were estimated by demographic, industry, and occupation. Differences in the prevalences of non-use were estimated and compared. RESULTS: The prevalence of HPD non-use was 53% among all noise-exposed workers in 2014. Workers in the Accommodation and Food Services industry had the highest prevalence (90%) and risk (PR: 2.47, 95% confidence interval: 1.54-3.96) of HPD non-use. The industries with the lowest prevalences of noise exposure, including Finance and Insurance (2%) and Health Care and Social Assistance (4%), had some of the highest prevalences of HPD non-use (80% and 83%, respectively). There were no statistically significant changes in HPD non-use among industries between 2007 and 2014. Among occupations, HPD non-use increased 37% in Arts, Design, Entertainment, Sports and Media, and decreased 39% in Architecture and Engineering. CONCLUSION: The prevalence of HPD non-use remains high; especially within industries and occupations with fewer noise-exposed workers. These groups need targeted attention to increase awareness and compliance. Employers should require HPD use and trainings among noise-exposed workers and provide an assortment of HPDs tailored to noise level and type, workplace environment, communication and audibility needs, and individual comfort and convenience.

Prevalence of hearing loss among noise-exposed workers within the services sector, 2006-2015.

OBJECTIVE: The purpose of this study is to estimate the prevalence of hearing loss among noise-exposed U.S. workers within the Services sector. METHODS: Audiograms for 1.9 million workers (158,436 within Services) from 2006 to 2015 were examined. Prevalence and adjusted risk for hearing loss as compared with a reference industry were estimated for the Services sector/sub-sectors, and all industries combined. RESULTS: The prevalence of hearing loss within Services was 17 compared to 16% for all industries combined. However, many sub-sectors greatly exceeded the overall prevalence (10-33% higher) and/or had adjusted risks significantly higher than the reference industry. Workers in Administration of Urban Planning and Community and Rural Development had the highest prevalence (50%), and workers in Solid Waste Combustors and Incinerators had more than double the risk, the highest of any sub-sector. Some sub-sectors traditionally viewed as 'low-risk' also had high prevalences and risks. CONCLUSIONS: Large numbers of workers within Services have an elevated risk of hearing loss and need immediate hearing conservation efforts. Additional research and surveillance are needed for sub-sectors for which there is low awareness of hearing hazards or a lack of hearing data.

Occupational noise exposure: A review of its effects, epidemiology, and impact with recommendations for reducing its burden.

Exposure to hazardous noise is one of the most common occupational risks, both in the U.S. and worldwide. Repeated overexposure to noise at or above 85 dBA can cause permanent hearing loss, tinnitus, and difficulty understanding speech in noise. It is also associated with cardiovascular disease, depression, balance problems, and lower income. About 22 million U.S. workers are currently exposed to hazardous occupational noise. Approximately 33% of working-age adults with a history of occupational noise exposure have audiometric evidence of noise-induced hearing damage, and 16% of noise-exposed workers have material hearing impairment. While the Mining, Construction, and Manufacturing sectors typically have the highest prevalence of noise exposure and hearing loss, there are noise-exposed workers in every sector and every sector has workers with hearing loss. Noise-induced hearing loss is preventable. Increased understanding of the biological processes underlying noise damage may lead to protective pharmacologic or genetic therapies. For now, an integrated public health approach that (1) emphasizes noise control over reliance on hearing protection, (2) illustrates the full impact of hearing loss on quality of life, and (3) challenges the cultural acceptance of loud noise can substantially reduce the impact of noise on worker health.

Prevalence of hearing loss among noise-exposed workers within the Mining and Oil and Gas Extraction sectors, 2006-2015.

BACKGROUND: The purpose of this study was to estimate the prevalence of hearing loss (HL) among noise-exposed US workers within the Mining, and Oil and Gas Extraction (OGE) sectors. METHODS: Audiograms of 1.9 million workers across all industries (including 9389 in Mining and 1076 in OGE) from 2006 to 2015 were examined. Prevalence and adjusted risk as compared to a reference industry (Couriers and Messengers) were estimated for all industries combined and the Mining and OGE sectors and subsectors. RESULTS: The prevalences of HL in Mining and OGE were 24% and 14%, respectively, compared with 16% for all industries combined. Many Mining and one OGE subsector exceeded these prevalences and most had an adjusted risk (prevalence ratio) significantly greater than the reference industry. Some subsectors, particularly in OGE, could not be examined due to low sample size. The prevalences in Construction Sand and Gravel Mining and Natural Gas Liquid Extraction were 36% and 28%, respectively. Workers within Support Activities for Coal Mining had double the risk of HL than workers in the reference industry. CONCLUSIONS: The many subsectors identified with high prevalences and/or worker risks for HL well above risks in the reference industry need critical attention to conserve worker hearing and maintain worker quality of life. Administrative and engineering controls can reduce worker hazardous noise exposures. Noise and ototoxic chemical exposure information is needed for many subsectors, as is audiometric testing results for OGE workers. Additional research is also needed to further characterize exposures and improve hearing conservation measures.

Cardiovascular conditions, hearing difficulty, and occupational noise exposure within US industries and occupations.

BACKGROUND: The purpose of this study was to estimate the prevalence of occupational noise exposure, hearing difficulty and cardiovascular conditions within US industries and occupations, and to examine any associations of these outcomes with occupational noise exposure. METHODS: National Health Interview Survey data from 2014 were examined. Weighted prevalence and adjusted prevalence ratios of self-reported hearing difficulty, hypertension, elevated cholesterol, and coronary heart disease or stroke were estimated by level of occupational noise exposure, industry, and occupation. RESULTS: Twenty-five percent of current workers had a history of occupational noise exposure (14% exposed in the last year), 12% had hearing difficulty, 24% had hypertension, 28% had elevated cholesterol; 58%, 14%, and 9% of these cases can be attributed to occupational noise exposure, respectively. CONCLUSIONS: Hypertension, elevated cholesterol, and hearing difficulty are more prevalent among noise-exposed workers. Reducing workplace noise levels is critical. Workplace-based health and wellness programs should also be considered.

Prevalence of Hearing Loss Among Noise-Exposed Workers Within the Health Care and Social Assistance Sector, 2003 to 2012.

OBJECTIVE: The purpose was to estimate the prevalence of hearing loss for noise-exposed U.S. workers within the Health Care and Social Assistance (HSA) sector. METHODS: Audiograms for 1.4 million workers (8702 within HSA) from 2003 to 2012 were examined. Prevalences and adjusted risks for hearing loss as compared with a reference industry were estimated for the HSA sector and all industries combined. RESULTS: While the overall HSA sector prevalence for hearing loss was 19%, the prevalences in the Medical Laboratories subsector and the Offices of All Other Miscellaneous Health Practitioners subsector were 31% and 24%, respectively. The Child Day Care Services subsector had a 52% higher risk than the reference industry. CONCLUSION: High-risk industries for hearing loss exist within the HSA sector. Further work is needed to identify the sources of noise exposure and protect worker hearing.

Prevalence of hearing loss among noise-exposed workers within the agriculture, forestry, fishing, and hunting sector, 2003-2012.

BACKGROUND: The purpose of this study was to estimate the prevalence of hearing loss among noise-exposed US workers within the Agriculture, Forestry, Fishing, and Hunting (AFFH) sector. METHODS: Audiograms for 1.4 million workers (17 299 within AFFH) from 2003 to 2012 were examined. Prevalence, and the adjusted risk for hearing loss as compared with the reference industry (Couriers and Messengers), were estimated. RESULTS: The overall AFFH sector prevalence was 15% compared to 19% for all industries combined, but many of the AFFH sub-sectors exceeded the overall prevalence. Forestry sub-sector prevalences were highest with Forest Nurseries and Gathering of Forest Products at 36% and Timber Tract Operations at 22%. The Aquaculture sub-sector had the highest adjusted risk of all AFFH sub-sectors (PR = 1.70; CI = 1.42-2.04). CONCLUSIONS: High risk industries within the AFFH sector need continued hearing conservation efforts. Barriers to hearing loss prevention and early detection of hearing loss need to be recognized and addressed.

Hearing Impairment Among Noise-Exposed Workers - United States, 2003-2012.

Hearing loss is the third most common chronic physical condition in the United States, and is more prevalent than diabetes or cancer (1). Occupational hearing loss, primarily caused by high noise exposure, is the most common U.S. work-related illness (2). Approximately 22 million U.S. workers are exposed to hazardous occupational noise (3). CDC compared the prevalence of hearing impairment within nine U.S. industry sectors using 1,413,789 noise-exposed worker audiograms from CDC's National Institute for Occupational Safety and Health (NIOSH) Occupational Hearing Loss Surveillance Project (4). CDC estimated the prevalence at six hearing impairment levels, measured in the better ear, and the impact on quality of life expressed as annual disability-adjusted life years (DALYs), as defined by the 2013 Global Burden of Disease (GBD) Study (5). The mining sector had the highest prevalence of workers with any hearing impairment, and with moderate or worse impairment, followed by the construction and manufacturing sectors. Hearing loss prevention, and early detection and intervention to avoid additional hearing loss, are critical to preserve worker quality of life.

Hearing difficulty and tinnitus among U.S. workers and non-workers in 2007.

BACKGROUND: Hearing loss and tinnitus are two potentially debilitating physical conditions affecting many people in the United States. The purpose of this study was to estimate the prevalence of hearing difficulty, tinnitus, and their co-occurrence within U.S. METHODS: Data from the 2007 National Health Interview Survey (NHIS) were examined. Weighted prevalence and adjusted prevalence ratios for self-reported hearing difficulty, tinnitus, and their co-occurrence were estimated and compared by demographic, among workers with and without occupational noise exposure, and across industries and occupations. RESULTS: Seven percent of U.S. workers never exposed to occupational noise had hearing difficulty, 5% had tinnitus and 2% had both conditions. However, among workers who had ever been exposed to occupational noise, the prevalence was 23%, 15%, and 9%, respectively (P < 0.0001). CONCLUSIONS: Hearing difficulty and tinnitus are prevalent in the U.S.; especially among noise-exposed workers. Improved strategies for hearing conservation or better implementation are needed.

Trends in worker hearing loss by industry sector, 1981-2010.

BACKGROUND: The purpose of this study was to estimate the incidence and prevalence of hearing loss for noise-exposed U.S. workers by industry sector and 5-year time period, covering 30 years. METHODS: Audiograms for 1.8 million workers from 1981-2010 were examined. Incidence and prevalence were estimated by industry sector and time period. The adjusted risk of incident hearing loss within each time period and industry sector as compared with a reference time period was also estimated. RESULTS: The adjusted risk for incident hearing loss decreased over time when all industry sectors were combined. However, the risk remained high for workers in Healthcare and Social Assistance, and the prevalence was consistently high for Mining and Construction workers. CONCLUSIONS: While progress has been made in reducing the risk of incident hearing loss within most industry sectors, additional efforts are needed within Mining, Construction and Healthcare and Social Assistance.

Do hearing protectors protect hearing?

BACKGROUND: We examined the association between self-reported hearing protection use at work and incidence of hearing shifts over a 5-year period. METHODS: Audiometric data from 19,911 workers were analyzed. Two hearing shift measures-OSHA standard threshold shift (OSTS) and high-frequency threshold shift (HFTS)-were used to identify incident shifts in hearing between workers' 2005 and 2009 audiograms. Adjusted odds ratios were generated using multivariable logistic regression with multi-level modeling. RESULTS: The odds ratio for hearing shift for workers who reported never versus always wearing hearing protection was nonsignificant for OSTS (OR 1.23, 95% CI 0.92-1.64) and marginally significant for HFTS (OR 1.26, 95% CI 1.00-1.59). A significant linear trend towards increased risk of HFTS with decreased use of hearing protection was observed (P = 0.02). CONCLUSION: The study raises concern about the effectiveness of hearing protection as a substitute for noise control to prevent noise-induced hearing loss in the workplace.

Prevalence of workers with shifts in hearing by industry: a comparison of OSHA and NIOSH Hearing Shift Criteria.

OBJECTIVE: The purpose of this study was to compare the prevalence of workers with National Institute for Occupational Safety and Health significant threshold shifts (NSTS), Occupational Safety and Health Administration standard threshold shifts (OSTS), and with OSTS with age correction (OSTS-A), by industry using North American Industry Classification System codes. METHODS: From 2001 to 2010, worker audiograms were examined. Prevalence and adjusted prevalence ratios for NSTS were estimated by industry. NSTS, OSTS, and OSTS-A prevalences were compared by industry. RESULTS: Twenty percent of workers had an NSTS, 14% had an OSTS, and 6% had an OSTS-A. For most industries, the OSTS and OSTS-A criteria identified 28% to 36% and 66% to 74% fewer workers than the NSTS criteria, respectively. CONCLUSIONS: Use of NSTS criteria allowing for earlier detection of shifts in hearing is recommended for improved prevention of occupational hearing loss.

Prevalence of hearing loss in the United States by industry.

BACKGROUND: Twenty-two million workers are exposed to hazardous noise in the United States. The purpose of this study is to estimate the prevalence of hearing loss among U.S. industries. METHODS: We examined 2000-2008 audiograms for male and female workers ages 18-65, who had higher occupational noise exposures than the general population. Prevalence and adjusted prevalence ratios (PRs) for hearing loss were estimated and compared across industries. RESULTS: In our sample, 18% of workers had hearing loss. When compared with the Couriers and Messengers industry sub-sector, workers employed in Mining (PR = 1.65, CI = 1.57-1.73), Wood Product Manufacturing (PR = 1.65, CL = 1.61-1.70), Construction of Buildings (PR = 1.52, CI = 1.45-1.59), and Real Estate and Rental and Leasing (PR = 1.61, CL = 1.51-1.71) [corrected] had higher risks for hearing loss. CONCLUSIONS: Workers in the Mining, Manufacturing, and Construction industries need better engineering controls for noise and stronger hearing conservation strategies. More hearing loss research is also needed within traditional "low-risk" industries like Real Estate.

Self-reported mental health status and recent mammography screening.

OBJECTIVE: The purpose of this study was to assess the association between self-perceived mental health status and mammography screening in Kentucky. METHODS: Using a cross-sectional design, we examined survey data from the 2002 Kentucky Behavioral Risk Factor Surveillance System (BRFSS) for women aged > or =40. Mental health status was measured by the reported number of days that mental health was not good; the number of days feeling sad, blue, or depressed; and the number of days feeling worried, tense, or anxious. The outcome was mammography within the last 2 years. Three logistic regression analyses were performed, one with each of the mental health status questions as the predictor variable. Analyses controlled for age, race, marital status, education, income, and health insurance status. RESULTS: The numbers of poor mental health days, depressed days, and anxious days were found to be significant or near-significant predictors of recent mammography. Odds ratios (ORs) comparing women reporting 30 poor mental health days, depressed days, or anxious days with similar women reporting zero days were estimated to be 1.68 (95% confidence interval [CI] 1.08-2.63), 1.49 (0.93-2.40), and 1.46 (0.96-2.23), respectively. CONCLUSIONS: Self-reported poor mental health, depression, and anxiety may be associated with nonreceipt of regular mammography screening. How mental health symptoms and self-reported poor mental health status contribute to decreased mammography screening should be explored.

Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres: results from a pilot study.

BACKGROUND: The objective of this report was to present data from an open-label cohort study in which patients with intrahepatic cholangiocarcinoma (ICC) underwent radioembolization with yttrium-90 ((90)Y) microspheres. METHODS: Twenty-four patients with histologically proven ICC were treated. The planned target dose was 120 Gray. Patients were stratified according to Eastern Cooperation Oncology Group (ECOG) performance status, tumor morphology (infiltrative vs peripheral), tumor distribution (solitary vs multifocal), and the presence or absence of portal vein thrombosis (PVT). Before and after the procedure, the following variables were assessed: 1) biochemical and clinical toxicity, 2) imaging (computed tomography/magnetic resonance imaging) response according to World Health Organization and European Association for the Study of Liver Disease (EASL) criteria, and 3) median survival after the first treatment using Kaplan-Meier methodology. RESULTS: In total, 48 (90)Y treatments were administered to hepatic segments or lobes. Fatigue and transient abdominal pain were reported in 18 patients (75%) and 10 patients (42%), respectively. One patient (4%) developed grade 3 bilirubin toxicity. One patient (4%) developed a treatment-related gastroduodenal ulcer. On imaging follow-up of 22 patients, tumors demonstrated a partial response in 6 patients (27%), stable disease in 15 patients (68%), and progressive disease in 1 patient (5%). By using EASL guidelines, 17 patients (77%) showed >50% tumor necrosis on imaging follow-up. Two patients (9%) demonstrated 100% tumor necrosis. The median overall survival for the entire cohort (n = 24) was 14.9 months. The median survival for patients with an ECOG performance status of 0, 1, and 2 was 31.8 months, 6.1 months, and 1 month, respectively (P < .0001); the median survival for patients without and with PVT was 31.8 months and 5.7 months, respectively (P = .0003); and the median survival for patients with peripheral versus periductal-infiltrative tumors was 31.8 months and 5.7 months, respectively (P = .0005). CONCLUSIONS: Radioembolization with (90)Y may be a therapeutic option for the treatment of unresectable ICC. Cancer 2008.