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Coffman VR, Hall DJ, Pisanic N, Nadimpalli M, McCormack M, Diener‐West M, Davis MF, Heaney CD. Personal protective equipment use during industrial hog operation work activities and acute lung function changes in a prospective worker cohort, North Carolina 2014-2015. Am J Ind Med 2021; 64:688-698. [PMID: 34091939 DOI: 10.1002/ajim.23260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Occupational activities related to industrial hog operation (IHO) worker lung function are not well defined. Therefore, we aimed to identify IHO work activities associated with diminished respiratory function and the effectiveness, if any, of personal protective equipment (PPE) use on IHOs. METHODS From 2014 to 2015, 103 IHO workers were enrolled and followed for 16 weeks. At each biweekly visit, work activities and PPE use were self-reported via questionnaire and lung function measurements were collected via spirometry. Generalized linear and linear fixed-effects models were fitted to cross-sectional and longitudinal data. RESULTS Increasing years worked on an IHO were associated with diminished lung function, but baseline and longitudinal work activities were largely inconsistent in direction and magnitude. Unexpectedly, a -0.3 L (95% confidence interval: -0.6, -0.04) difference in forced expiratory volume in the first second (FEV1 ) was estimated when workers wore PPE consistently (≥80% of the time at work) versus those weeks they did not. In post-hoc analyses, we found that coveralls and facemasks were worn less consistently when workers experienced worse barn conditions and had more contact with pigs, but coveralls were worn more consistently as cleaning activities increased. CONCLUSIONS Similar to past studies, baseline estimates were likely obscured by healthy worker effect bias, but showed decrements in worker lung function as years of work increased. A challenge to disentangling the effect of work activities on lung function was the discovery that IHO workers used PPE differently according to the work task. These data suggest that interventions may be targeted toward improving barn conditions so that workers can consistently utilize IHO-provided PPE.
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Affiliation(s)
- Vanessa R. Coffman
- Division of Epidemiology and Biostatistics, School of Public Health University of Illinois at Chicago Chicago Illinois USA
| | - Devon J. Hall
- Rural Empowerment Association for Community Help (REACH) Warsaw North Carolina USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - Maya Nadimpalli
- Department of Civil and Environmental Engineering Tufts University Medford Massachusetts USA
- Center for Integrated Management of Antimicrobial Resistance (CIMAR) Tufts University Boston Massachusetts USA
| | - Meredith McCormack
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- School of Medicine Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for Global Health Johns Hopkins University Baltimore Maryland USA
| | - Marie Diener‐West
- Johns Hopkins Center for Global Health Johns Hopkins University Baltimore Maryland USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- School of Nursing Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - Meghan F. Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- School of Medicine Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - Christopher D. Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for Global Health Johns Hopkins University Baltimore Maryland USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
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Coffman VR, Hall DJ, Pisanic N, Nadimpalli M, McCormack M, Diener-West M, Davis MF, Heaney CD. The use of personal protective equipment during common industrial hog operation work activities and acute lung function changes in a prospective worker cohort, North Carolina, USA. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 33173898 DOI: 10.1101/2020.11.03.20205252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction As occupational activities related to acute industrial hog operation (IHO) worker lung function are not well defined, we aimed to identify IHO work activities associated with diminished respiratory function and the effectiveness, if any, of personal protective equipment (PPE) on IHOs. Methods From 2014-2015, 103 IHO workers were enrolled and followed for 16 weeks. At each bi-weekly visit, lung function measurements were collected via spirometry and work activities and PPE use were self-reported via questionnaire. Generalized linear and linear fixed-effects models were fitted to cross-sectional and longitudinal data. Results At baseline, increasing years worked on an IHO were associated with diminished lung function, but other activities were less consistent in direction and magnitude. In longitudinal models, only reports of working in feeding/finisher barns, showed a consistent association. However, a -0.3 L (95% confidence interval: -0.6, -0.04) difference in FEV 1 was estimated when workers wore PPE consistently versus those weeks they did not. In post-hoc analyses, we found that coveralls and facemasks were worn less consistently when workers experienced worse barn conditions and had more contact with pigs, but coveralls were worn more consistently as cleaning activities increased. Conclusions Similar to past studies, baseline estimates were likely obscured by healthy worker bias. Also making it challenging to disentangle the effect of work activities on lung function was the discovery that IHO workers used PPE differently according to work task. These data suggest that interventions may be targeted toward improving barn conditions so that workers can consistently utilize IHO-provided PPE. KEY MESSAGES What is already known about this subject?: Working on industrial hog operations may be deleterious to long- and short-term respiratory health due to airborne bacteria, endotoxin, hazardous gases, dust, and dander in barns. In efficacy studies PPE has been shown to be protective, but studies have shown that PPE utilization among hog workers has historically been sub-optimal.What are the new findings?: As barn conditions worsened and contact with pigs increased, workers in this cohort reported wearing coveralls and face masks less often; however, they reported increased PPE use as they conducted more cleaning activities at work. During weeks when workers wore PPE their lung function declined, a possible cause being the improper use of the equipment leading to a false sense of protection or re-exposure to hazardous contaminants.How might this impact on policy or clinical practice in the foreseeable future?: Given COVID-19, the H1N1 "swine flu" pandemic, our knowledge of antimicrobial resistant pathogens, and increasing awareness about how food systems are linked to the spread of emerging infectious diseases, occupational health intervention research and workplace policies may focus on creating barn environments that are more conducive to PPE use which could help protect workers and consequently the community.
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Kitjakrancharoensin P, Yasan K, Hongyantarachai K, Ratanachokthorani K, Thammasarn J, Kuwuttiwai D, Ekanaprach T, Jittakarm R, Nuntapravechpun R, Hotarapavanon S, Kulrattanarak S, Tongkaew S, Deemeechai S, Mungthin M, Rangsin R, Wongsrichanalai V, Sakboonyarat B. Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease Among Agriculturists in a Rural Community, Central Thailand. Int J Chron Obstruct Pulmon Dis 2020; 15:2189-2198. [PMID: 32982211 PMCID: PMC7501975 DOI: 10.2147/copd.s262050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose The present study aimed to determine the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) among agriculturists in a remote rural community in central Thailand. Methods A cross-sectional study was conducted in January 2020. Face-to-face interviews were conducted using standardized questionnaires to determine demographic characteristics and risk behaviors. COPD was defined by the spirometric criterion for airflow limitation constituting a postbronchodilator fixed ratio of FEV1/FVC <0.70 following the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines 2019. Multivariable logistic regression analysis was used to determine the risk factors for COPD, and the magnitude of association was presented as adjusted odds ratio (AOR) with 95% confidence interval (95% CI). Results A total of 546 agriculturists were enrolled in the study. The overall prevalence of COPD was 5.5% (95% CI: 3.6–7.4). The prevalence of COPD among males was 8.0% (95% CI: 4.7–11.3), and 3.2% (95% CI: 1.1–5.2) among females. The risk factors of COPD included age ≥60 years old (AOR 2.7, 95% CI: 1.1–7.0), higher intensity of smoking (AOR 1.1, 95% CI: 1.0–1.1), swine farm worker (AOR 4.1, 95% CI: 1.7–10.3), cattle farm worker (AOR 3.3, 95% CI: 1.4–8.2) and home cooking (AOR 2.7, 95% CI: 0.8–9.7). Conclusion Our data emphasized that COPD was one of the significant health problems among agriculturists in a rural community. Agricultural jobs such as animal farmers and behavioral factors such as smoking were associated with COPD. Effective public health interventions, especially, modifying risk behaviors, should be promoted in remote rural areas to prevent the disease and reduce its morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Mathirut Mungthin
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
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Ho T, Cusack RP, Chaudhary N, Satia I, Kurmi OP. Under- and over-diagnosis of COPD: a global perspective. Breathe (Sheff) 2019; 15:24-35. [PMID: 30838057 PMCID: PMC6395975 DOI: 10.1183/20734735.0346-2018] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Globally, chronic obstructive pulmonary disease (COPD) is the fourth major cause of mortality and morbidity and projected to rise to third within a decade as our efforts to prevent, identify, diagnose and treat patients at a global population level have been insufficient. The European Respiratory Society and American Thoracic Society, along with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document, have highlighted key pathological risk factors and suggested clinical treatment strategies in order to reduce the mortality and morbidity associated with COPD. This review focuses solely on issues related to the under- and over-diagnosis of COPD across the main geographical regions of the world and highlights some of the associated risk factors. Prevalence of COPD obtained mainly from epidemiological studies varies greatly depending on the clinical and spirometric criteria used to diagnose COPD, i.e. forced expiratory volume in 1 s to forced vital capacity ratio <0.7 or 5% below the lower limit of normal, and this subsequently affects the rates of under- and over-diagnosis. Although under-utilisation of spirometry is the major reason, additional factors such as exposure to airborne pollutants, educational level, age of patients and language barriers have been widely identified as other potential risk factors. Co-existent diseases, such as asthma, bronchiectasis, heart failure and previously treated tuberculosis, are reported to be the other determinants of under- and over-diagnosis of COPD. COPD is a major cause of morbidity and mortality, but misdiagnosis of COPD is a huge problem worldwide. Its main causes are under-utilisation of spirometry and lack of uniformity in diagnosis criteria, particularly in resource poor settings.http://ow.ly/KfP330nonkh
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Affiliation(s)
- Terence Ho
- Firestone Institute of Respiratory Health, Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
| | - Ruth P Cusack
- Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
| | - Nagendra Chaudhary
- Dept of Paediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal.,All authors contributed equally
| | - Imran Satia
- Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
| | - Om P Kurmi
- Population Health Research Institute, Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
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Odo NU, Raynor PC, Beaudoin A, Somrongthong R, Scheftel JM, Donahue JG, Bender JB. Personal Protective Equipment Use and Handwashing Among Animal Farmers: A Multi-site Assessment. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:363-368. [PMID: 25626124 DOI: 10.1080/15459624.2015.1006635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The goal of this study was to compare and contrast the use of personal protective equipment (PPE) and the practice of handwashing among participants of four studies assessing poultry and swine farms in the midwestern United States and in Thailand. This largely descriptive exercise was designed to assess and compare the frequency of these protective practices among the study populations. There were a total of 1113 surveys analyzed across the four studies. The respondents included workers in direct contact with animals as well as flock owners and veterinarians tending to farms. Handwashing was the most common practice observed among all participants with 42% "always" and 35% "sometimes" washing their hands after contact with the animals. This practice was least common among Minnesota swine workers. Even Thai poultry farmers, who demonstrated the lowest overall PPE use, reported a higher frequency of handwashing. Mask use during animal farming activities ("always" or "sometimes") was least commonly practiced, ranging from 1% in Thailand to 26% among backyard poultry farmers in Minnesota. Minnesota poultry and swine farmers had similar frequencies of mask (26%) and glove use (51% and 49%). All other comparisons differed significantly across the four sites (p-values <0.05). The use of PPE in animal farming differed by study location and is likely related to prevalent norms in the respective regions. Overall, the use of PPE did not appear to be influenced by the particular animal (poultry or swine) being farmed. These findings may prove useful to regulating bodies and farm owners in formulating policy or planning strategies for improving personal hygiene practices in animal farming and preparing for influenza and other potential zoonotic disease outbreaks.
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Affiliation(s)
- Nnaemeka U Odo
- a School of Public Health, University of Minnesota , Minneapolis , Minnesota
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Tobacco Smoking and Environmental Risk Factors for Chronic Obstructive Pulmonary Disease. Clin Chest Med 2014; 35:17-27. [DOI: 10.1016/j.ccm.2013.09.011] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Basinas I, Schlünssen V, Takai H, Heederik D, Omland Ø, Wouters IM, Sigsgaard T, Kromhout H. Exposure to inhalable dust and endotoxin among Danish pig farmers affected by work tasks and stable characteristics. ACTA ACUST UNITED AC 2013; 57:1005-19. [PMID: 23792973 DOI: 10.1093/annhyg/met029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To identify working tasks and stable characteristics that determine intensity and variability of personal exposure to dust and endotoxin among pig farmers. METHODS Three hundred fifty-four personal full-shift measurements were performed in 231 farmers employed in 53 Danish pig farms. Filters were gravimetrically analysed for inhalable dust and for endotoxin by the Limulus amebocyte lysate assay. Information on working tasks and stable characteristics were collected using self-reported activity diaries and walk-through surveys performed in conjunction with the measurements. Associations between log-transformed dust and endotoxin exposure and working tasks and stable characteristics were examined using linear mixed-effects analysis. In these models, worker and farm identity were treated as random effects and working tasks and stable characteristics as fixed effects. Both separate and combined models for tasks and stable characteristics were elaborated. RESULTS Inhalable dust concentrations ranged between 0.1 and 48 mg m(-3) and endotoxin concentrations varied between 9.2 and 370,000 EU m(-3). Field work activities played a dominant role on the exposure variability. Indoor working tasks with intense animal activity or handling of feed materials increased exposure concentrations, whereas engagement in field work was associated with lower exposure concentrations. High-pressure water cleaning increased endotoxin exposure but did not affect exposure to inhalable dust. Stable characteristics related to feeding practices and type of ventilation were determinants of exposure to inhalable dust. For endotoxin, the most important determinants were use of dry feed and slatted floor coverage. Feeding practices solely explained all between-farms variability in exposure to inhalable dust and endotoxin. CONCLUSIONS These findings suggest feeding systems, flooring and ventilation to be potential areas where improved methods can reduce exposure to dust and endotoxin among pig farmers. Further, they highlight particular tasks involving feeding and intense animal handling as sources of very high levels of exposure. The pig farming industry is encouraged to focus on exposure reduction. Use of respirators during performance of working tasks where levels of exposure are particularly high ought to be considered until adequate hygienic solutions have been established.
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Affiliation(s)
- Ioannis Basinas
- Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Bartholins Allé 2, Building 1260, 8000 Aarhus C, Denmark
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Figueiredo VCN. Morbidades referidas por trabalhadoras que produzem joias folheadas em Limeira, SP. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2011. [DOI: 10.1590/s0303-76572011000200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO INTRODUÇÃO: a cidade de Limeira (SP) se caracteriza por ser um polo de empresas do ramo de joias folheadas e bijuterias, sendo a maior parte da mão de obra composta por mulheres. OBJETIVO: verificar as morbidades referidas por mulheres expostas ao cianeto no setor de bijuterias e joias folheadas na cidade de Limeira em 2007. METEDOLOGIA: estudo transversal realizado com 383 trabalhadoras, comparando-se um grupo de 191 mulheres trabalhadoras em galvanoplastias consideradas qualitativamente expostas ao cianeto com um grupo de 192 mulheres não expostas ao cianeto. Foi aplicado o Índice de Capacidade para o Trabalho, o Questionário de Tolerância de Fagerström e um questionário sociodemográfico e ocupacional. RESULTADOS: O grupo considerado exposto ao cianeto apresentou: menor média de tempo de trabalho no cargo (p = 0,008), maior proporção que trabalha com produtos químicos (p < 0,001), que usa Equipamento de Proteção Individual (p < 0,001), que recebe equipamento das empresas em que trabalham (p < 0,001), menor quantidade de morbidades referidas (p = 0,042), mas maior prevalência de bronquite crônica (p = 0,027), sinusite crônica (p = 0,022) e disfunções da tireoide (p = 0,022). CONCLUSÕES: os resultados apontam para a necessidade de pesquisas de coorte que analisem a associação entre os agravos apresentados e a exposição ao cianeto.
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Von Essen S, Moore G, Gibbs S, Larson KL. Respiratory issues in beef and pork production: recommendations from an expert panel. J Agromedicine 2011; 15:216-25. [PMID: 20665307 DOI: 10.1080/1059924x.2010.486283] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper summarizes "Respiratory Issues in Confined Feeding Operations," a panel discussion at the Agricultural Safety and Health Council of America/National Institute for Occupational Safety and Health conference, "Be Safe, Be Profitable: Protecting Workers in Agriculture," Dallas/Fort Worth, Texas, January 27-28, 2010. Occupational exposure to confined animal feeding operations is associated with cough, wheezing, and shortness of breath. Published data shows that 20% to 40% of hog confinement workers experience such symptoms, although most are able to continue working in this industry. Endotoxin is one component of hog barn dust that is associated with respiratory disease in workers. Endotoxin levels on cattle feedlots can also be in the range linked with occupational lung disease. The cattle industry has not yet prepared guidance documents for producers, in part because much less is known about the prevalence of lung disease in its workers. However, the pork industry provides information for pork producers on reducing their respiratory health risks through a multifaceted approach, including the use of respirators. Some jobs cannot be done safely without respiratory protection, such as entering manure pits. It is less clear for other jobs when respirators should be worn. Use of respiratory protection should be considered but not mandated for all persons working in close proximity to livestock in dusty conditions. A respiratory protection program may also serve as a cost effective biosecurity measure to protect animals from human pathogens such as influenza virus. Proper design and management of barn ventilation systems is critical for maintaining temperature and humidity levels for optimal animal growth; as well as decreasing the level of gases and respirable dusts. The pork and the cattle industries support occupational health and safety; however, the governmental guidance and recommendations for such programs are limited for the agricultural industries as a whole. The industries should lead the way in the effort to improve respiratory protection for workers. Overall, a team approach that includes input from managers, workers, and veterinarians is important for the reduction of respiratory hazards on livestock farms.
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