Cost-effectiveness of comprehensive preventive measures for coal workers' pneumoconiosis in China.

BACKGROUND: Coal workers' pneumoconiosis (CWP) remains one of the most severe occupational diseases in China. Despite the implementation of CWP comprehensive preventive measures, the unreasonable allocation of investment by coal enterprises limits the effect of preventing CWP, especially when the health resources are inadequate. This study aims to evaluate the cost-effectiveness of comprehensive measures for CWP from the perspective of coal enterprises. METHODS: Comprehensive measures and two primary interventions (engineering controls and individual protective equipment) were selected. A time-dependent Markov model was developed to evaluate cost and quality-adjusted life-years (QALYs). The input data were collected from the survey and literature. A hypothetical null situation, in which the currently implemented interventions were eliminated, was used as a comparator based on the generalised cost-effectiveness analysis (GCEA) recommended by the World Health Organization (WHO). The primary outcomes of the model were reported in terms of incremental cost-effectiveness ratios (ICERs). Uncertainty was verified using one-way and probabilistic sensitivity analyses. RESULTS: The QALYs of the comprehensive measures, engineering controls, and individual protective equipment were 17.60, 17.50, and 16.85 years, respectively. Compared with null, the ICERs of the interventions were 65,044.73, 30,865.15, and 86,952.41 RMB/QALY, respectively. Individual protective equipment was dominated by an ICER of -11,416.02 RMB/QALY compared to engineering controls. Sensitivity analysis suggested the robustness of the results. CONCLUSIONS: The comprehensive preventive measures for CWP that are currently implemented in Chinese state-owned mines are cost-effective. In comprehensive measures, engineering controls are more cost-effective than individual protective equipment. Investment in engineering controls should be increased to improve the cost-effectiveness of preventing CWP.

Respiratory health of American Indian and Alaska Native coal miners participating in the Coal Workers' Health Surveillance Program, 2014-2019.

BACKGROUND: In 2014, a federal rule reduced occupational exposure limits to coal mine dust and expanded medical surveillance eligibility beyond underground miners to surface and contract coal miners. This expansion may have provided an opportunity for more American Indian and Alaska Native (AI/AN) coal miners to participate in screening, since many surface coal mines are located near AI/AN communities and may employ AI/AN miners. Therefore we sought to better understand the respiratory health of AI/AN coal miners by characterizing prevalence of coal workers' pneumoconiosis (CWP), progressive massive fibrosis (PMF), and abnormal lung function in this population. METHODS: Descriptive analysis of 1405 chest radiographs and 627 spirometry test results for AI/AN miners who participated in the Coal Workers' Health Surveillance Program (CWHSP) during 2014-2019 was conducted. RESULTS: Most AI/AN miners (0-25+ years of tenure) were western United States residents (82.3%) and active surface miners (76.9%) with no underground tenure. Among miners with at least 10 years of tenure, prevalence of CWP was 3.0%, and of PMF was 0.3%. Lung function abnormalities were seen in 9.0% with primarily restrictive patterns. CONCLUSIONS: The prevalence of CWP, PMF, and lung function abnormality among active and former AI/AN coal miners was higher than seen in a larger CWHSP study of active western miners working primarily underground with 10+ years of tenure. Interventions that eliminate or control coal mine dust exposure, identify miners with CWP early, and limit respiratory disease progression and complications remain vital for eliminating the preventable adverse health effects of coal mining. Comprehensive demographic data on the coal mining workforce are needed to improve CWHSP participation assessment.

Respiratory surveillance for coal mine dust and artificial stone exposed workers in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand.

Coal mine lung dust disease (CMDLD) and artificial stone (AS) silicosis are preventable diseases which have occurred in serious outbreaks in Australia recently. This has prompted a TSANZ review of Australia's approach to respiratory periodic health surveillance. While regulating respirable dust exposure remains the foundation of primary and secondary prevention, identification of workers with early disease assists with control of further exposure, and with the aims of preserving lung function and decreasing respiratory morbidity in those affected. Prompt detection of an abnormality also allows for ongoing respiratory specialist clinical management. This review outlines a medical framework for improvements in respiratory surveillance to detect CMDLD and AS silicosis in Australia. This includes appropriate referral, improved data collection and interpretation, enhanced surveillance, the establishment of a nationwide Occupational Lung Disease Registry and an independent advisory group. These measures are designed to improve health outcomes for workers in the coal mining, AS and other dust-exposed and mining industries.

[Comprehensive rehabilitation of individualized exercise program for coal workers pneumoconiosis in Huaibei Coal Mine Group].

Objective: To explore the effect of comprehensive rehabilitation treatment of individualized exercise program on lung function, exercise ability, quality of life and biochemical indexes of coal workers' pneumoconiosis patients, and to provide scientific and effective methods for rehabilitation treatment of coal workers' pneumoconiosis. Methods: In Huaibei Coal Mine Occupational Disease Prevention and Control Hospital, the data of pneumoconiosis patients treated by pneumoconiosis department in the hospital were collected and sorted out. 80 patients were selected according to the inclusion and exclusion criteria. Using a random number table, they were randomly divided into two groups with 40 cases in each group. The data investigated in this study include the results before and after treatment. Pulmonary function index, BMI index, six-minute walking distance (6MWD) , quality of life questionnaire (SF-36) , hospital anxiety and depression scale (HADS) , st George's breathing questionnaire (sgrq) , c-reactive protein (CRP) and blood oxygen saturation (SpO(2)) were used to evaluate and compare the efficacy of the two groups. Results: The lung function indexes of the test group were significantly higher than those of the control group after treatment (P<0.05) , including forced vital capacity, forced vital capacity in the first second, maximum expiratory flow, expiratory flow when vital capacity was 75% and expiratory flow when vital capacity was 25%. The forced vital capacity, the first-second forced vital capacity and the maximum expiratory flow of the patients in the test group were higher after treatment than before (P<0.05) . The six-minute walking distance of the test group was greater than that of the control group after treatment (P<0.05) . After treatment, the scores of st George's breathing questionnaire in the test group were lower than those in the control group (P<0.05) . The scores of quality of life questionnaire in the test group were higher than those in the control group after treatment (P<0.05) . Conclusion: The comprehensive rehabilitation treatment of individualized exercise program improved the endurance and exercise ability of pneumoconiosis patients, improved the respiratory status and quality of life of pneumoconiosis patients in Huaibei Coal Mine, improved the lung function of pneumoconiosis patients, and improved the forced vital capacity of patients, but the small airway function has not been significantly improved.

Novel approach for suppressing cutting dust using foam on a fully mechanized face with hard parting.

The cutting dust created by the shearer drum is the main source of dust on a fully mechanized coal face. However, overexposure to respirable dust may cause pneumoconiosis in coal workers, while coal dust may lead to serious explosions. The fully mechanized face known as II1051 Face, found at the Zhuxianzhuang Coal Mine located in east China, generates dust by way of the drum on a high-power shear. The coal seam involves hard rock parting so there is a high concentration of cutting dust when the shearer is working. Thus, we developed a new foam dust suppression method with an air self-suction system based on an analysis of the dust generation characteristics that suppressed the shearer cutting dust level. The new foam system was evaluated in a field test where the dust concentration was measured at two points. The results showed that the foam reduced the cutting dust concentration significantly. The respirable dust exposure levels were reduced from 378.4 mg/m(3)to 53.5 mg/m(3)and the visibility was enhanced dramatically. Thus, we conclude that our new foam system is highly efficient at capturing cutting dust, and it has a much lower water consumption. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: Contact angle of cutting dust sample, migration trajectory of cutting dust, technological process for suppressing shearer cutting dust using foam, the layout of the foam dust suppression system on coal face, real object of the air self-suction type foam generator, the special foam nozzle used for shearers, relevant experimental results of the air self-suction foam system.].

"Nuisance dust": unprotective limits for exposure to coal mine dust in the United States, 1934-1969.

I examine the dismissal of coal mine dust as a mere nuisance, not a potentially serious threat to extractive workers who inhaled it. In the 1930s, the US Public Health Service played a major role in conceptualizing coal mine dust as virtually harmless. Dissent from this position by some federal officials failed to dislodge either that view or the recommendation of minimal limitations on workplace exposure that flowed from it. Privatization of regulatory authority after 1940 ensured that miners would lack protection against respiratory disease. The reform effort that overturned the established misunderstanding in the late 1960s critically depended upon both the production of scientific findings and the emergence of a subaltern movement in the coalfields. This episode illuminates the steep challenges often facing advocates of stronger workplace health standards.

Focusing on Coal Workers' Lung Diseases: A Comparative Analysis of China, Australia, and the United States.

China has high and increasing annual rates of occupational lung diseases such as pneumoconiosis and silicosis. In contrast, Australia and the United States of America (USA) have greatly lowered their annual rates of lung diseases since the 1970s. This paper systematically compared and analysed the multi-elements of coal dust management and health management in these three countries to provide a reference for China. Regarding coal dust management, this paper found that coal workers in China are more susceptible to lung diseases compared to workers in the USA and Australia, considering fundamental aspects such as mine type, coal rank, and geological conditions. In addition, the controllable aspects such as advanced mitigation, monitoring methods, and the personal protective equipment of coal dust were relatively inadequate in China compared to the USA and Australia. Health management in China was found to have multiple deficiencies in health examination, co-governance, and compensations for coal workers suffering from lung diseases and healthcare for retired coal workers. These deficiencies may be attributed to insufficient medical resources, the Chinese government-dominated governance, ineffective procedures for obtaining compensation, and the lack of effective and preventive healthcare programs for the retired coal workers. Based on the USA and Australia experience, some suggestions for improvement were proposed.