Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition.

BACKGROUND: Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations. METHODS: Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition. RESULTS: Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition. CONCLUSIONS: Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015.

Media Reports as a Tool for Timely Monitoring of COVID-19-Related Deaths Among First Responders-United States, April 2020.

We aimed to describe coronavirus disease 2019 (COVID-19) deaths among first responders early in the COVID-19 pandemic. We used media reports to gather timely information about COVID-19-related deaths among first responders during March 30-April 30, 2020, and evaluated the sensitivity of media scanning compared with traditional surveillance. We abstracted information about demographic characteristics, occupation, underlying conditions, and exposure source. Twelve of 19 US public health jurisdictions with data on reported deaths provided verification, and 7 jurisdictions reported whether additional deaths had occurred; we calculated the sensitivity of media scanning among these 7 jurisdictions. We identified 97 COVID-19-related first-responder deaths during the study period through media and jurisdiction reports. Participating jurisdictions reported 5 deaths not reported by the media. Sixty-six decedents worked in law enforcement, and 31 decedents worked in fire/emergency medical services. Media reports rarely noted underlying conditions. The media scan sensitivity was 88% (95% CI, 73%-96%) in the subset of 7 jurisdictions. Media reports demonstrated high sensitivity in documenting COVID-19-related deaths among first responders; however, information on risk factors was scarce. Routine collection of data on industry and occupation could improve understanding of COVID-19 morbidity and mortality among all workers.

Cleaning Products and Work-Related Asthma, 10 Year Update.

OBJECTIVE: To describe the frequency of work-related asthma (WRA) and characteristics of individuals with exposure to cleaning products 1998 to 2012, compared with 1993 to 1997. METHODS: Cases of WRA from products used for cleaning or disinfecting surfaces were identified from California, Massachusetts, Michigan (1998 to 2012), New Jersey (1998 to 2011), and New York (2009 to 2012). RESULTS: There were 1199 (12.4%) cleaning product cases among all 9667 WRA cases; 77.8% women, 62.1% white non-Hispanic, and average age of 43 years. The highest percentages worked in healthcare (41.1%), and were building cleaners (20.3%), or registered nurses (14.1%). CONCLUSIONS: The percentage of WRA cases from exposure to cleaning products from 1998 to 2012 was unchanged from 1993 to 1997 indicating that continued and additional prevention efforts are needed to reduce unnecessary use, identify safer products, and implement safer work processes.

Reported injury, hospitalization, and injury fatality rates among New Jersey adolescent workers.

BACKGROUND: Workplace injuries are a public health concern, including among adolescents and young adults. Secondary school career-technical-vocational education related injuries are mandated by code under jurisdiction of New Jersey Department of Education to be reported online to New Jersey Safe Schools Program. These are the only U.S. law-based surveillance data for young workers in secondary school career-technical-vocational education. New Jersey Department of Health's hospitalization and fatality records provide additional information about other secondary school career-technical-vocational education and non- secondary school career-technical-vocational education related injuries not necessarily reported to New Jersey Safe Schools Program. This report compared data available to the New Jersey Department of Health and New Jersey Safe Schools Program on injuries among young workers ages 14-21 years. METHODS: Annual work-related hospitalizations, 2007-2016, were abstracted from hospital discharge data. Denominator data from the U.S. Bureau of Labor Statistics was used to estimate annual crude rate of hospitalizations per 100,000 employed persons. Hospitalization rates were stratified by demographic data from the U.S. Bureau of Labor Statistics. Hospitalization rates for primary diagnoses and job title/status with ≥2 documented cases were reported. Annual crude fatality rates per 100,000 full time equivalent workers, age ≥ 16 years, were estimated for 1990-2016 using annual average full time equivalent workers and the U.S. National Institute Occupational Safety and Health's Employed Labor Force Query System as denominator. RESULTS: Annual crude hospitalization rates decreased over time. Hospitalization and fatality rates were higher among young adult workers ages 19-21 years; non-Hispanic Whites; and, males. Percent fatality for ages 19-21 years was greater than ages 14-17 years and 18 years. Declines in hospitalization rates corresponded to decreases in reported injuries among career-technical-vocational education students. Age distribution varied slightly between hospital discharge data and New Jersey Safe Schools Program data. CONCLUSION: Hospitalization and fatality rates were higher among males than among females, possibly reflecting a tendency for males to engage in riskier jobs than females. Understanding injury disparities can inform public health prevention efforts. Trainings/interventions should aim at addressing the most frequently diagnosed conditions or nature of reported injuries, within those most impacted career clusters like sales/restaurant workers.

Tree-Related Injuries Associated With Response and Recovery From Hurricane Sandy, New Jersey, 2011-2014.

OBJECTIVES: Extreme weather events require extensive tree removal and disposal, tasks associated with severe injury risks among workers and residents. To help understand the risks of such activities, we evaluated the impact of a large and destructive storm (Hurricane Sandy in 2012) on the incidence of tree-related injuries. METHODS: We searched chief-complaint text fields for patients aged 18-65 from 2011-2014 emergency department visit records submitted by New Jersey hospitals through the state-based syndromic surveillance system. Tree-related keywords (eg, saw, branch, wood chip, woodchip, tree) identified possible injuries that we then reviewed to exclude unrelated cases and classify mechanisms of tree-related injury. We used Poisson regression analysis to evaluate changes in the rates of probable tree-related injuries, adjusting for total emergency department visits and seasonal variation. RESULTS: We identified 698 probable tree-related injuries from 2011-2014 among patients aged 18-65, including 104 (14.9%) falls, 241 (34.5%) machine-related injuries, 311 (44.6%) struck-by injuries, and 42 (6.0%) other tree-related injuries. Tree-related injuries increased significantly in the quarter immediately after Hurricane Sandy (November 2012-January 2013) compared with the same quarter the year before (rate ratio [RR] = 1.67; 95% confidence interval [CI], 1.13-2.47) and the year after (RR = 2.47; 95% CI, 1.62-3.78) Hurricane Sandy, especially for struck-by injuries compared with the year before (RR = 2.74; 95% CI, 1.47-5.12) and the year after (RR = 4.17; 95% CI, 2.09-8.32) Hurricane Sandy. More than one-third of the injuries (33.4%) involved chainsaws. CONCLUSIONS: A major hurricane was associated with an increase in tree-related injuries in emergency departments, especially for mechanisms consistent with handling downed and damaged trees. Further research should confirm these findings and evaluate opportunities for preventing tree-related injuries.

Evaluation of a state based syndromic surveillance system for the classification and capture of non-fatal occupational injuries and illnesses in New Jersey.

BACKGROUND: This preliminary study evaluates a real-time syndromic surveillance system to track occupationally-related emergency room visits throughout New Jersey. METHODS: Emergency Department (ED) chief complaint fields were evaluated from 79 of 80 hospitals in NJ in 2014, using work-related keywords and ICD-9 E-codes, to determine its ability to capture non-fatal work-related injuries. Sensitivity analysis and descriptive statistics, were used to evaluate and summarize the occupational injuries identified. RESULTS: Overall, 11 919 (0.3%) possible work-related ED visits were identified from all ED visits. Events with the greatest number of ED visits were slips, trips, and falls (1679, 14%). Nature of injury included cuts, lacerations (1041, 9%). The part of the body most affected was the back (1414, 12%). This work-related classifier achieved a sensitivity of 5.4%, a specificity of 99.8%, and a PPV of 2.8%. CONCLUSIONS: This evaluation demonstrated that the syndromic surveillance reporting system can yield real-time knowledge of work-related injuries.

Work-Related Unintentional Injuries Associated With Hurricane Sandy in New Jersey.

OBJECTIVE: We aimed to evaluate the occurrence of work-related injuries after Hurricane Sandy potentially related to response and recovery. METHODS: Emergency and hospital discharges (patients aged 18-65 years) with a diagnosis of unintentional injury were obtained from the New Jersey Department of Health. Work-related injuries were identified as those with a workers' compensation payer or other work-related codes. Counties were categorized as high-, medium-, or low-impact areas. Poisson regression analysis was used to compare the rate of work-related injury the year following Sandy landfall with the 3 previous years. RESULTS: Total work-related injuries declined the week immediately after Sandy (rate ratio [RR]: 0.85; 95% confidence interval [CI]: 0.69-1.05) and no overall increase was found in the year after Hurricane Sandy. However, high-impact counties showed an elevated risk of work-related injuries in the first and third quarters after Hurricane Sandy among men, especially for blacks and Hispanics. The greatest excesses occurred in the third quarter after the storm, May to July, for falls (RR: 1.30; 95% CI: 1.08-1.57), cut/pierce injuries (RR: 1.24; 95% CI: 1.09-1.40), struck-by injuries (RR: 1.17; 95% CI: 1.02-1.34), and overexertion (RR: 1.26; 95% CI: 1.10-1.44). CONCLUSIONS: Hospital data suggested an increase in injuries associated with rebuilding and recovery rather than with initial response. Future efforts aimed at prevention should evaluate the mechanisms and circumstances of injury in more detail. (Disaster Med Public Health Preparedness. 2016;10:394-404).

Assessing Barriers to the Use of Fall Protection in Small Residential Construction Companies in New Jersey.

Three focus groups were conducted with residential construction workers from local New Jersey labor organizations to characterize barriers to fall protection use among residential construction contractors who work for companies with fewer than ten employees. Thirty-six residential construction workers volunteered to participate, the average age was thirty-nine years, and twenty-four (67%) were of Hispanic origin. Twelve (33%) of the participants reported having fallen from greater than 6 ft at work and twenty (56%) of the participants had known someone who has fallen from greater than 6 ft. Sixteen (44%) had not been provided with fall protection equipment by their employer and eighteen (50%) reported their current employer had not provided workplace safety training. Factors that created barriers to use of fall protection equipment such as equipment availability, employee/employer relationships, cultural differences, and company size were identified. Results from this study confirm that falls remain a concern among residential construction workers in small companies.

Swimming facilities and work-related asthma.

BACKGROUND: Exposure to chlorinated water in swimming facilities may aggravate preexisting asthma or cause new onset asthma. This may be a particular problem for individuals who work and therefore spend prolonged time at swimming facilities. Chloramines formed by the interaction of chlorine-based disinfection products with the nitrogen in water from human sweat, urine and skin cells are the suspected causal agents. METHODS: Cases were reviewed from the state surveillance systems in California (CA), Michigan (MI) and New Jersey (NJ) to identify individuals with confirmed work-related asthma (WRA) attributed to exposures in swimming pools, water parks or hydrotherapy spas. A standardized method was used to confirm cases. RESULTS: A total of 44 confirmed cases of WRA were identified; 17 from 1994 to 2011 in CA, 15 from 1991 to 2012 in MI and 12 from 1990 to 2011 in NJ. A majority (52.2%) of the cases were new onset; 31.8% secondary to an acute exposure incident and 20.4% to repeated exposure. These represented 0.3-1.6% of all confirmed cases of WRA received during these time periods. Maintenance workers (34.9%) and lifeguards (31.8%) were the most common occupations. CONCLUSIONS: Swimming pool workers were identified from three states where the pool environment was either a trigger of preexisting asthma or associated with new onset of WRA. Regulations to require air monitoring and improvements in ventilation are recommended to reduce exposure levels of chloramines, the presumed etiologic agents. Clinical assessment of patients with asthma should include consideration of the effect on respiratory symptoms from exposures in a swimming pool environment.

Health risk assessment related to dermal exposure of chlorpyrifos: a case study of rice growing farmers in Nakhon Nayok Province, Central Thailand.

To date, pesticides, especially organophosphate pesticide such as chlorpyrifos, have been frequently applied to paddy fields over time to maintain product quality, protect agricultural crops from various pests, and increase yield. This study evaluates dermal exposure to chlorpyrifos in rice farmers along with providing a health risk assessment. Thirty-five rice farmers participated and completed an in-person interview, and patch technique was used to evaluate dermal exposure to chlorpyrifos. The chlorpyrifos residue was extracted from the gauze patches and quantified by gas chromatography equipped with flame photometric detector (GC-FPD). The results showed that chlorpyrifos concentrations were greater in males (526.34 ± 478.84 mg/kg) than females (500.75 ± 595.15 mg/kg). Average daily dose sampled from seven points on male and female farmers were 31.72 × 10(-4), 193.32 × 10(-4), 5.38 × 10(-4), 190.48 × 10(-4), 170.47 × 10(-4), 465.91 × 10(-4), and 43.04 × 10(-4) mg/kg-day. The hazard quotient (HQ) at the mean and 95th percentile level was found to be greater than acceptable (HQ > 1). Rice-growing farmers in this area may be at risk for adverse health effects due to continuous dermal exposure to chlorpyrifos from their improper use of personal protective equipment (PPE).

Health risk reduction behaviors model for scavengers exposed to solid waste in municipal dump sites in Nakhon Ratchasima Province, Thailand.

The aim of this study was to evaluate the effect of comprehensive health risk protection behaviors, knowledge, attitudes, and practices among scavengers in open dump sites. A control group of 44 scavengers and an intervention group of 44 scavengers participated in this study. Interventions included the use of personal protective equipment, health protection training, and other measures. The analysis showed significant differences before and after the intervention program and also between the control and intervention groups. These observations suggest that further action should be taken to reduce adverse exposure during waste collection. To reduce health hazards to workers, dump site scavenging should be incorporated into the formal sector program. Solid waste and the management of municipal solid waste has become a human and environmental health issue and future research should look at constructing a sustainable model to help protect the health of scavengers and drive authorities to adopt safer management techniques.

Hepatic metallothionein and Glutathione-S-Transferase responses in two populations of rice frogs, Fejervarya limnocharis, naturally exposed to different environmental cadmium levels.

Glutathione-S-Transferase (GST) and metallothionein are important biomarker endpoints in studying the effect of Cd exposure. The purpose of this research was to study the correlation between hepatic GST and metallothionein with hepatic Cd in wild Fejervarya limnocharis exposed to environmental Cd. Results showed that frogs from contaminated sites had significantly higher hepatic metallothionein (3.58 mg/kg wet weight) and GST activity (0.259 µmol/min/mg total protein) than those from the reference site (2.36 mg/kg wet weight and 0.157 µmol/min/mg total protein respectively). There was a significantly positive correlation between hepatic Cd and GST activity (r = 0.802, p = 0.009) but not between hepatic Cd and metallothionein (r = 0.548, p = 0.139). The results concluded that while frogs from the contaminated site had higher GST and metallothionein, only GST showed significant positive correlation with hepatic Cd levels, indicating that hepatic GST activity may be used as a biomarker endpoint.

Perchlorate exposure in lactating women in an urban community in New Jersey.

Perchlorate is most widely known as a solid oxidant for missile and rocket propulsion systems although it is also present as a trace contaminant in some fertilizers. It has been detected in drinking water, fruits, and vegetables throughout New Jersey and most of the United States. At sufficiently high doses, perchlorate interferes with the uptake of iodine into the thyroid and may interfere with the development of the skeletal system and the central nervous system of infants. Therefore, it is important to quantify perchlorate in breast milk to understand potential perchlorate exposure in infants. In this study we measured perchlorate in breast milk, urine, and drinking water collected from 106 lactating mothers from Central New Jersey. Each subject was asked to provide three sets of samples over a 3-month period. The average±SD perchlorate level in drinking water, breast milk, and urine was 0.168±0.132 ng/mL (n=253), 6.80±8.76 ng/mL (n=276), and 3.19±3.64 ng/mL (3.51±6.79 µg/g creatinine) (n=273), respectively. Urinary perchlorate levels were lower than reference range values for women of reproductive age (5.16±11.33 µg/g creatinine, p=0.03), likely because of perchlorate secretion in breast milk. Drinking water perchlorate levels were ≤1.05 ng/mL and were not positively correlated with either breast milk or urine perchlorate levels. These findings together suggest that drinking water was not the most important perchlorate exposure source for these women. Creatinine-adjusted urine perchlorate levels were strongly correlated with breast milk perchlorate levels (r=0.626, p=<0.0005). Breast milk perchlorate levels in this study are consistent with widespread perchlorate exposure in lactating women and thus infants. This suggests that breast milk may be a source of exposure to perchlorate in infants.

Inhalation exposure of organophosphate pesticides by vegetable growers in the Bang-Rieng subdistrict in Thailand.

This study investigated inhalation exposure to organophosphate pesticides (OPPs) and evaluated the associated health risks to vegetable growers living in the Bang-Rieng agricultural community. Air samples were collected by using personal sampling pumps with sorbent tubes placed in the vegetable growers' breathing zone. Samples were collected during both wet and dry seasons. Residues of organophosphate pesticides, that is, chlorpyrifos, dicrotofos, and profenofos, were analyzed from 33 vegetable growers and 17 reference subjects. Results showed that median concentrations of OPPs in air in farm areas were in the range of 0.022-0.056 mg/m(3) and air in nonfarm areas in the range of <0.0016-<0.005 mg/m(3). The concentration of the three pesticides in the vegetable growers was significantly higher than that of the references during both seasons. The results also indicate that the vegetable growers may be at risk for acute adverse effects via the inhalation of chlorpyrifos and dicrotofos during pesticide application, mixing, loading, and spraying. It is suggested that authorities and the community should implement appropriate strategies concerning risk reduction and risk management.

Analytical method developed for measurement of dialkylphosphate metabolites in urine collected from children non-occupationally exposed to organophosphate pesticides in an agricultural community in Thailand.

There has been increasing concern in regards to organophosphate (OP) pesticide exposure among farm workers and their families in Thailand's agricultural areas. Therefore, the development of an analytical method for estimating OP pesticide exposure is necessary to allow for monitoring of OP pesticide exposures within these populations. This paper describes an analytical method developed to measure dialkylphosphate (DAP) metabolites in urine. The methods in this study are important in the biological monitoring of OP metabolites in agricultural families in Thailand and can be used as an initial guidance procedure in any environmental toxicological laboratory in Thailand.

New Jersey migrant and seasonal farm workers: enumeration and access to healthcare study.

Despite the demanding physical labor Migrant and Seasonal Farm Workers (MSFW) provide to meet consumer demands and keep the nation's agricultural industry gainful, MSFWs are the most economically disadvantaged population in the nation. MSFWs lack sufficient access to health care and suffer more illnesses than the general population. Besides the difficulties in providing adequate health care to this population, enumeration of MSFWs has been an even greater challenge due to their mobility and illegal status. Through the analysis of secondary data sources, this study looks to approximate the number of MSFWs in the state of New Jersey and to investigate MSFW access to health care. Farm workers are a vital part of not only New Jersey's agricultural economy but also the entire nation's economy. Understanding the health needs of this population, and knowing the number of individuals that comprise this population, would not only help eliminate many health problems but it also would better prepare health officials in meeting the needs of the MSFW population.

Assessing and improving bioterrorism preparedness among first responders: a pilot study.

Following the September 11 terrorist attacks, the vulnerability of the United States became apparent. It also became evident that there was a need for respiratory protection. The purpose of this study was to determine the prior knowledge and perceptions of emergency medical technicians with respect to bioterrorism and to enhance their current knowledge to better prepare them for possible future events. The study was also designed to create a certified pool of trainers who would be capable of fit-testing all squad members with N-100 respirators. Representatives were recruited from each of the Hunterdon County, New Jersey, rescue squads. Participants attended a train-the-trainer session. Before the session and after, they were tested on knowledge and perceptions about relevant bioterrorism issues and were given an educational presentation on bioterrorism, threatening agents, respiratory health, and proper protection, along with being introduced to the fit-test steps for N-100 respirator masks. The response rate for the training was 94 percent. The authors measured and compared responses on the pre-test and the post-test with respect to knowledge, behaviors, and perceptions, and the results indicated a change following the training. The study thus provided evidence that the train-the-trainer program is an effective method of providing public health preparedness training to members of community organizations and agencies.

Vulnerability assessment of New Jersey's food supply to invasive species: the New Jersey IMPORT project.

The United States' environment and economy have been severely impacted by unintentionally introduced biological organisms for the last 100 years. Our ecosystems and biological reserves of conservation importance are regularly invaded by non-indigenous species. To help prevent future invaders from entering the ports, this project undertaken at the Port of Elizabeth proposed to: 1. Catalog the different vegetable and fruit crops entering this country; 2. Evaluate the potential risk to New Jersey crops that an introduced exotic pest might pose; and 3. Evaluate the potential that imported crops entering the U.S. have for harboring exotic pests. The New Jersey IMPORT report, or Invasive Management Promoting Open and Responsible Trade project, details a newly designed ecological risk assessment tool to evaluate entry potential of invasive pests at the Port of Elizabeth. Risk designations were assigned to shipments of four fruits; seven vegetables; and two field/forage crops based on: i) Country of origin; ii) Amounts of commodities imported; and iii) Endemic pests present in exporting countries. Between 5,000 and 180,000 tons of crops were imported into the Port of Elizabeth from October 2001 to 2003. Pest risk analyses were drafted for twenty-five intercepted insects taken from the Port Information Network. In addition, eighteen pest risk analyses were drafted for invasive fungi, bacteria, and viruses of global concern as alerted by ProMed Digest. It was concluded that three crops imported remain at high risk: apples, peppers, and tomatoes. Peaches, soybeans, lettuce, sweet corn, potatoes, squash, and eggplant imported were considered moderate risk. Blueberries, cranberries, and alfalfa were considered low risk.