Legionnaires' disease in transportation, construction and other occupations in 39 US jurisdictions, 2014-2016.

BACKGROUND: Certain workers are at increased risk for acquiring Legionnaires' disease compared with other workers. This study aims to identify occupations at increased risk for acquiring Legionnaires' disease. METHODS: Using data from the US Centers for Disease Control and Prevention's Supplemental Legionnaires' Disease Surveillance System, this study identified Legionnaires' disease confirmed patients ≥16 years of age in 39 states with reported symptom onset during 2014-2016. Age-adjusted and sex-adjusted incidence rate ratios (IRR) stratified by occupation group were calculated by comparing Legionnaires' disease patients in an occupation group (eg, transportation) to those in all other occupation groups (eg, non-transportation). RESULTS: A total of 2553 patients had a known occupation group. The two occupations with the highest burden were transportation (N=287; IRR=2.11) and construction (N=269; IRR=1.82). Truck drivers comprised the majority (69.7%) of the transportation occupation group and construction labourers comprised almost half (49%) of the construction occupation group. The healthcare support occupation had the highest IRR (N=75; IRR=2.16). CONCLUSION: Transportation and construction workers, who are generally not covered by guidance related to building water systems, have increased risk of Legionnaires' disease compared with other workers. One hypothesised risk factor for truck drivers is the use of non-genuine windshield cleaner in their vehicles. A simple intervention is to use genuine windshield cleaner with bactericidal properties (ie, includes isopropanol/methanol) which can reduce the risk of Legionella growth and transmission. To improve surveillance of Legionnaires' disease and identification of similar exposures, the authors encourage the collection of occupation and industry information for all patients with Legionnaires' disease.

Excess risk of SARS-CoV-2 infection among in-person nonhealthcare workers in six states, September 2020-June 2021.

BACKGROUND: While the occupational risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for healthcare personnel in the United States has been relatively well characterized, less information is available on the occupational risk for workers employed in other settings. Even fewer studies have attempted to compare risks across occupations and industries. Using differential proportionate distribution as an approximation, we evaluated excess risk of SARS-CoV-2 infection by occupation and industry among non-healthcare workers in six states. METHODS: We analyzed data on occupation and industry of employment from a six-state callback survey of adult non-healthcare workers with confirmed SARS-CoV-2 infection and population-based reference data on employment patterns, adjusted for the effect of telework, from the U.S. Bureau of Labor Statistics. We estimated the differential proportionate distribution of SARS-CoV-2 infection by occupation and industry using the proportionate morbidity ratio (PMR). RESULTS: Among a sample of 1111 workers with confirmed SARS-CoV-2 infection, significantly higher-than-expected proportions of workers were employed in service occupations (PMR 1.3, 99% confidence interval [CI] 1.1-1.5) and in the transportation and utilities (PMR 1.4, 99% CI 1.1-1.8) and leisure and hospitality industries (PMR 1.5, 99% CI 1.2-1.9). CONCLUSIONS: We found evidence of significant differences in the proportionate distribution of SARS-CoV-2 infection by occupation and industry among respondents in a multistate, population-based survey, highlighting the excess risk of SARS-CoV-2 infection borne by some worker populations, particularly those whose jobs require frequent or prolonged close contact with other people.

Reported Exposures Among In-Person Workers With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in 6 States, September 2020-June 2021.

BACKGROUND: Surveillance systems lack detailed occupational exposure information from workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The National Institute for Occupational Safety and Health partnered with 6 states to collect information from adults diagnosed with SARS-CoV-2 infection who worked in person (outside the home) in non-healthcare settings during the 2 weeks prior to illness onset. METHODS: The survey captured demographic, medical, and occupational characteristics and work- and non-work-related risk factors for SARS-CoV-2 infection. Reported close contact with a person known or suspected to have SARS-CoV-2 infection was categorized by setting as exposure at work, exposure outside of work only, or no known exposure/did not know. Frequencies and percentages of exposure types are compared by respondent characteristics and risk factors. RESULTS: Of 1111 respondents, 19.4% reported exposure at work, 23.4% reported exposure outside of work only, and 57.2% reported no known exposure/did not know. Workers in protective service occupations (48.8%) and public administration industries (35.6%) reported exposure at work most often. More than one third (33.7%) of respondents who experienced close contact with ≥10 coworkers per day and 28.8% of respondents who experienced close contact with ≥10 customers/clients per day reported exposures at work. CONCLUSIONS: Exposure to occupational SARS-CoV-2 was common among respondents. Examining differences in exposures among different worker groups can help identify populations with the greatest need for prevention interventions. The benefits of recording employment characteristics as standard demographic information will remain relevant as new and reemerging public health issues occur.

Industry-specific prevalence of elevated blood lead levels among Pennsylvania workers, 2007-2018.

OBJECTIVES: To use industry-specific denominators to more accurately examine trends in prevalence rates for occupational cases of elevated blood lead levels (eBLLs) in Pennsylvania. METHODS: We used adult (aged ≥16 years) blood lead level data from Pennsylvania (2007-2018) and industry-specific denominator data from the US Census Bureau's County Business Patterns to calculate prevalence rates for eBLLs, defined as ≥25 µg/dL. RESULTS: Of the 19 904 cases with eBLLs, 92% were due to occupational lead exposure, with 83% from workers in the battery manufacturing industry. In 2018, the prevalence rate of eBLLs for battery manufacturing (8036.4 cases per 100 000 employed battery manufacturing workers) was 543 times the overall Pennsylvania prevalence rate. The prevalence rate for battery manufacturing steeply declined 71% from 2007 to 2018. CONCLUSIONS: The battery manufacturing industry had the highest burden of occupational lead exposure in Pennsylvania, illustrating the importance of using industry-specific denominators to accurately identify sources of lead exposure. Although the prevalence rate of eBLLs declined over time, lead exposure remains a major concern among battery manufacturing workers.

Anhydrous Ammonia Chemical Release - Lake County, Illinois, April 2019.

On April 25, 2019, a farm tractor towing two 2-ton ammonia tanks on a county road in Lake County, Illinois, experienced a mechanical failure that resulted in the release of anhydrous ammonia, a colorless, pungent, irritating gas that can cause severe respiratory and ocular damage (1). Approximately 80% of anhydrous ammonia produced in the United States is used as a fertilizer in agriculture (1). Eighty-three persons, including first responders, motorists, and neighborhood residents, were evaluated at area hospitals because of exposure to the gas. Two weeks after the release, the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC's National Center for Environmental Health (NCEH) collaborated with the Lake County Health Department and the Illinois Department of Public Health on an investigation using ATSDR's Assessment of Chemical Exposures program to describe the release, review the emergency response, and determine health effects associated with the exposure. First responders, community residents, and hospital personnel reported communication challenges related to the nature of the gas release and effective protective measures. Among the 83 persons evaluated at six area hospitals for effects of the chemical release, 14 (17%) were hospitalized, including eight (10%) who were admitted to the intensive care unit (ICU), seven (8%) of whom required endotracheal intubation and mechanical ventilation; no deaths occurred. In addition, ICU health care providers experienced symptoms of secondary exposure. The National Institute for Occupational Safety and Health's Emergency Responder Health Monitoring and Surveillance Program has specific recommendations and tools to protect responders during all phases of a response (2). Hospitals also need to review institutional policies and procedures for chemical mass casualty events, including decontamination (3). Prompt and correct identification of hazardous material (hazmat) events, and clear communication among responding entities, including on-scene and hospital responders, is important to ensure effective response after a chemical release.

Symptom Profiles of a Convenience Sample of Patients with COVID-19 - United States, January-April 2020.

Coronavirus disease 2019 (COVID-19) was first detected in the United States in January 2020 (1), and by mid-July, approximately 3.4 million cases had been reported in the United States (2). Information about symptoms among U.S. COVID-19 patients is limited, especially among nonhospitalized patients. To better understand symptom profiles of patients with laboratory-confirmed COVID-19 in the United States, CDC used an optional questionnaire to collect detailed information on a convenience sample of COVID-19 patients from participating states. Symptom data were analyzed by age group, sex, hospitalization status, and symptom onset date relative to expansion of testing guidelines on March 8, 2020 (3). Among 164 symptomatic patients with known onset during January 14-April 4, 2020, a total of 158 (96%) reported fever, cough, or shortness of breath. Among 57 hospitalized adult patients (aged ≥18 years), 39 (68%) reported all three of these symptoms, compared with 25 (31%) of the 81 nonhospitalized adult patients. Gastrointestinal (GI) symptoms and other symptoms, such as chills, myalgia, headache, and fatigue, also were commonly reported, especially after expansion of testing guidelines. To aid prompt recognition of COVID-19, clinicians and public health professionals should be aware that COVID-19 can cause a wide variety of symptoms.

Descriptive evaluation of methods for identifying work-related emergency department injury visits.

BACKGROUND: Use of worker's compensation (WC) as payer underestimates work-related (WR) injuries. We evaluated three methods to identify WR injuries: WC as payer, ICD-9-CM work-status codes E000.0/E000.1, and other ICD-9-CM external cause codes. METHODS: We identified injury-related emergency department visits from North Carolina's syndromic surveillance system (2010-2013). Characteristics were compared by indicator. We manually reviewed 800 admission notes to confirm if the visit was WR or non-WR; WR keywords from the review were applied to all visits. RESULTS: 133 156 injury-related visits (age, 16 years or older) were identified: WC = 69%, work-status codes = 18%, other ICD-9-CM codes = 13%. Among manually reviewed visits: few visits identified by WC (0.3%) or work-status codes (2%) were non-WR, while 12% of other ICD-9-CM code identified visits were non-WR; 53%, 46%, and 31% of visits identified by WC, work-status codes, and other ICD-9-CM codes were WR, respectively. CONCLUSIONS: Findings support use of WC and work-status codes to capture WR injuries; other ICD-9-CM codes should be used with caution or in combination with other indicators.

Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths - United States, 2007-2012.

The opioid epidemic affects multiple segments of the U.S. population (1). Occupational patterns might be critical to understanding the epidemic. Opioids are often prescribed for specific types of work-related injuries, which vary by occupation* (2). CDC used mortality data from the National Occupational Mortality Surveillance (NOMS) system to examine unintentional or undetermined drug overdose mortality within 26 occupation groups. This study included data from the 21 U.S. states participating in NOMS during 2007-2012.† Drug overdose mortality was compared with total mortality using proportional mortality ratios (PMRs) indirectly standardized for age, sex, race, year, and state. Mortality patterns specific to opioid-related overdose deaths were also assessed. Construction occupations had the highest PMRs for drug overdose deaths and for both heroin-related and prescription opioid-related overdose deaths. The occupation groups with the highest PMRs from methadone, natural and semisynthetic opioids, and synthetic opioids other than methadone were construction, extraction (e.g., mining, oil and gas extraction), and health care practitioners. The workplace is an integral part of life for the majority of the adult U.S. population; incorporating workplace research and interventions likely will benefit the opioid epidemic response.

Persistence of livestock-associated antibiotic-resistant Staphylococcus aureus among industrial hog operation workers in North Carolina over 14 days.

OBJECTIVES: This study aimed to evaluate the persistence of nasal carriage of Staphylococcus aureus, methicillin-resistant S. aureus and multidrug-resistant S. aureus over 14 days of follow-up among industrial hog operation workers in North Carolina. METHODS: Workers anticipating at least 24 h away from work were enrolled June-August 2012. Participants self-collected a nasal swab and completed a study journal on the evening of day 1, and each morning and evening on days 2-7 and 14 of the study. S. aureus isolated from nasal swabs were assessed for antibiotic susceptibility, spa type and absence of the scn gene. Livestock association was defined by absence of scn. RESULTS: Twenty-two workers provided 327 samples. S. aureus carriage end points did not change with time away from work (mean 49 h; range >0-96 h). Ten workers were persistent and six were intermittent carriers of livestock-associated S. aureus. Six workers were persistent and three intermittent carriers of livestock-associated multidrug-resistant S. aureus. One worker persistently carried livestock-associated methicillin-resistant S. aureus. Six workers were non-carriers of livestock-associated S. aureus. Eighty-two per cent of livestock-associated S. aureus demonstrated resistance to tetracycline. A majority of livestock-associated S. aureus isolates (n=169) were CC398 (68%) while 31% were CC9. No CC398 and one CC9 isolate was detected among scn-positive isolates. CONCLUSIONS: Nasal carriage of livestock-associated S. aureus, multidrug-resistant S. aureus and methicillin-resistant S. aureus can persist among industrial hog operation workers over a 14-day period, which included up to 96 h away from work.

Non-Fatal Work-Related Farm Injuries Occurring to Michigan Adults and Youths.

Farming is one of the top industries in Michigan and has the highest fatality rate. National sources of non-fatal farm injuries underestimate the burden, especially among children. In this paper, we provide a more accurate estimate of non-fatal farm injuries in Michigan by using an ongoing multi-source surveillance system. Michigan's farm-injury surveillance system includes abstractions of hospital-based medical records, poison control center calls, ambulance runs, and workers' compensation claims for individuals with a farm-related injury. For this analysis, injury onset occurred in 2015 to 2021 and included all injuries regardless of age or occupation. We identified 4,306 injuries in adults and 336 injuries in youth. For those 0-13 years of age all but two were family members. For those 14-15 and 16-17 years of age, 19% and 45%, respectively were hired hands. For adults, 51% were owner/operators, 43% were hired hands, and 5% were family members. For all ages, the most frequent injury source was cattle. Lacerations/cuts/punctures were the most common type of injury for those < 14 years of age while for older individuals it was contusions/bruises. The plurality of injuries occurred in the summer months. Children working on a farm are in unique situation and tracking injuries and identifying injury sources provide necessary information to protect their health and well-being. Michigan's farm-injury surveillance system will continue to provide a comprehensive count of work-related injuries among Michigan's farming population. The information is used to direct public health intervention both at the individual and population level.

Evaluation and Revision of Historical ESSENCE Syndromic Surveillance Definition Used to Identify Work-Related Emergency Department Visits.

OBJECTIVES: Occupational health surveillance programs have rarely incorporated syndromic surveillance. We documented a process for evaluating and revising syndromic surveillance definitions, using the example of work-related emergency department (ED) visits. MATERIALS AND METHODS: Of 140 331 481 ED visits in the National Syndromic Surveillance Program from May 15, 2016, through October 31, 2017, we extracted 391 827 records for phase 1 that met the previously unevaluated original work-related definition or included a work-related employment status ICD-10-CM code (Y99.0/Y99.1; International Classification of Diseases, Tenth Revision, Clinical Modification). Also for phase 1, we evaluated the performance of the original work-related definition using ICD-10-CM work-related employment status codes as a reference standard. In phase 2, we extracted 99 109 records containing candidate work-related keywords. Finally, in phase 3, we examined individual keywords and developed and evaluated a revised definition. RESULTS: The revised work-related definition identified 259 153 visits by keyword alone, 104 342 visits by ICD-10-CM work-related employment status codes alone, and 16 385 ED visits by both methods. Sensitivity (13.6% vs 11.3%) and positive predictive value (5.9% vs 4.8%) were higher for the revised definition than for the original work-related definition. Manual review indicated that 91.3% (95% CI, 89.6%-93.0%) of visits identified by the revised definition keywords met the study criteria for work-related visits as compared with 75.5% (95% CI, 73.0%-78.4%) of visits for the original work-related definition. PRACTICE IMPLICATIONS: The original work-related definition performed suboptimally because keywords were not sufficiently specific. The revised definition is an improvement but requires testing in real-world scenarios. The presented methods for developing a syndromic surveillance definition are useful, not only for occupational health, but for identification of other subpopulations treated in the ED.

A population-based epidemiologic study of emergency department visits for anaphylaxis in Florida.

BACKGROUND: Previous population-based analyses of emergency department (ED) visits for anaphylaxis have been limited to small populations in limited geographic areas and focused on children or have included patients who had allergic conditions other than anaphylaxis. OBJECTIVE: We sought to describe the epidemiology and risk factors among patients with anaphylaxis presenting to Florida EDs. METHODS: Two thousand seven hundred fifty-one patients with anaphylaxis were identified for 2005-2006 within ED records by using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and a validated ICD-9-CM-based algorithm. Age- and sex-specific rates were calculated. Regression analyses were used to determine relative risks for anaphylaxis caused by various triggers (food, venom, and medication) and risk factors (age, sex, race, and ethnicity). RESULTS: The highest observed rates were among the youngest male subjects (8.2/100,000 Floridians aged 0-4 years) and among adult female subjects (15-54 years) grouped in 10-year age categories (9.9-10.9/100,000 Floridians). Male and black subjects were 20% and 25%, respectively, more likely to have a food trigger than female and white subjects. White, male, and older subjects were more likely to have an anaphylaxis-related ED visit caused by insect stings. Venom-induced anaphylaxis was more likely in August through October. Children were less likely than those older than 70 years (referent) to have medication-induced anaphylaxis (P < .03). CONCLUSION: This is the only ED-based population study in a US lower-latitude state. The overall rate is considerably lower than other US ED-based population studies. The rates of anaphylaxis by age group differed by sex. Male and black subjects were more likely to have a food trigger.

Review of unintentional non-fire-related carbon monoxide poisoning morbidity and mortality in Florida, 1999-2007.

OBJECTIVE: Previous Florida evaluations of carbon monoxide (CO) poisoning have been disaster focused. The majority of prevention messages and risk-factor identification efforts have revolved around hurricane season (June-November). We evaluated the prevalence, risk factors, and causes of CO poisoning within Florida throughout the year to produce a more complete presentation of the burden of CO poisoning. METHODS: We obtained data from death certificates, hospital discharge records, and emergency department records. We limited our analysis to unintentional poisonings, calculating rates for age, gender, race, and ethnicity, and reviewing poisoning chronology, location, and exposure situation. RESULTS: From 1999 to 2007, 493 people were hospitalized, and 230 individuals died as a result of non-fire-related CO poisoning. From 2005 to 2007, 781 people visited emergency departments for non-fire-related CO poisoning. Rates of severe poisoning resulting in hospitalization or death were highest among the elderly (0.56 visits and 0.63 deaths per 100,000 Floridians). Acute poisoning rates were highest among people 25-34 years of age (2.48 visits per 100,000 Floridians). Poisonings were primarily due to motor vehicle exhaust (21%-69%) and generator exposure (12%-33%), and the majority (50%-70%) occurred within the home. A large number of poisonings (25%-29%) occurred during the winter months, outside of hurricane season. CONCLUSION: The findings of this study indicate a need for additional prevention strategies in conjunction with current activities to more effectively reduce the number of CO poisonings in Florida. Prevention activities should be conducted year-round, and additional strategies should include public awareness of the hazards of motor vehicle exhaust.

Algorithm for the diagnosis of anaphylaxis and its validation using population-based data on emergency department visits for anaphylaxis in Florida.

BACKGROUND: Epidemiologic studies of anaphylaxis have been limited by significant underdiagnosis. OBJECTIVE: The purpose of this study was to develop and validate a method for capturing previously unidentified anaphylaxis cases by using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) based datasets. METHODS: Florida emergency department data for the years 2005 and 2006 from the Florida Agency for Health Care Administration were used. Patients with anaphylaxis were identified by using ICD-9-CM codes specifically indicating anaphylaxis or an ICD-9-CM algorithm based on the definition of anaphylaxis proposed at the 2005 National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network symposium. Cases ascertained with the algorithm were compared with the traditional case-ascertainment method. Comparisons included demographic and clinical risk factors, proportion of monthly visits, and age/sex-specific rates. Cases ascertained with anaphylaxis ICD-9-CM codes were excluded from those ascertained with the algorithm. RESULTS: One thousand one hundred forty-nine patients were identified by using anaphylaxis ICD-9-CM codes, and 1,602 patients were identified with the algorithm. The clinical risk factors and demographics of cases were consistent between the 2 methods. However, the algorithm was more likely to identify older subjects (P < .0001), those with hypertension or heart disease (P < .0001), and subjects with venom-induced anaphylaxis (P < .0001). CONCLUSION: This study introduces and validates an ICD-9-CM-based diagnostic algorithm for the diagnosis of anaphylaxis to capture subjects missed by using the ICD-9-CM anaphylaxis codes. Fifty-eight percent of anaphylaxis cases would be missed without the use of the algorithm, including 88% of venom-induced cases.

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.

Deaths in Children and Adolescents Associated With COVID-19 and MIS-C in the United States.

OBJECTIVES: To describe the demographics, clinical characteristics, and hospital course among persons <21 years of age with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated death. METHODS: We conducted a retrospective case series of suspected SARS-CoV-2-associated deaths in the United States in persons <21 years of age during February 12 to July 31, 2020. All states and territories were invited to participate. We abstracted demographic and clinical data, including laboratory and treatment details, from medical records. RESULTS: We included 112 SARS-CoV-2-associated deaths from 25 participating jurisdictions. The median age was 17 years (IQR 8.5-19 years). Most decedents were male (71, 63%), 31 (28%) were Black (non-Hispanic) persons, and 52 (46%) were Hispanic persons. Ninety-six decedents (86%) had at least 1 underlying condition; obesity (42%), asthma (29%), and developmental disorders (22%) were most commonly documented. Among 69 hospitalized decedents, common complications included mechanical ventilation (75%) and acute respiratory failure (82%). The sixteen (14%) decedents who met multisystem inflammatory syndrome in children (MIS-C) criteria were similar in age, sex, and race and/or ethnicity to decedents without MIS-C; 11 of 16 (69%) had at least 1 underlying condition. CONCLUSIONS: SARS-CoV-2-associated deaths among persons <21 years of age occurred predominantly among Black (non-Hispanic) and Hispanic persons, male patients, and older adolescents. The most commonly reported underlying conditions were obesity, asthma, and developmental disorders. Decedents with coronavirus disease 2019 were more likely than those with MIS-C to have underlying medical conditions.

Quality of life for patients living with ostomies: influence of contact with an ostomy nurse.

PURPOSE: This study was conducted to determine whether or not contact with a WOC nurse improves quality of life for ostomy patients. METHODOLOGY: Home health care agencies, hospitals, and a durable medical equipment company in northern Florida were contacted to participate in the study. The role of the participating facilities was to address the provided envelopes and mail the patient survey packet (introductory letter, Ostomy Quality of Life Questionnaire [OQLQ], and demographic survey) directly to the patient. RESULTS: The mean age or respondents was 62 years, and the mean time of living with an ostomy was 10 years. Ninety-six percent of the sample participants did not attend support groups, yet nearly 50% reported receiving education following discharge home. Analysis of OQLQ scores revealed statistically significant differences based on who the respondent lived with, the number of comorbidities, how the respondent received supplies, and the type of appliance worn. There was no significant difference between respondents who saw an ostomy nurse and those who did not among the various sections of the OQLQ, even though 83% indicated seeing an ostomy nurse. Body image was a concern to respondents. CONCLUSION: The data demonstrated that most participants maintained satisfactory quality of life despite the presence of an ostomy. Individuals who were working part-time had a better health-related quality of life than those who worked full-time. More than 50% of our study sample participants reported satisfaction with the healthcare services they received, regardless of whether services were provided by a WOC or a nonspecialist nurse.

PACE EH post project assessment of quality of life changes in a Florida community related to infrastructure improvements.

The Indian River county health department, environmental health division (IRCHD EH) in Florida implemented the Protocol for Assessing Community Excellence in Environmental Health (PACE EH) in the low-income community of West Wabasso, Florida. Over two and a half years, IRCHD EH worked with the community and various governmental agencies to bring much-needed improvements to the area. At the end of the two and a half years, a survey was conducted to discover if the residents' quality of life had increased due to the community's improvements. The survey results yielded high satisfaction rates among residents. The general response was that their feelings of safety and overall well-being attributed to infrastructure improvements in their community had increased significantly. An unforeseen benefit realized by all parties involved was a renewed trust in government. The majority of surveyed residents (91%) felt that governmental agencies were better able to respond to their issues.

Carbon monoxide poisoning in Florida during the 2004 hurricane season.

BACKGROUND: During August-September 2004, four major hurricanes hit Florida, resulting in widespread power outages affecting several million households. Carbon monoxide (CO) poisonings during this period were investigated to identify ways to prevent future poisoning. METHODS: Medical records from ten hospitals (two with hyperbaric oxygen chambers) were reviewed to identify individuals diagnosed with unintentional CO poisoning between August 13 and October 15, 2004. Multiple attempts were made to interview one person from each nonfatal incident. Medical examiner records and reports of investigations conducted by the U.S. Consumer Product Safety Commission of six fatal poisonings from five additional incidents were also reviewed. RESULTS: A total of 167 people treated for nonfatal CO poisoning were identified, representing 51 incidents. A portable, gasoline-powered generator was implicated in nearly all nonfatal incidents and in all fatal poisonings. Generators were most often located outdoors, followed by inside the garage, and inside the home. Telephone interviews with representatives of 35 (69%) incidents revealed that concerns about theft or exhaust most often influenced the choice of location. Twenty-six (74%) households did not own a generator before the hurricanes, and 86% did not have a CO detector at the time of the poisoning. Twenty-one (67%) households reported reading or hearing CO education messages before the incident. CONCLUSIONS: Although exposure to public education messages may have encouraged more appropriate use of generators, a substantial number of people were poisoned even when the devices were operated outdoors. Additional educational efforts and engineering solutions that reduce CO emission from generators should be the focus of public health activities.

Evaluation of the Components of the North Carolina Syndromic Surveillance System Heat Syndrome Case Definition.

OBJECTIVES: To improve heat-related illness surveillance, we evaluated and refined North Carolina's heat syndrome case definition. METHODS: We analyzed North Carolina emergency department (ED) visits during 2012-2014. We evaluated the current heat syndrome case definition (ie, keywords in chief complaint/triage notes or International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] codes) and additional heat-related inclusion and exclusion keywords. We calculated the positive predictive value and sensitivity of keyword-identified ED visits and manually reviewed ED visits to identify true positives and false positives. RESULTS: The current heat syndrome case definition identified 8928 ED visits; additional inclusion keywords identified another 598 ED visits. Of 4006 keyword-identified ED visits, 3216 (80.3%) were captured by 4 phrases: "heat ex" (n = 1674, 41.8%), "overheat" (n = 646, 16.1%), "too hot" (n = 594, 14.8%), and "heatstroke" (n = 302, 7.5%). Among the 267 ED visits identified by keyword only, a burn diagnosis or the following keywords resulted in a false-positive rate >95%: "burn," "grease," "liquid," "oil," "radiator," "antifreeze," "hot tub," "hot spring," and "sauna." After applying the revised inclusion and exclusion criteria, we identified 9132 heat-related ED visits: 2157 by keyword only, 5493 by ICD-9-CM code only, and 1482 by both (sensitivity = 27.0%, positive predictive value = 40.7%). Cases identified by keywords were strongly correlated with cases identified by ICD-9-CM codes (rho = .94, P < .001). CONCLUSIONS: Revising the heat syndrome case definition through the use of additional inclusion and exclusion criteria substantially improved the accuracy of the surveillance system. Other jurisdictions may benefit from refining their heat syndrome case definition.