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 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.

Prediction of the length of service at the onset of coal workers' pneumoconiosis based on neural network.

Three environmental parameters, i.e. dust concentrations, dust dispersion, and free silica content, were introduced into the traditional indices of the neural network model in order to construct a new prediction index and explore a new method for preventing the incidence of pneumoconiosis with intelligent accuracy and universality. Data of the pneumoconiosis patients from Huabei Mining Group (HBMG) of China from 1980 to 2017 were collected. SPSS22.0 was used to develop the combined models based on Back Propagation (BP) neural network model, Radial Basis Function (RBF) neural network model, and Multiple Linear Regression (MLR) model. The paired sample t-test was performed between the real and predicted values. According to this model, it was predicted that 382 coal workers in HBMG were likely to suffer from pneumoconiosis in 2022 and the incidence rate was 4.48%. It is necessary to take prevention measures and transfer these workers from their current positions. In four combined models, the BP-MLR combined model achieved the optimal error parameters and the most accurate prediction. This study provided a scientific basis for effective control and prevention of the incidence of the pneumoconiosis.

Coal mining and lung disease in the 21st century.

PURPOSE OF REVIEW: To review the impact of coal mining and resurgence of coal workers' pneumoconiosis (CWP) in 21st century and effect of ambient air pollution on lung function. RECENT FINDINGS: At the beginning of 21st century, statistics by National Institute for Occupational Safety and Health showed a steep rise in pneumoconiosis. This was followed by numerous epidemiologic and pathologic studies that confirmed increasing CWP prevalence as well as disease in younger miners and those with a shorter mining tenure. Recent studies have demonstrated that poor dust control in mines, a relative shift in composition of the coal mine dust, small sized mines and increase in surface mining are all possible contributors to this resurgence. There is also growing literature evaluating the effects of worsening air pollution on health, including decreasing lung function and development of emphysema, worsening quality of life measures and lung cancer. SUMMARY: This irreversible but preventable disease currently haunts approximately 60 000 miners across United States and millions across the world. Its resurgence despite the strict dust regulations is a setback from the public health standpoint. The continued reliance on coal for energy will continue to place coal miners at danger of developing disease as well as the world.

Establishment and application of an index system for prevention of coal workers' pneumoconiosis: a Delphi and analytic hierarchy process study in four state-owned coal enterprises of China.

OBJECTIVE: To explore the difference of cumulative incidence rate of coal workers' pneumoconiosis (CWP) among four large state-owned coal enterprises in northern China, we created an index system for evaluating the quality of comprehensive measures against CWP and applied the system to evaluate and compare the measures of the four coal enterprises. METHODS: A two-round Delphi investigation was conducted to identify the indicators in the index system. The weight values of the indicators were calculated with analytic hierarchy process methods. Measures of CWP, mine annals, records and other information in each coal mine of the four enterprises were collected. The evaluation scores, which ranged from 0 to 100, were calculated and compared with. RESULTS: A three-grade index system with 3 first-grade indicators, 9 second-grade indicators and 44 tertiary-grade indicators was established. The expert authority coefficient (Cr ) was 0.75 and the Kendall's coefficient of concordance (Kendall's W) was 0.15 (χ2=193.30, P<0.001). The weight value of 'Geological conditions' was 0.43, equal to 'Dust control engineering technology', and that of 'Occupational health management' was 0.14. The medians and quartiles of the evaluation scores of comprehensive measures against CWP of the four enterprises were 58.38 (54.60~63.02), 64.63 (60.83~67.06), 72.99 (68.92~77.67) and 75.07 (70.73~79.20), respectively. CONCLUSIONS: The index system could be effectively used for evaluation and comparison of the comprehensive measures against CWP among different enterprises. The geological conditions and dust control engineering technology played an important role in preventing and controlling CWP.

Respiratory diseases caused by coal mine dust.

OBJECTIVE: To provide an update on respiratory diseases caused by coal mine dust. METHODS: This article presents the results of a literature review initially performed for an International Conference on Occupational and Environmental Lung Disease held in summer 2013. RESULTS: Coal mine dust causes a spectrum of lung diseases collectively termed coal mine dust lung disease (CMDLD). These include Coal Workers' Pneumoconiosis, silicosis, mixed dust pneumoconiosis, dust-related diffuse fibrosis (which can be mistaken for idiopathic pulmonary fibrosis), and chronic obstructive pulmonary disease. CMDLD continues to be a problem in the United States, particularly in the central Appalachian region. Treatment of CMDLD is symptomatic. Those with end-stage disease are candidates for lung transplantation. Because CMDLD cannot be cured, prevention is critical. CONCLUSIONS: Coal mine dust remains a relevant occupational hazard and miners remain at risk for CMDLD.

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.].

Coal mine dust lung disease. New lessons from old exposure.

Coal mining remains a sizable industry, with millions of working and retired coal miners worldwide. This article provides an update on recent advances in the understanding of respiratory health issues in coal miners and focuses on the spectrum of disease caused by inhalation of coal mine dust, termed coal mine dust lung disease. In addition to the historical interstitial lung diseases (coal worker's pneumoconiosis, silicosis, and mixed dust pneumoconiosis), coal miners are at risk for dust-related diffuse fibrosis and chronic airway diseases, including emphysema and chronic bronchitis. Recent recognition of rapidly progressive pneumoconiosis in younger miners, mainly in the eastern United States, has increased the sense of urgency and the need for vigilance in medical research, clinical diagnosis, and exposure prevention. Given the risk for disease progression even after exposure removal, along with few medical treatment options, there is an important role for chest physicians in the recognition and management of lung disease associated with work in coal mining.

Laboratory studies of the impact of calcite on in vitro and in vivo effects of coal dust: a potential preventive agent for coal workers' pneumoconiosis?

BACKGROUND: Bioavailable iron (BAI) in coal, which may play a key role in causing coal workers' pneumoconiosis (CWP), is present at relatively high levels in Appalachian coals. Calcite decreases BAI and is more plentiful in Western coals than in Appalachian coals, possibly explaining the lower CWP prevalence among Western miners. METHODS: We measured effects of calcite on BAI in non-cellular and cellular systems involving Pennsylvania (PA) coal dust. We also tested in vivo effects of calcite on transferrin receptor and markers of epithelial mesenchymal transition (EMT) and inflammation in mice exposed to PA coal. RESULTS: Calcite rapidly eliminated BAI in an aqueous suspension of PA coal. Ferritin induction in human lung epithelial cells exposed to PA coal was effectively eliminated by calcite. Mouse lung tissue markers indicated increased EMT after exposure to PA coal dust, but not after exposure to PA coal plus calcite. Markers of inflammation increased following exposure to PA coal alone, but not following exposure to PA coal plus calcite. CONCLUSION: Additional research may lead to the use of supplemental calcite in coal mining as a safe and effective way to prevent CWP among Appalachian coal miners.

"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.

[Epidemiological analysis of new cases of pneumoconiosis in Ningxia Hui Autonomous Region, China from 2006 to 2010].

OBJECTIVE: To investigate the epidemiological characteristics of pneumoconiosis in Ningxia Hui Autonomous Region, China from 2006 to 2009. METHODS: Statistical analysis was performed on the types, populations, ages, and geographic distribution of the pneumoconiosis cases in Ningxia from 2006 to 2010, as reported in China Information System for Diseases Control and Prevention. RESULTS: A total of 625 new cases of pneumoconiosis (4 death cases) occurred throughout Ningxia from 2006 to 2010. Of the new cases, 538 (86.1%) suffered stage I pneumoconiosis, 70 (11.2%) stage II pneumoconiosis, and 17 (2.72%) stage III pneumoconiosis. Silicosis and coal-workers' pneumoconiosis were the dominant types of pneumoconiosis, accounting for 97.44% (609/625) of all cases. Of the 625 cases, 557 (89.12%) were distributed in Shizuishan City, and 563 (90.08%) were engaged in coal and metallurgical industries. Most cases were in the 35-year-old group and 45-year-old group, and the lengths of dust-exposed service mostly ranged from 10 to 29 years. CONCLUSION: In Ningxia, pneumoconiosis control should focus in the state-owned, middle-sized coal enterprises in Shizuishan City. Health surveillance should be enhanced in the workers with more than 10 years of dust-exposed service or aged more than 35 years, so as to reduce the incidence of occupational diseases.

The influence of dust standards on the prevalence and severity of coal worker's pneumoconiosis at autopsy in the United States of America.

CONTEXT: Coal worker's pneumoconiosis is a major occupational lung disease in the United States. The disease is primarily controlled through reducing dust exposure in coal mines using technological improvements and through the establishment of dust standards by regulatory means. OBJECTIVE: To determine if dust standards established in the US Federal Coal Mine Health and Safety Act of 1969 have reduced the prevalence and severity of coal worker's pneumoconiosis. DESIGN: The study population included materials from 6103 deceased coal miners submitted to the National Coal Workers' Autopsy Study from 1971 through 1996. Type and severity of coal worker's pneumoconiosis were classified using standardized diagnostic criteria. RESULTS: Among miners who worked exclusively prior to the 1969 dust standard, 82.6% had coal macules, 46.3% coal nodules, 28.2% silicotic nodules, and 10.3% progressive massive fibrosis. Lower prevalences were noted among miners exposed exclusively to post-1970 dust levels: 58.8% had coal macules, 15.0% coal nodules, 8.0% silicotic nodules, and 1.2% progressive massive fibrosis. The differences in prevalence were highly significant (P < .001) for all types of pneumoconiosis, including progressive massive fibrosis, after adjustment for age, years of mining, and smoking status. CONCLUSIONS: The study confirms a beneficial impact of the first 25 years of the dust standard established by the 1969 act on the prevalence and severity of coal worker's pneumoconiosis in US coal miners. However, pneumoconiosis continues to occur among miners who have worked entirely within the contemporary standard, suggesting a need for further reductions in exposure to respirable coal mine dust.

[Value of oxygenic injury sensitive index in the screening of the early coal workers' pneumoconiosis].

OBJECTIVE: To study the significance of oxidative injury in the screening of coal workers' pneumoconiosis (CWP). METHODS: With the method of nitrate reductase, TBA, et al, the content of NO, MDA and other indexes of peroxidation in plasma lipid were detected in 112 patients suffering from coal workers' pneumoconiosis and 114 healthy coal workers as controls. RESULTS: There were statistical significant between two groups (P < 0.05) with the content or density of MDA, CuZn-SOD, GSH-Px, T-AOC, UA, NO and iNOS except CP. As screening index of pneumoconiosis, there were statistical significant in area under the curve (AUC) of MDA, T-AOC, NO and iNOS between the two groups by ROC. As screening index of pneumoconiosis, MDA, T-AOC, NO and iNOS can be selected as early screening index. Especially, T-AOC was the best index of four indexes (sensitivity is 70.5%, specificity is 68.1%). CONCLUSION: Joint screening of MDA, T-AOC and iNOS is better than single index or series of T-AOC and MDA to the screening of CWP.