Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 52
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
2.
Am J Ind Med ; 63(2): 105-114, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31743489

RESUMO

The burden and prognosis of malignant mesothelioma in the United States have remained largely unchanged for decades, with approximately 3200 new cases and 2400 deaths reported annually. To address care and research gaps contributing to poor outcomes, in March of 2019 the Mesothelioma Applied Research Foundation convened a workshop on the potential usefulness and feasibility of a national mesothelioma registry. The workshop included formal presentations by subject matter experts and a moderated group discussion. Workshop participants identified top priorities for a registry to be (a) connecting patients with high-quality care and clinical trials soon after diagnosis, and (b) making useful data and biospecimens available to researchers in a timely manner. Existing databases that capture mesothelioma cases are limited by factors such as delays in reporting, deidentification, and lack of exposure information critical to understanding as yet unrecognized causes of disease. National disease registries for amyotrophic lateral sclerosis (ALS) in the United States and for mesothelioma in other countries, provide examples of how a registry could be structured to meet the needs of patients and the scientific community. Small-scale pilot initiatives should be undertaken to validate methods for rapid case identification, develop procedures to facilitate patient access to guidelines-based standard care and investigational therapies, and explore approaches to data sharing with researchers. Ultimately, federal coordination and funding will be critical to the success of a National Mesothelioma Registry in improving mesothelioma outcomes and preventing future cases of this devastating disease.

3.
MMWR Morb Mortal Wkly Rep ; 68(46): 1081-1086, 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31751322

RESUMO

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). CDC has published recommendations for health care providers regarding EVALI (2-4). Recently, researchers from Utah and New York published proposed diagnosis and treatment algorithms for EVALI (5,6). EVALI remains a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis, and evaluation should be guided by clinical judgment. Because patients with EVALI can experience symptoms similar to those associated with influenza or other respiratory infections (e.g., fever, cough, headache, myalgias, or fatigue), it might be difficult to differentiate EVALI from influenza or community-acquired pneumonia on initial assessment; EVALI might also co-occur with respiratory infections. This report summarizes recommendations for health care providers managing patients with suspected or known EVALI when respiratory infections such as influenza are more prevalent in the community than they have been in recent months (7). Recommendations include 1) asking patients with respiratory, gastrointestinal, or constitutional symptoms about the use of e-cigarette, or vaping, products; 2) evaluating those suspected to have EVALI with pulse oximetry and obtaining chest imaging, as clinically indicated; 3) considering outpatient management for clinically stable EVALI patients who meet certain criteria; 4) testing patients for influenza, particularly during influenza season, and administering antimicrobials, including antivirals, in accordance with established guidelines; 5) using caution when considering prescribing corticosteroids for outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections; 6) recommending evidence-based treatment strategies, including behavioral counseling, to help patients discontinue using e-cigarette, or vaping, products; and 7) emphasizing the importance of annual influenza vaccination for all persons aged ≥6 months, including patients who use e-cigarette, or vaping products.


Assuntos
Surtos de Doenças , Lesão Pulmonar/terapia , Guias de Prática Clínica como Assunto , Vaping/efeitos adversos , Humanos , Lesão Pulmonar/epidemiologia , Estados Unidos/epidemiologia
5.
MMWR Morb Mortal Wkly Rep ; 68(41): 919-927, 2019 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-31633675

RESUMO

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical partners are investigating a multistate outbreak of lung injury associated with the use of electronic cigarette (e-cigarette), or vaping, products. In late August, CDC released recommendations for health care providers regarding e-cigarette, or vaping, product use associated lung injury (EVALI) based on limited data from the first reported cases (1,2). This report summarizes national surveillance data describing clinical features of more recently reported cases and interim recommendations based on these data for U.S. health care providers caring for patients with suspected or known EVALI. It provides interim guidance for 1) initial clinical evaluation; 2) suggested criteria for hospital admission and treatment; 3) patient follow-up; 4) special considerations for groups at high risk; and 5) clinical and public health recommendations. Health care providers evaluating patients suspected to have EVALI should ask about the use of e-cigarette, or vaping, products in a nonjudgmental and thorough manner. Patients suspected to have EVALI should have a chest radiograph (CXR), and hospital admission is recommended for patients who have decreased blood oxygen (O2) saturation (<95%) on room air or who are in respiratory distress. Health care providers should consider empiric use of a combination of antibiotics, antivirals, or steroids based upon clinical context. Evidence-based tobacco product cessation strategies, including behavioral counseling, are recommended to help patients discontinue use of e-cigarette, or vaping, products. To reduce the risk of recurrence, patients who have been treated for EVALI should not use e-cigarette, or vaping, products. CDC recommends that persons should not use e-cigarette, or vaping, products that contain tetrahydrocannabinol (THC). At present, CDC recommends persons consider refraining from using e-cigarette, or vaping, products that contain nicotine. Irrespective of the ongoing investigation, e-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant. Persons who do not currently use tobacco products should not start using e-cigarette, or vaping, products.


Assuntos
Surtos de Doenças , Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar/terapia , Guias de Prática Clínica como Assunto , Vaping/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Humanos , Lesão Pulmonar/epidemiologia , Lesão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
6.
J Occup Environ Med ; 61(12): 1045-1051, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31626070

RESUMO

OBJECTIVE: The National Institute for Occupational Safety and Health (NIOSH) B Reader Program provides the opportunity for physicians to demonstrate proficiency in the International Labour Office (ILO) system for classifying radiographs of pneumoconioses. We summarize trends in participation and examinee attributes and performance during 1987 to 2018. METHODS: Since 1987, NIOSH has maintained details of examinees and examinations. Attributes of examinees and their examination performance were summarized. Simple linear regression was used in trend analysis of passing rates over time. RESULTS: The mean passing rate for certification and recertification for the study period was 40.4% and 82.6%, respectively. Since the mid-1990s, the number of B Readers has declined and the mean age and years certified have increased. CONCLUSIONS: To address the declining B Reader population, NIOSH is currently taking steps to modernize the program and offer more opportunities for training and testing.

7.
MMWR Morb Mortal Wkly Rep ; 68(36): 787-790, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31513561

RESUMO

On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.


Assuntos
Pneumopatias/epidemiologia , Guias de Prática Clínica como Assunto , Índice de Gravidade de Doença , Vaping/efeitos adversos , Humanos , Estados Unidos/epidemiologia
8.
Am J Ind Med ; 62(11): 927-937, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31461179

RESUMO

BACKGROUND: A cluster of severe lung disease occurred at a manufacturing facility making industrial machines. We aimed to describe disease features and workplace exposures. METHODS: Clinical, functional, radiologic, and histopathologic features were characterized. Airborne concentrations of thoracic aerosol, metalworking fluid, endotoxin, metals, and volatile organic compounds were measured. Facility airflow was assessed using tracer gas. Process fluids were examined using culture, polymerase chain reaction, and 16S ribosomal RNA sequencing. RESULTS: Five previously healthy male never-smokers, ages 27 to 50, developed chest symptoms from 1995 to 2012 while working in the facility's production areas. Patients had an insidious onset of cough, wheeze, and exertional dyspnea; airflow obstruction (mean FEV1 = 44% predicted) and reduced diffusing capacity (mean = 53% predicted); and radiologic centrilobular emphysema. Lung tissue demonstrated a unique pattern of bronchiolitis and alveolar ductitis with B-cell follicles lacking germinal centers, and significant emphysema for never-smokers. All had chronic dyspnea, three had a progressive functional decline, and one underwent lung transplantation. Patients reported no unusual nonoccupational exposures. No cases were identified among nonproduction workers or in the community. Endotoxin concentrations were elevated in two air samples; otherwise, exposures were below occupational limits. Air flowed from areas where machining occurred to other production areas. Metalworking fluid primarily grew Pseudomonas pseudoalcaligenes and lacked mycobacterial DNA, but 16S analysis revealed more complex bacterial communities. CONCLUSION: This cluster indicates a previously unrecognized occupational lung disease of yet uncertain etiology that should be considered in manufacturing workers (particularly never-smokers) with airflow obstruction and centrilobular emphysema. Investigation of additional cases in other settings could clarify the cause and guide prevention.

10.
Arch Environ Occup Health ; 74(1-2): 15-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30501580

RESUMO

The year 2017 marked the 50th anniversary of NIOSH's Respiratory Health Division (RHD). RHD began in 1967 as the Appalachian Laboratory for Occupational Respiratory Diseases (ALFORD), with a focus on coal workers' pneumoconiosis. ALFORD became part of NIOSH in 1971 and added activities to address work-related respiratory disease more generally. Health hazard evaluations played an important role in understanding novel respiratory hazards such as nylon flock, diacetyl, and indium-tin oxide. Epidemiologic and laboratory studies addressed many respiratory hazards, including coal mine dust, silica, asbestos, cotton dust, beryllium, diesel exhaust, and dampness and mold. Surveillance activities tracked the burden of diseases and enhanced the quality of spirometry and chest radiography used to screen workers. RHD's efforts to improve scientific understanding, inform strategies for prevention, and disseminate knowledge remain important now and for the future.


Assuntos
Pneumopatias/história , Doenças Profissionais/história , Exposição Ocupacional/história , História do Século XX , História do Século XXI , Humanos , Estados Unidos
13.
MMWR Morb Mortal Wkly Rep ; 67(30): 819-824, 2018 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-30070982

RESUMO

Coal workers' pneumoconiosis (CWP) is a preventable occupational lung disease caused by inhaling coal mine dust that can lead to premature* death (1,2). To assess trends in premature mortality attributed to CWP (3), CDC analyzed underlying† causes of death data from 1999 to 2016, the most recent years for which complete data are available. Years of potential life lost to life expectancy (YPLL) and years of potential life lost before age 65 years (YPLL65)§ were calculated (4). During 1999-2016, a total of 38,358 YPLL (mean per decedent = 8.8 years) and 2,707 YPLL65 (mean per decedent = 7.3 years) were attributed to CWP. The CWP-attributable YPLL decreased from 3,300 in 1999 to 1,813 in 2007 (p<0.05). No significant change in YPLL occurred after 2007. During 1996-2016, however, the mean YPLL per decedent significantly increased from 8.1 to 12.6 per decedent (p<0.001). Overall, CWP-attributable YPLL65 did not change. The mean YPLL65 per decedent decreased from 6.5 in 1999 to 4.3 in 2002 (p<0.05), sharply increased to 8.9 in 2005, and then gradually decreased to 6.5 in 2016 (p<0.001). Increases in YPLL per decedent during 1999-2016 indicate that over time decedents aged ≥25 years with CWP lost more years of life relative to their life expectancies, suggesting increased CWP severity and rapid disease progression. This finding underscores the need for strengthening proven prevention measures to prevent premature CWP-associated mortality.


Assuntos
Antracose/mortalidade , Minas de Carvão , Expectativa de Vida/tendências , Mortalidade Prematura/tendências , Doenças Profissionais/mortalidade , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
15.
MMWR Morb Mortal Wkly Rep ; 66(28): 747-752, 2017 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-28727677

RESUMO

Silicosis is usually a disease of long latency affecting mostly older workers; therefore, silicosis deaths in young adults (aged 15-44 years) suggests acute or accelerated disease.* To understand the circumstances surrounding silicosis deaths among young persons, CDC analyzed the underlying and contributing causes† of death using multiple cause-of-death data (1999-2015) and industry and occupation information abstracted from death certificates (1999-2013). During 1999-2015, among 55 pneumoconiosis deaths of young adults with International Classification of Diseases, Tenth Revision (ICD-10) code J62 (pneumoconiosis due to dust containing silica),§ 38 (69%) had code J62.8 (pneumoconiosis due to other dust containing silica), and 17 (31%) had code J62.0 (pneumoconiosis due to talc dust) listed on their death certificate. Decedents whose cause of death code was J62.8 most frequently worked in the manufacturing and construction industries and production occupations where silica exposure is known to occur. Among the 17 decedents who had death certificates listing code J62.0 as cause of death, 13 had certificates with an underlying or a contributing cause of death code listed that indicated multiple drug use or drug overdose. In addition, 13 of the 17 death certificates listing code J62.0 as cause of death had information on decedent's industry and occupation; among the 13 decedents, none worked in talc exposure-associated jobs, suggesting that their talc exposure was nonoccupational. Examining detailed information on causes of death (including external causes) and industry and occupation of decedents is essential for identifying silicosis deaths associated with occupational exposures and reducing misclassification of silicosis mortality.


Assuntos
Vigilância da População , Silicose/mortalidade , Adolescente , Adulto , Feminino , Humanos , Masculino , Estados Unidos/epidemiologia , Adulto Jovem
16.
Curr Allergy Asthma Rep ; 16(11): 77, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27796792

RESUMO

Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitizers or irritants including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review focuses on allergic occupational respiratory diseases in HCWs.


Assuntos
Alérgenos/efeitos adversos , Asma Ocupacional/diagnóstico , Pessoal de Saúde/estatística & dados numéricos , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Transtornos Respiratórios/etiologia , Rinite/diagnóstico , Humanos
17.
Semin Respir Crit Care Med ; 36(3): 433-48, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26024350

RESUMO

This review provides an update on literature published over the past 5 years that is relevant to using chest computed tomography (CT) as a tool for preventing occupational respiratory disease. An important area of investigation has been in the use of low-dose CT (LDCT) to screen asbestos-exposed populations for lung cancer. Two recent systematic reviews have reached conclusions in support of screening. Based on the limited evidence that is currently available, the Finnish Institute of Occupational Health has recommended LDCT screening in asbestos-exposed individuals if their personal combination of risk factors yields a risk for lung cancer equal to that needed for entry into the National Lung Screening Trial. It has also recommended further research, such as to document the optimal frequency of screening and the effectiveness of screening. Recent literature continues to support high-resolution CT (HRCT) as being more sensitive than chest radiography in detecting pneumoconiosis. However, there are insufficient data to determine the effectiveness of HRCT screening in improving individual outcomes if used in screening for pneumoconiosis and its routine use for this purpose cannot be recommended. However, if HRCT is used to evaluate populations, recent literature shows that the International Classification of HRCT for Occupational and Environmental Respiratory Diseases provides an important tool for reproducible evaluation and recording of findings. HRCT is an important tool for individual patient management and recent literature has documented that chest HRCT findings are significantly associated with outcomes such as pulmonary function and mortality.


Assuntos
Doenças Profissionais/prevenção & controle , Doenças Respiratórias/prevenção & controle , Tomografia Computadorizada por Raios X/métodos , Asbestose/diagnóstico por imagem , Asbestose/prevenção & controle , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/prevenção & controle , Programas de Rastreamento/métodos , Doenças Profissionais/diagnóstico por imagem , Pneumoconiose/diagnóstico por imagem , Pneumoconiose/prevenção & controle , Doenças Respiratórias/diagnóstico por imagem , Doenças Respiratórias/etiologia , Fatores de Risco
18.
J Occup Environ Med ; 56 Suppl 10: S18-22, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25285970

RESUMO

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.


Assuntos
Antracose/etiologia , Idoso , Antracose/diagnóstico , Antracose/mortalidade , Antracose/prevenção & controle , Causas de Morte , Carvão Mineral , Efeitos Psicossociais da Doença , Estudos Transversais , Diagnóstico Diferencial , Poeira , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estados Unidos
20.
Am J Respir Crit Care Med ; 189(8): 983-93, 2014 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-24735032

RESUMO

PURPOSE: This document addresses aspects of the performance and interpretation of spirometry that are particularly important in the workplace, where inhalation exposures can affect lung function and cause or exacerbate lung diseases, such as asthma, chronic obstructive pulmonary disease, or fibrosis. METHODS: Issues that previous American Thoracic Society spirometry statements did not adequately address with respect to the workplace were identified for systematic review. Medline 1950-2012 and Embase 1980-2012 were searched for evidence related to the following: training for spirometry technicians; testing posture; appropriate reference values to use for Asians in North America; and interpretative strategies for analyzing longitudinal change in lung function. The evidence was reviewed and technical recommendations were developed. RESULTS: Spirometry performed in the work setting should be part of a comprehensive workplace respiratory health program. Effective technician training and feedback can improve the quality of spirometry testing. Posture-related changes in FEV1 and FVC, although small, may impact interpretation, so testing posture should be kept consistent and documented on repeat testing. Until North American Asian-specific equations are developed, applying a correction factor of 0.88 to white reference values is considered reasonable when testing Asian American individuals in North America. Current spirometry should be compared with previous tests. Excessive loss in FEV1 over time should be evaluated using either a percentage decline (15% plus loss expected due to aging) or one of the other approaches discussed, taking into consideration testing variability, worker exposures, symptoms, and other clinical information. CONCLUSIONS: Important aspects of workplace spirometry are discussed and recommendations are provided for the performance and interpretation of workplace spirometry.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/etiologia , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Medicina do Trabalho/normas , Espirometria/normas , Asma/diagnóstico , Asma/etiologia , Medicina Baseada em Evidências , Volume Expiratório Forçado , Humanos , Vigilância da População , Postura , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/etiologia , Fibrose Pulmonar/diagnóstico , Fibrose Pulmonar/etiologia , Valores de Referência , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA