Research gaps and needs for preventing worker fatigue in the transportation and utilities industries.

BACKGROUND: The transportation and utilities industries include establishments engaged in the movement of passengers and freight, or the provision of public power, water, and other services. Along with the warehousing industry, they make up the US National Occupational Research Agenda's Transportation, Warehousing and Utilities (TWU) industry sector. In 2018 the sector composed 5% of the US workforce, with approximately 8 million workers. TWU workers experienced 19% of all fatalities among U.S. workers in 2018 and 7% of total occupational injuries and illnesses. METHODS: Around-the-clock operations, heavy workloads, long and irregular shifts, complicated schedules, and time pressures characterize work across the US TWU sector. However, there are considerable differences in worker priorities and concerns between TWU industries. Major areas of concern within the sector include disparities in work schedules; required training for employee fatigue awareness and prevention; physical and mental job demands; and safety culture. RESULTS: Strategies for fatigue mitigation are critical to reduce the prevalence of injuries, safety-critical events, and crashes in TWU workers. Further research on the incidence and characterization of fatigue among TWU workers will guide the development of effective mitigation strategies. The influence of work scheduling on missed sleep opportunities and disrupted circadian rhythms should be determined. Evaluation of fatigue mitigation strategies can lead to the adoption of the most effective ones for each TWU industry. CONCLUSION: Implementation of effective strategies is critical for the health, safety, wellbeing, and productivity of workers in the TWU sector.

Vital signs: seat belt use among long-haul truck drivers--United States, 2010.

BACKGROUND: Motor vehicle crashes were the leading cause of occupational fatalities in the United States in 2012, accounting for 25% of deaths. Truck drivers accounted for 46% of these deaths. This study estimates the prevalence of seat belt use and identifies factors associated with nonuse of seat belts among long-haul truck drivers (LHTDs), a group of workers at high risk for fatalities resulting from truck crashes. METHODS: CDC analyzed data from its 2010 national survey of LHTD health and injury. A total of 1,265 drivers completed the survey interview. Logistic regression was used to examine the association between seat belt nonuse and risk factors. RESULTS: An estimated 86.1% of LHTDs reported often using a seat belt, 7.8% used it sometimes, and 6.0% never. Reporting never using a belt was associated with often driving ≥10 mph (16 kph) over the speed limit (adjusted odds ratio [AOR] = 2.9), working for a company with no written safety program (AOR = 2.8), receiving two or more tickets for moving violations in the preceding 12 months (AOR = 2.2), living in a state without a primary belt law (AOR = 2.1); and being female (AOR = 2.3). CONCLUSIONS: Approximately 14% of LHTDs are at increased risk for injury and death because they do not use a seat belt on every trip. Safety programs and other management interventions, engineering changes, and design changes might increase seat belt use among LHTDs. IMPLICATIONS FOR PUBLIC HEALTH: Primary state belt laws can help increase belt use among LHTDs. Manufacturers can use recently collected anthropometric data to design better-fitting and more comfortable seat belt systems.

Obesity and other risk factors: the national survey of U.S. long-haul truck driver health and injury.

BACKGROUND: Drivers of heavy and tractor-trailer trucks accounted for 56% of all production and nonsupervisory employees in the truck transportation industry in 2011. There are limited data for illness and injury in long-haul truck drivers, which prompted a targeted national survey. METHODS: Interviewers collected data during 2010 from 1,670 long-haul truck drivers at 32 truck stops across the 48 contiguous United States that were used to compute prevalence estimates for self-reported health conditions and risk factors. RESULTS: Obesity (69% vs. 31%, P < 0.01) and current smoking (51% vs. 19%, P < 0.01) were twice as prevalent in long-haul truck drivers as in the 2010 U.S. adult working population. Sixty-one percent reported having two or more of the risk factors: hypertension, obesity, smoking, high cholesterol, no physical activity, 6 or fewer hours of sleep per 24-hr period. CONCLUSION: Survey findings suggest a need for targeted interventions and continued surveillance for long-haul truck drivers.

Pulmonary azygous lobe--an anatomical variant.

Pulmonary azygous lobe is one of the common lung malformations. There is only few article about azygous lobe. Its a small accessory lobe sometimes found on the upper part of the right lung, separated from the rest of the upper lobe by a deep groove lodging the ayzygous vein. This reports decribes the presence of azygous lobe, a rare anatomical variant, encounted during chest x-ray discussion. We describe here the anatomical basis and the clinical significance of azygous lobe.

Occupational exposures to respirable crystalline silica during hydraulic fracturing.

This report describes a previously uncharacterized occupational health hazard: work crew exposures to respirable crystalline silica during hydraulic fracturing. Hydraulic fracturing involves high pressure injection of large volumes of water and sand, and smaller quantities of well treatment chemicals, into a gas or oil well to fracture shale or other rock formations, allowing more efficient recovery of hydrocarbons from a petroleum-bearing reservoir. Crystalline silica ("frac sand") is commonly used as a proppant to hold open cracks and fissures created by hydraulic pressure. Each stage of the process requires hundreds of thousands of pounds of quartz-containing sand; millions of pounds may be needed for all zones of a well. Mechanical handling of frac sand creates respirable crystalline silica dust, a potential exposure hazard for workers. Researchers at the National Institute for Occupational Safety and Health collected 111 personal breathing zone samples at 11 sites in five states to evaluate worker exposures to respirable crystalline silica during hydraulic fracturing. At each of the 11 sites, full-shift samples exceeded occupational health criteria (e.g., the Occupational Safety and Health Administration calculated permissible exposure limit, the NIOSH recommended exposure limit, or the ACGIH threshold limit value), in some cases, by 10 or more times the occupational health criteria. Based on these evaluations, an occupational health hazard was determined to exist for workplace exposures to crystalline silica. Seven points of dust generation were identified, including sand handling machinery and dust generated from the work site itself. Recommendations to control exposures include product substitution (when feasible), engineering controls or modifications to sand handling machinery, administrative controls, and use of personal protective equipment. To our knowledge, this represents the first systematic study of work crew exposures to crystalline silica during hydraulic fracturing. Companies that conduct hydraulic fracturing using silica sand should evaluate their operations to determine the potential for worker exposure to respirable crystalline silica and implement controls as necessary to protect workers.

Truck driver reported unrealistically tight delivery schedules linked to their opinions of maximum speed limits and hours-of-service rules and their compliance with these safety laws and regulations.

Objectives: The study objectives were to examine U.S. long-haul truck drivers (LHTDs)' opinions on their safety needs and to assess the associations of driver reported unrealistically tight delivery schedules with: (1) their opinions on their compensation, maximum speed limits, and Hours-of-Service (HOS) regulations, and (2) their behaviors of noncompliance with these safety laws and regulations. Methods: National Institute for Occupational Safety and Health analyzed data from its 2010 national survey of LHTD health and injury. A total of 1,265 drivers completed the survey. Logistic regression was used to examine the associations between driver reported unrealistically tight delivery schedule and their opinion on safety and unsafe driving behaviors. Results: Drivers who reported often receiving an unrealistically tight delivery schedule (an estimated 15.5% of LHTDs) were significantly more likely than drivers who reported never receiving an unrealistically tight delivery schedule to report that: (1) increasing the current maximum speed limit on interstate highways by 10 miles per hour (mph) would improve safety (odds ratio (OR) = 2.1); (2) strictly enforcing HOS rules would not improve safety (OR = 1.8); (3) they often drove 10 mph or more over the speed limit (OR = 7.5); (4) HOS regulations were often violated (OR = 10.9); (5) they often continued to drive despite fatigue, bad weather, or heavy traffic because their must delivery or pick up a load at a given time (OR = 7.5); and (6) their work was never adequately rewarded (OR = 4.5). When presented with 11 potential safety strategies, the largest percentage of LHTDs (95.4%) selected that building more truck stops/parking areas would improve truck driver safety. Conclusions: Driver reported unrealistically tight delivery schedules are associated with drivers' beliefs in safety laws/regulations and risk-taking behaviors. LHTDs see building more truck stops/rest areas as the most wanted safety need among the 11 potential safety strategies that were asked about in the survey.

A Descriptive Study of Musculoskeletal Injuries in Long-Haul Truck Drivers: A NIOSH National Survey.

Long-haul truck drivers are significantly affected by musculoskeletal injuries with incidence rates 3.5 times higher than the national average. Yet, little is known about injuries that affect long-haul trucks drivers. In 2010, interviewers collected data from 1,265 long-haul truck drivers at 32 truck stops across the United States. These surveys were analyzed to describe all self-reported musculoskeletal injuries. Injuries to the arm (26.3%) and back (21.1%) were the two areas most reported in the survey. Musculoskeletal injuries were most often caused by falls (38.9%) and contact with an object or equipment (33.7%) resulting most commonly in sprains/strains (60%). This large scale survey highlights the significance of musculoskeletal injuries in long-haul truck drivers and suggests the need to develop interventions to prevent injuries and improve recovery once injuries occur.

A Pilot Study of Healthy Living Options at 16 Truck Stops Across the United States.

PURPOSE: There is a growing body of evidence that the built environment influences diet and exercise and, as a consequence, community health status. Since long-haul truck drivers spend long periods of time at truck stops, it is important to know if this built environment includes resources that contribute to the emotional and physical well-being of drivers. SETTING: The truck stop environment was defined as the truck stop itself, grocery stores, and medical clinics near the truck stop that could be accessed by a large truck or safely on foot. DESIGN: Researchers at the National Institute for Occupational Safety and Health (NIOSH) developed and utilized a checklist to record the availability of resources for personal hygiene and comfort, communication and mental stimulation, health care, safety, physical activity, and nutrition at truck stops. SUBJECTS: The NIOSH checklist was used to collect data at a convenience sample of 16 truck stops throughout the United States along both high-flow and low-flow truck traffic routes. MEASURES: The checklist was completed by observation within and around the truck stops. RESULTS: No truck stops offered exercise facilities, 94% lacked access to health care, 81% lacked a walking path, 50% lacked fresh fruit, and 37% lacked fresh vegetables in their restaurant or convenience store. CONCLUSION: The NIOSH found that most truck stops did not provide an overall healthy living environment.

National Survey of US Long-Haul Truck Driver Health and Injury: health behaviors.

OBJECTIVE: To compare selected health behaviors and body mass index (modifiable risk factors) of US long-haul truck drivers to the US working population by sex. METHODS: The National Survey of US Long-Haul Truck Driver Health and Injury interviewed a nationally representative sample of long-haul truck drivers (n = 1265) at truck stops. Age-adjusted results were compared with national health surveys. RESULTS: Compared with US workers, drivers had significantly higher body mass index, current cigarette use, and pack-years of smoking; lower prevalence of annual influenza vaccination; and generally lower alcohol consumption. Physical activity level was low for most drivers, and 25% had never had their cholesterol levels tested. CONCLUSIONS: Working conditions common to long-haul trucking may create significant barriers to certain healthy behaviors; thus, transportation and health professionals should address the unique work environment when developing interventions for long-haul drivers.

NIOSH national survey of long-haul truck drivers: Injury and safety.

Approximately 1,701,500 people were employed as heavy and tractor-trailer truck drivers in the United States in 2012. The majority of them were long-haul truck drivers (LHTDs). There are limited data on occupational injury and safety in LHTDs, which prompted a targeted national survey. The National Institute of Occupational Safety and Health conducted a nationally representative survey of 1265 LHTDs at 32 truck stops across the contiguous United States in 2010. Data were collected on truck crashes, near misses, moving violations, work-related injuries, work environment, safety climate, driver training, job satisfaction, and driving behaviors. Results suggested that an estimated 2.6% of LHTDs reported a truck crash in 2010, 35% reported at least one crash while working as an LHTD, 24% reported at least one near miss in the previous 7 days, 17% reported at least one moving violation ticket and 4.7% reported a non-crash injury involving days away from work in the previous 12 months. The majority (68%) of non-crash injuries among company drivers were not reported to employers. An estimate of 73% of LHTDs (16% often and 58% sometimes) perceived their delivery schedules unrealistically tight; 24% often continued driving despite fatigue, bad weather, or heavy traffic because they needed to deliver or pick up a load at a given time; 4.5% often drove 10miles per hours or more over the speed limit; 6.0% never wore a seatbelt; 36% were often frustrated by other drivers on the road; 35% often had to wait for access to a loading dock; 37% reported being noncompliant with hours-of-service rules (10% often and 27% sometimes); 38% of LHTDs perceived their entry-level training inadequate; and 15% did not feel that safety of workers was a high priority with their management. This survey brings to light a number of important safety issues for further research and interventions, e.g., high prevalence of truck crashes, injury underreporting, unrealistically tight delivery schedules, noncompliance with hours-of-service rules, and inadequate entry-level training.

Anti-asthmatic effects of onions. Alk(en)ylsulfinothioic acid alk(en)yl-esters inhibit histamine release, leukotriene and thromboxane biosynthesis in vitro and counteract PAF and allergen-induced bronchial obstruction in vivo.

Five alk(en)ylsulfinothioic acid alk(en)yl-esters isolated from onions and four synthetic thiosulfinates inhibited 5-lipoxygenase of porcine leucocytes, histamine release and leukotriene B4 and C4 biosynthesis of human polymorphonuclear leucocytes, thromboxane B2 biosynthesis by human platelets and allergen- and PAF-induced bronchial obstruction of guinea-pigs. The anti-asthmatic and anti-inflammatory effects of onions depend in part on the thiosulfinate moiety: (Formula: see text).

Sequestration of the lung in children.

Nine cases of sequestration of the lung were seen in children. Bronchopulmonary sequestration of the lung is a distinct congenital anomaly and clinical entity that can be distinguished from other congenital abnormalities of the lung. Such a congenital anomaly must be considered in children who, on roentgenologic examination, are found to have an opacity in the lower lung fields. Intralobar bronchopulmonary sequestration often is associated with recurrent pulmonary sepsis, whereas extralobar sequestration is less likely to be symptomatic and usually exhibits no abnormal physical findings. In a unique case, we found an extralobar sequestration associated with an esophageal duplication that communicated with the sequestered lobe but not with the esophagus. This situation represents a transitional stage in embryonic development of extralobar sequestration. Intralobar and extralobar forms of sequestration show many common characteristics indicating a common embryogenesis. Surgical excision, consisting of lobectomy or segmentectomy, is safe and effective and may be accomplished without morbidity or mortality.

A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer.

OBJECTIVE: To evaluate whether baseline or procedural stress during in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) affects pregnancy or live birth delivery rates. DESIGN: Prospective study. SETTING: Seven clinics in Southern California between 1993 and 1998. PATIENT(S): One hundred and fifty-one women completed two questionnaires. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The number of oocytes aspirated and fertilized, the number of embryos transferred, the achievement of a pregnancy, live birth delivery, and infant outcomes. RESULT(S): Positive-affect negative-affect score at baseline negatively influenced the number of oocytes retrieved and embryos transferred. A higher expectation of pregnancy was associated with greater numbers of oocytes fertilized and embryos transferred. At baseline, the risk of no live birth was 93% lower for women who had the highest positive-affect score compared to those with the lowest score. Furthermore, the score on the Infertility Reaction Scale was related to negative outcomes in live birth delivery, infant birth weight, and multiple births. During the time of the procedure, the PANAS and Bipolar Profile of Moods States results were related to the number of oocytes fertilized and embryos transferred; stress did not affect pregnancy or delivery. CONCLUSION(S): Baseline (acute and chronic) stress affected biologic end points (i.e., number of oocytes retrieved and fertilized), as well as pregnancy, live birth delivery, birth weight, and multiple gestations, whereas (procedural) stress only influenced biologic end points.

Vesicointestinal fissure revisited.

This complicated anomaly of bladder exstrophy, intestinal fistula, and various degrees of colonic atresia with imperforate anus is readily recognizable. The long-term result of conventional management has been disappointing. Fecal and urinary incontinence have been unavoidable and a source of disappointment to patients and parents. An alternative method of total management is detailed. This variation of management may result in earlier and more complete social acceptability of the child so afflicted. At as young an age as possible, the vesicointestinal connection is detached and the bladder defect as well as the intestinal opening closed. The short colon is freed and transected at its midpoint. The right half of the colon is brought out through a separate wound as a colostomy. The distal half of the divided colon is brought out as mucous fistula on the left. This distal colonic segment is the proposed future colonic loop for urinary diversion to be fashioned in the first year of life. The exstrophied bladder is removed at a later date. Epispadias in the male may be repaired later. A Pediatric Ostomy Club has been organized to include a pediatric stomal therapist and involved nurses and physicians. The group gives the parents advice and moral support. We believe that this approach will permit the child to go to school and carry on relatively normal activity and to be socially acceptable. An overview of our total experience in the management of 25 patients with vesicointestinal fistula details the result in 9 surviving patients.

Double choledochus with ectopic drainage into the stomach-a rare congenital anomaly of the biliary ductal system.

A patient with an accessory bile duct originating from the left common hepatic duct and emptying into the stomach along the lesser curvature presented with periodic symptomatic bile gastritis. Reimplantation of the accessory duct into the duodenum relieved his symptoms.

Reconstruction of penile agenesis by a posterior sagittal approach.

Penile agenesis is a rare condition requiring gender reassignment and staged perineal reconstruction. This report describes two children reconstructed by taking advantage of the posterior sagittal approach. This approach allows a precise anatomic dissection, construction of a neovagina and accurate positioning of all perineal orifices. We think that this is the preferred approach for this rare condition.

Congenital cricopharyngeal achalasia.

Fifteen infants with congenital cricopharyngeal achalasia are reviewed. Although most of the patients had symptoms at birth, the diagnosis was frequently not confirmed until later in the first year of life. While four of the infants had only cricopharyngeal achalasia, 11 had associated diseases related to the central nervous system. Those patients without associated diseases improved spontaneously with conservative management; most of the infants with other abnormalities also improved, although their clinical progress was slower and more complicated. In three of the patients, the symptoms were persistent and there were two deaths related to associated diseases. Cricopharyngeal myotomy was performed on two children with only moderate improvement in symptoms. Congenital cricopharyngeal achalasia is more common than formerly recognized. When suspected, an esophagram with tele- or cineradiography is essential to confirm the diagnosis. Esophageal motility studies will quantify changes and also evaluate lower esophageal dysfunction not easily identified on esophagrams.

Occupational exposure to noise and ototoxic organic solvents.

The objectives of this study were to review the literature on the effects of occupational exposure to organic solvents on the auditory system and to identify work settings in which exposure to these agents and to noise might occur. The criteria for selecting the chemicals were (a) evidence available that indicated that the chemicals may affect the auditory system and enhance noise effects, and (b) the ubiquity of their use. References to ototoxicity were noted for three proven neurotoxicants, i.e., carbon disulfide, toluene, and trichloroethylene, and for two probable human neurotoxicants--styrene and xylene. The percentages of workers (estimated by NIOSH National Occupational Exposure Survey) exposed to these solvents in each economic sector are shown. Work settings are identified where multiple exposures occur to solvents and noise. The need for future research is discussed.