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.
We linked an outbreak of cryptosporidiosis to ozonated apple cider by using molecular and epidemiologic methods. Because ozonation was insufficient in preventing this outbreak, its use in rendering ...apple cider safe for drinking is questioned.
Background: Proper asthma management and control depend on patients having affordable access to healthcare yet financial barriers to asthma care are common. Objective: To examine associations of ...work-related asthma (WRA) with financial barriers to asthma care and adverse asthma outcomes. Research Design: Cross-sectional, random-digit-dial survey conducted in 37 states and District of Columbia. Subjects: A total of 27,927 ever-employed adults aged ≥ 18 years with current asthma. Measures: Prevalence ratios (PR) for the associations of WRA with financial barriers to asthma care and of WRA with adverse asthma outcomes stratified by financial barriers. Results: Persons with WRA were significantly more likely than those with non-WRA to have at least 1 financial barrier to asthma care PR, 1.66; 95% confidence interval (CI), 1.43—1.92. Individuals with WRA were more likely to experience adverse asthma outcomes such as asthma attack (PR, 1.31; 95% CI, 1.22—1.40), urgent treatment for worsening asthma (PR, 1.57; 95% CI, 1.39—1.78), asthma-related emergency room visit (PR, 1.69; 95% CI, 1.41—2.03), and very poorly controlled asthma (PR, 1.54; 95% CI: 1.36—1.75). After stratifying for financial barriers to asthma care, the associations did not change. Conclusions: Financial barriers to asthma care should be considered in asthma management, and individuals with WRA are more likely to experience financial barriers. However, individuals with WRA are more likely to experience adverse asthma outcomes than individuals with non-WRA, regardless of financial barriers. Additional studies are needed to identify medical, behavioral, occupational, or environmental factors associated with adverse asthma outcomes among individuals with WRA.
Objective: The objective of the study is to examine associations between use of specific pesticides and lifetime allergic rhinitis and current asthma in US primary farm operators.
Methods: The 2011 ...Farm and Ranch Safety Survey data from 11,210 primary farm operators were analyzed. Pesticide use on the farm was determined using an affirmative response to the question of whether the operator ever mixed, loaded, or applied pesticides on their farm in the 12 months prior to the interview. Operators who answered "yes" were further asked about the specific trade name and formulation identifiers of the product they used and personal protective equipment (PPE) used. Data were weighted to produce national estimates. Adjusted prevalence odds ratios (PORs) were calculated using logistic regression. The referent group included operators who did not use any pesticides in the 12 months prior to the interview.
Results: Of an estimated 2.1 million farm operators, 40.0% used pesticides, 30.8% had lifetime allergic rhinitis, and 5.1% had current asthma. Insecticide and herbicide use were significantly associated with lifetime allergic rhinitis and current asthma. The use of 2,4-dichlorophenoxyacetic acid (POR = 1.5; 95% CI 1.2-1.9) and carbaryl (POR = 2.3; 1.4-3.7) was significantly associated with lifetime allergic rhinitis. Of operators using pesticides, 64.9% used PPE the last time they mixed, loaded, or applied pesticides.
Conclusions: Pesticide use was associated with lifetime allergic rhinitis and current asthma among farm operators. Further studies are needed to clarify the dose-response relationship between pesticide use and adverse respiratory health effects.
Cigarette smoking has declined considerably among U.S. adults over several decades (1); however, increases have occurred in the use of noncigarette tobacco products in recent years, and the use of ...multiple tobacco products has become common among current users of noncigarette tobacco products (2,3). Differences in tobacco use have also been observed across population subgroups, including among working adults (2,4). CDC analyzed National Health Interview Survey (NHIS) data for 2014-2016 to describe the most recent prevalence estimates of current (every day or some days) tobacco product use among working U.S. adults by industry and occupation. Among working adults, 22.1% (32.7 million) currently used any form of tobacco; 15.4% used cigarettes, 5.8% used other combustible tobacco (cigars, pipes, water pipes or hookahs, very small cigars, and bidis), 3.0% used smokeless tobacco, and 3.6% used electronic cigarettes (e-cigarettes); 4.6% (6.9 million) reported current use of two or more tobacco products. By industry, any tobacco use ranged from 11.0% among education services to 34.3% among construction workers; current use of two or more tobacco products was highest among construction workers (7.1%). By occupation, any tobacco use ranged from 9.3% among life, physical, and social science workers to 37.2% among installation, maintenance, and repair workers; current use of two or more tobacco products was highest among installation, maintenance, and repair workers (10.1%). Proven interventions to prevent and reduce tobacco product use, including current use of multiple products, among working adults are important (5,6). Workplace tobacco-control interventions have been especially effective in reducing cigarette smoking prevalence (7).
Objective: Various approaches have been developed to identify persons with asthma using survey data. To assess agreement between current and active asthma classifications, 2011-2012 Asthma Call-back ...Survey landline telephone household data from 38 states, District of Columbia, and Puerto Rico for adults aged ≥18 years who have ever been told by a health professional they have asthma were analyzed. Methods: Respondents were classified to have current asthma if they reported still having asthma, and active asthma if they reported within the past year: 1) talking to a doctor about asthma, 2) taking asthma medication, or 3) having any symptoms of asthma. Agreement between classifications was assessed using the Kappa statistic. Results: Among adults ever told by a health professional they have asthma, an estimated 72% had current asthma and 75% had active asthma. Overall, 67% of individuals met classifications of both current and active asthma and 20% had neither current nor active asthma (Kappa = 0.68). The Kappa increased to 0.72 when talking to a doctor about asthma was removed from the active asthma classification. Conclusions: Results indicated substantial agreement between current and active asthma. Agreement was strengthened when talking to a doctor about asthma was removed from the active asthma classification.
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.
Objective: Asthma Call-back Survey methodology has been changed recently, as a new sampling design, weights calculation (2011-2012), and revised work-related asthma (WRA) section (2012) were ...implemented. To assess the effect of these changes on the WRA and possible WRA estimates among ever-employed adults with current asthma, we analyzed 2007-2012 data for 37 505 ever-employed adults (≥18 years) collected from 19 US states (representing an estimated 10 million adults each year). Methods: Using data from landline telephone (LLP) households, we calculated estimates applying poststratification weights (2007-2010) and "raking" weights (2011-2012). Also, using data from LLP/cellular telephone (CP) households combined, we calculated estimates applying "raking" weights (2012). Results: Based on LLP household data, the WRA estimates ranged from 7.8% to 9.7% during 2007-2010, was 9.1% in 2011 and 15.4% in 2012. Possible WRA estimates ranged from 35.1% to 38.1% during 2007-2010, was 38.1% in 2011 and 39.8% in 2012. Using the 2012 LLP/CP household data, the WRA and possible WRA estimates were 15.4% and 38.9%, respectively. Conclusions: Implementation of "raking" weights did not substantially change the WRA or possible WRA estimates among ever-employed adults with current asthma. The WRA and possible WRA estimates based on LLP and LLP/CP samples in 2012 were comparable, as CP users are younger and less likely to have WRA. The substantial upward shift in the 2012 WRA estimates likely was associated with the revision to the WRA section.
Little is known about specialist-specific variations in guideline agreement and adoption.
To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone ...components of the National Asthma Education and Prevention Program's Third Expert Panel Report.
Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and "almost always" adhering to recommendations (ie, ≥75% of the time).
Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups "almost always" assessed asthma control (66.2%, standard error SE 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P = .06), asked about nighttime awakening (91.9% vs 76.5%, P = .03) and emergency department visits (92.2% vs 76.5%, P = .03), assessed home triggers (70.5% vs 52.6%, P = .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing.
Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.
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