Factors associated with the timely diagnosis of malaria and the utilization of types of healthcare facilities: a retrospective study in the Republic of Korea

BACKGROUND

This study aimed to analyze trends in the timely diagnosis of malaria cases over the past 10 years in relation to the utilization of different types of healthcare facilities.

METHODS

The study included 3,697 confirmed and suspected cases of malaria reported between January 1, 2013, and December 31, 2022, in the national integrative disease and healthcare management system. Some cases lacking a case report or with information missing from the case report were excluded from the analysis. A generalized linear model with a Poisson distribution was constructed to estimate risk ratios and 95% confidence intervals adjusted for other variables, such as distance.

RESULTS

When cases involving diagnosis >5 days after symptom onset in confirmed patients (5DD) were examined according to the type of healthcare facility, the risk ratio of 5DD cases was found to be higher for tertiary hospitals than for public health facilities. Specifically, the risk ratio was higher when the diagnosis was established at a tertiary hospital, even after a participant had visited primary or secondary hospitals. In an analysis adjusted for the distance to each participant's healthcare facility, the results did not differ substantially from the results of the crude analysis.

CONCLUSION

It is imperative to improve the diagnostic capabilities of public facilities and raise awareness of malaria at primary healthcare facilities for effective prevention and control.

Comparing the effectiveness of bivalent and monovalent COVID-19 vaccines against COVID-19 infection during the winter season of 2022-2023: A real-world retrospective observational matched cohort study in the Republic of Korea

OBJECTIVES

To compare the effectiveness of bivalent and monovalent COVID-19 vaccines throughout the 2022-2023 winter season based on real-world data.

METHODS

This retrospective observational matched cohort study used the national vaccination program and a surveillance dataset from the Republic of Korea, and included adults aged >18 years who received bivalent or monovalent COVID-19 vaccines between October 11, 2022, and December 17, 2022. Cox proportional hazard models were used to estimate the hazard ratio for COVID-19 infection between the groups.

RESULTS

We included 29,245 matched individuals in the bivalent and monovalent vaccine groups, respectively. The bivalent vaccine recipients showed 12.2% (95% confidence interval [CI] 6.5-17.7%) additional protection against COVID-19 infection compared with the monovalent vaccine recipients. The additional protection provided by bivalent vaccines was significantly higher among residents of long-term care facilities (39.4%, 95% CI 21.6-53.1%). Maximum additional protection was observed 3 to 4 months after completing the vaccination (17.6%, 95% CI 6.6-27.3%).

CONCLUSION

Bivalent COVID-19 vaccines showed significantly better protection against infection than monovalent vaccines among adults during the 2022-2023 winter season. Our results highlight that immunization programs with bivalent vaccines comprising recent variants can be an effective measure to prepare for seasonal COVID-19 circulation.

Estimated impact of the national hepatitis B immunization program on acute viral hepatitis B among adolescents in South Korea

OBJECTIVES

We aimed to estimate the impact of the national hepatitis B immunization program on the incidence of acute hepatitis B infection among adolescents in South Korea.

METHODS

We estimated the counterfactual incidence rate of reported acute hepatitis B among adolescents from 2016 to 2020 compared to the assumption that the national hepatitis B immunization program for children had not been implemented since 1995. The impact of the national hepatitis B immunization program for adolescents was measured by estimating the absolute risk reduction and averted acute hepatitis B infections among adolescents from 2016 to 2020 attributed to the national immunization program.

RESULTS

The relative risk reduction of acute hepatitis B among adolescents was estimated to be 83.5% after implementing the national hepatitis B immunization program. The incidence rate of reported acute hepatitis B infections among adolescents decreased from 0.39 to 0.06 per 100,000 person-years, and 43 acute hepatitis B infections, including 17 symptomatic cases, were averted annually from 2016 to 2020 by the national hepatitis B immunization program.

CONCLUSION

The national hepatitis B immunization program for children was effective in preventing acute hepatitis B infection among adolescents in South Korea.

Required Elements for an Integrated Biosurveillance Platform: A Capacity and Needs Assessment of the Central Government in the Republic of Korea

New and reemerging infectious disease outbreaks threaten human safety worldwide, increasing the urgency to implement biosurveillance systems that enhance government capacity in public health emergency preparedness and response. To do so, it is necessary to evaluate existing surveillance and response activities and identify potential barriers at the national level. This study aimed to assess the current status and readiness of government agencies in South Korea, particularly for information sharing and use, and to identify barriers and opportunities in developing an agency-integrated biosurveillance system. The target sample size was 66 government officials, working at 6 relevant government ministries. We invited a total of 100 officials to participate. A total of 34 government officials completed the survey (34.0% response rate), 18 (52.9%) of whom were affiliated with the Korea Disease Control and Prevention Agency or the Ministry of Health and Welfare. Findings revealed that information sharing between government agencies occurred frequently, but a discrepancy existed in terms of the type of information shared and stored. Although information sharing with other agencies and ministries occurred at all stages-prevention, preparation, response, and recovery-it mostly revolved around preventive activities, with no respondents reportedly sharing recovery-related information. An agency-integrated biosurveillance system is crucial in preparing for the next pandemic, as well as supporting information sharing, analysis, and interpretation across humans, animals, and the environment. It is key to national and global health security.

Association between face covering policies and the incidence of coronavirus disease 2019 in European countries

OBJECTIVES

This study was conducted to determine the impact of the strengthening or relaxation of face covering mandates on the subsequent national case incidence of coronavirus disease 2019 (COVID-19) in Europe as the full vaccination rate was increasing.

METHODS

European countries in which case incidence increased for 3 consecutive weeks were monitored and analyzed using COVID-19 incidence data shared by the World Health Organization (WHO). The epidemic trend of COVID-19 in Europe was compared with that of countries elsewhere in the world based on WHO weekly epidemiological reports from June 20 to October 30, 2021. In addition, this study provided insight into the impact of government mask mandates on COVID-19 incidence in Europe by measuring the index scores of those facial covering policies before and after mandate relaxation or strengthening. The effects of the vaccination rate and the speed of vaccination on COVID-19 incidence were also analyzed.

RESULTS

The incidence of COVID-19 after the relaxation of face covering mandates was significantly higher than before relaxation. However, no significant difference was observed in vaccination rate between countries with increased and decreased incidence. Instead, rapid vaccination delayed the resurgence in incidence.

CONCLUSIONS

The findings suggest that face covering policies in conjunction with rapid vaccination efforts are essential to help mitigate the spread of COVID-19.

Time-series comparison of COVID-19 case fatality rates across 21 countries with adjustment for multiple covariates

OBJECTIVES

Although it is widely used as a measure for mortality, the case fatality rate (CFR) ofcoronavirus disease 2019 (COVID-19) can vary over time and fluctuate for many reasons otherthan viral characteristics. To compare the CFRs of different countries in equal measure, weestimated comparable CFRs after adjusting for multiple covariates and examined the mainfactors that contributed to variability in the CFRs among 21 countries.

METHODS

For statistical analysis, time-series cross-sectional data were collected from OurWorld in Data, CoVariants.org, and GISAID. Biweekly CFRs of COVID-19 were estimated bypooled generalized linear squares regression models for the panel data. Covariates includedthe predominant virus variant, reproduction rate, vaccination, national economic status,hospital beds, diabetes prevalence, and population share of individuals older than age 65. Intotal, 21 countries were eligible for analysis.

RESULTS

Adjustment for covariates reduced variation in the CFRs of COVID-19 across countriesand over time. Regression results showed that the dominant spread of the Omicron variant,reproduction rate, and vaccination were associated with lower country-level CFRs, whereasage, the extreme poverty rate, and diabetes prevalence were associated with higher countrylevel CFRs.

CONCLUSION

A direct comparison of crude CFRs among countries may be fallacious, especiallyin a cross-sectional analysis. Our study presents an adjusted comparison of CFRs over timefor a more proper comparison. In addition, our findings suggest that comparing CFRs amongdifferent countries without considering their context, such as the epidemic phase, medicalcapacity, surveillance strategy, and socio-demographic traits, should be avoided.

Changes in the pattern and disease burden of acute viral respiratory infections before and during the COVID-19 pandemic

Objectives

We conducted a comparative analysis of the differences in the incidence of 8 acute respiratory viruses and the changes in their patterns before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Three sentinel surveillance systems of the Korea Disease Control and Prevention Agency and data from the Health Insurance Review and Assessment Service were analyzed. The average numbers of reported cases and the related hospital admissions and outpatient data were compared between April 2018–2019 and 2020–2021. Changes in the disease burden and medical expenditures between these 2 time periods were evaluated.

Results

During the COVID-19 pandemic, the number of reported cases of all acute respiratory viral infections, except for human bocavirus, decreased significantly. Data from the Health Insurance Review and Assessment Service also showed decreases in the actual amount of medical service usage and a marked reduction in medical expenditures.

Conclusion

Non-pharmacological interventions in response to COVID-19 showed preventive effects on the transmission of other respiratory viruses, as well as COVID-19. Although COVID-19 had a tremendous impact on society as a whole, with high social costs, there were also positive effects, such as a reduction in the incidence of acute respiratory viral infections.

Generic Logic Model for Coronavirus Disease-2019 Responses Based on the South Korean Experience

BACKGROUND

As the global coronavirus disease-2019 (COVID-19) pandemic continues, many countries have implemented public health policies, such as lockdowns and physical distancing measures, to prevent its spread. South Korea's response to COVID-19, which prevented an increase in confirmed cases and increased resilience, has been considered very effective.

PURPOSE

To analyze Korea's response to COVID-19 in 2020 and develop a logic model to evaluate performance effectiveness in follow-up studies.

METHODS

By content analysis of Korea Disease Control and Prevention Agency (KDCA) press releases, we defined the problems and identified the causes of the health and social effects of the COVID-19 outbreak. Next, we created a problem tree and developed a logic model that comprised inputs, activities, outputs, outcomes, and impacts. Finally, we held expert consultations to obtain expert opinions regarding the logic model and to ensure the model's validity.

RESULTS

South Korea's COVID-19 response policy mitigated the social and health impacts. The 2020 COVID-19 responses had four outcomes (identifying cases on time, preventing transmission of coronavirus infection, effective treatment of COVID-19 cases, protecting public resilience and well-being) and 12 outputs; South Korea conducted 32 activities.

CONCLUSION

The results can be a practical reference for managing problems faced in other countries. Korean policy may be of interest in the future for international decision-makers in charge of policy enforcement and those who may be called on to respond to new infectious diseases.

Reconstructing a COVID-19 outbreak within a religious group using social network analysis simulation in Korea

OBJECTIVES

We reconstructed a coronavirus disease 2019 (COVID-19) outbreak to examine how a large cluster at a church setting spread before being detected and estimate the potential effectiveness of complying with mask-wearing guidelines recommended by the government.

METHODS

A mathematical model with a social network analysis (SNA) approach was used to simulate a COVID-19 outbreak. A discrete-time stochastic simulation model was used to simulate the spread of COVID-19 within the Sarang Jeil church. A counterfactual experiment using a calibrated baseline model was conducted to examine the potential benefits of complying with a mask-wearing policy.

RESULTS

Simulations estimated a mask-wearing ratio of 67% at the time of the outbreak, which yielded 953.8 (95% confidence interval [CI], 937.3 to 970.4) cases and was most consistent with the confirmed data. The counterfactual experiment with 95% mask-wearing estimated an average of 45.6 (95% CI, 43.4 to 47.9) cases with a standard deviation of 20.1. The result indicated that if the church followed government mask-wearing guidelines properly, the outbreak might have been one-twentieth the size.

CONCLUSIONS

SNA is an effective tool for monitoring and controlling outbreaks of COVID-19 and other infectious diseases. Although our results are based on simulations and are thus limited, the precautionary implications of social distancing and mask-wearing are still relevant. Since person-to-person contacts and interactions are unavoidable in social and economic life, it may be beneficial to develop precise measures and guidelines for particular organizations or places that are susceptible to cluster outbreaks.

A scoping review on data integration in the field of infectious diseases, 2009-2018

Background and Aim: Little is known about data integration in public health research and its impact. This study aimed to summarize known collaboration information, the characteristics of the datasets used, the methods of data integration, and knowledge gaps. Materials and Methods: We reviewed papers on infectious diseases from two or more datasets published during 2009- 2018, before the coronavirus disease pandemic. Two independent researchers searched the Medline and Global Health databases using predetermined criteria. Results: Of the 2375 items retrieved, 2272 titles and abstracts were reviewed. Of these, 164 were secondary reviews. Full-text reviews identified 153 relevant articles; we excluded 11 papers that did not meet our inclusion criteria. Of the 153 papers, 150 were single-country studies. Most papers were from North America (n=47). Viral diseases were the most commonly researched diseases (n=66), and many studies sought to define infection rates (n=62). Data integration usually employed unique national identifiers (n=37) or address-based identifiers (n=30). Two data sources were combined (n=121), and at least one data source typically included routine surveillance information. Conclusion: We found a growing usage of data integration in infectious diseases, emphasizing the advantages of data integration and linkage analysis, and reiterating its importance in public health emergency preparedness and response.

Dynamics of the COVID-19 epidemic in the post-vaccination period in Korea: a rapid assessment

OBJECTIVES

Coronavirus disease 2019 (COVID-19) has had a tremendous impact on public health and socioeconomic conditions globally. Although non-pharmaceutical interventions (NPIs) such as social distancing effectively reduced the incidence of COVID-19, especially in Korea, demand for vaccination has increased to minimize the social costs of NPIs. This study estimated the potential benefits of COVID-19 vaccination in Korea.

METHODS

A mathematical model with vaccinated-susceptible-latent-infectious-recovered compartments was used to simulate the COVID-19 epidemic. The compartments were stratified into age groups of 0-19 years, 20-59 years, and 60 years or older. Based on the Korea Disease Control and Prevention Agency national vaccination plan for the second quarter of 2021, announced on March 15, we developed vaccination scenarios (with 150,000 dose/d and 100% compliance as the main scenario). Comparing scenarios without vaccination or with higher/lower vaccination rates and compliance, we estimated the numbers of COVID-19 cases that will be prevented by vaccination.

RESULTS

The results projected 203,135 cases within a year after April 2021 without vaccination, which would be reduced to 71,248 (64.9% decrease) by vaccination. Supposing a vaccination rate of 150,000 dose/d and 100% compliance, social distancing interventions for those aged 20 or more can be retracted after January 1, 2022.

CONCLUSIONS

We expect COVID-19 vaccination to be effective in Korea. Health authorities should minimize delays in vaccination and vaccine avoidance to maximize the effectiveness of vaccination and end social distancing early.

The Evolving Policy Debate on Border Closure in Korea

OBJECTIVES

In this paper, we aimed to investigate the evolving debate over border closure in Korea during the coronavirus disease 2019 (COVID-19) pandemic, to address the main themes associated with border closure, and to discuss the factors that need to be considered when making such decisions.

METHODS

We collated and reviewed previously conducted review studies on border closures during infectious disease outbreaks to derive relevant themes and factors.

RESULTS

According to our systematic review on border closures and travel restrictions, the effects of such containment efforts are limited. We suggest considering the following factors when determining whether to impose border closure measures: (1) disease characteristics, (2) timeliness of implementation, (3) transmission delay and the basic reproduction number, (4) globalization and pandemics, and (5) social and economic costs.

CONCLUSIONS

Our assessment indicates that the effects of border closures are at best temporary and limited. Alternative measures must be contemplated and implemented to suppress the spread of COVID-19 in particular and infectious diseases more broadly.

Implementation System of a Biosurveillance System in the Republic of Korea and Its Legal Ramifications

Laws are fundamental tools that regulate and manage various issues to protect the rights of the people in a society. Legislation on disease surveillance enables agencies to regulate and manage public health, including preventing the spread of infectious diseases. We assessed the Infectious Disease Prevention and Control Act of Korea (IDPCA) through the lens of biosurveillance to understand its effectiveness in protecting public health. In addition, the relevant legislation and regulations of the United States and the World Health Organization were examined. The evaluation concludes that the current IDPCA is limited in terms of providing guidance for early detection of and response to hazards using integrated data and an information-sharing system. Further revision of the laws is needed to enable early detection and warning of potential threats to public health.

The authors assessed the Infectious Disease Prevention and Control Act of Korea (IDPCA) through the lens of biosurveillance to understand its effectiveness in protecting public health. The relevant legislation and regulations of the United States and the World Health Organization also were examined. They concluded that the current IDPCA is limited in terms of providing guidance for early detection of and response to hazards using integrated data and an information-sharing system.

Estimating the medical capacity required to administer mass prophylaxis: a hypothetical outbreak of smallpox virus infection in Korea

OBJECTIVES

The aim of this study was to estimate the medical surge capacity required for mass prophylaxis based on a hypothetical outbreak of smallpox.

METHODS

We performed a simulation using the Bioterrorism and Epidemic Outbreak Response Model and varied some important parameters, such as the number of core medical personnel and the number of dispensing clinics.

RESULTS

Gaps were identified in the medical surge capacity of the Korean government, especially in the number of medical personnel who could respond to the need for mass prophylaxis against smallpox.

CONCLUSIONS

The Korean government will need to train 1,000 or more medical personnel for such an event, and will need to prepare many more dispensing centers than are currently available.

Enhancing 'Whole-of-Government' Response to Biological Events in Korea: Able Response 2014

Since 2011, the Republic of Korea (ROK) and United States (U.S.) have been collaborating to conduct inter- and intra-governmental exercises to jointly respond to biological events in Korea. These exercises highlight U.S. interest in increasing its global biosurveillance capability and the ROK’s interest in improving cooperation among ministries to respond to crises. With Able Response (AR) exercises, the ROK and U.S. have improved coordination among US and ROK government and defense agencies responding to potential bio-threats and identified additional areas on which to apply refinements in policies and practices. In 2014, the AR exercise employed a Biosurveillance Portal (BSP) to facilitate more effective communication among participating agencies and countries including Australia. In the present paper, we seek to provide a comprehensive assessment of the AR 2014 (AR14) exercise and make recommendations for future improvements. Incorporating a more realistic response in future scenarios by integrating a tactical response episode in the exercise is recommended.

Syndromic Surveillance System for Korea-US Joint Biosurveillance Portal: Design and Lessons Learned

Driven by the growing importance of situational awareness of bioterrorism threats, the Republic of Korea (ROK) and the United States have constructed a joint military capability, called the Biosurveillance Portal (BSP), to enhance biosecurity. As one component of the BSP, we developed the Military Active Real-time Syndromic Surveillance (MARSS) system to detect and track natural and deliberate disease outbreaks. This article describes the ROK military health data infrastructure and explains how syndromic data are derived and made available to epidemiologists. Queries corresponding to 8 syndromes, based on published clinical effects of weaponized pathogens, were used to classify military hospital patient records to form aggregated daily syndromic counts. A set of ICD-10 codes for each syndrome was defined through literature review and expert panel discussion. A study set of time series of national daily counts for each syndrome was extracted from the Defense Medical Statistical Information System between January 1, 2011, and May 31, 2014. A stratified, adjusted cumulative summation algorithm was implemented for each syndrome group to signal alerts prompting investigation. The algorithm was developed by calculating sensitivity to sets of 1,000 artificial outbreak signals randomly injected in the dataset, with each signal injected in a separate trial. Queries and visualizations were adapted from the Suite for Automated Global bioSurveillance. Findings indicated that early warning of outbreaks affecting fewer than 50 patients will require analysis at subnational levels, especially for common syndrome groups. Developing MARSS to improve sensitivity will require modification of underlying syndromic diagnosis codes, engineering to coordinate alerts among subdivisions, and enhanced algorithms. The bioterrorist threat in the Korean peninsula mandates these efforts.

Sensor space group analysis for fNIRS data

BACKGROUND

Functional near-infrared spectroscopy (fNIRS) is a method for monitoring hemoglobin responses using optical probes placed on the scalp. fNIRS spatial resolution is limited by the distance between channels defined as a pair of source and detector, and channel positions are often inconsistent across subjects. These challenges can lead to less accurate estimate of group level effects from channel-specific measurements.

NEW METHOD

This paper addresses this shortcoming by applying random-effects analysis using summary statistics to interpolated fNIRS topographic images. Specifically, we generate individual contrast images containing the experimental effects of interest in a canonical scalp surface. Random-effects analysis then allows for making inference about the regionally specific effects induced by (potentially) multiple experimental factors in a population.

RESULTS

We illustrate the approach using experimental data acquired during a colour-word matching Stroop task, and show that left frontopolar regions are significantly activated in a population during Stroop effects. This result agrees with previous neuroimaging findings.

COMPARED WITH EXISTING METHODS

The proposed methods (i) address potential misalignment of sensor locations between subjects using spatial interpolation; (ii) produce experimental effects of interest either on a 2D regular grid or on a 3D triangular mesh, both representations of a canonical scalp surface; and (iii) enables one to infer population effects from fNIRS data using a computationally efficient summary statistic approach (random-effects analysis). Significance of regional effects is assessed using random field theory.

CONCLUSIONS

In this paper, we have shown how fNIRS data from multiple subjects can be analysed in sensor space using random-effects analysis.

Prevalence of musculoskeletal symptoms among agricultural workers in the United States: an analysis of the National Health Interview Survey, 2004-2008

Ergonomic risks from agricultural tasks can compromise musculoskeletal health of workers. This study estimated prevalence of musculoskeletal symptoms in a sample representing almost 2 million US agricultural industry workers. This study used National Health Interview Survey data from 2004 to 2008. Weighted prevalence was calculated by demographic and employment factors. Prevalence ratios were calculated using generalized linear models with the Poisson distribution assumption. Prevalence rates of low back and neck pain in the previous 3 months were 24.3% and 10.5%, respectively, among agricultural workers. Monthly prevalence of joint pain was 17.0% for hips/knees, 9.8% for shoulders, 9.5% for wrists/hands, 5.4% for elbows, and 4.7% for ankles/toes. Agricultural workers had a significantly higher prevalence of shoulder pain than all other industry workers (prevalence ratios [PR] = 1.28, 95% confidence interval [CI]: 1.02-1.61). This study provides detailed national estimates of musculoskeletal symptom prevalence to understand the burden and the need for intervention among agricultural workers.

Risk of Infections Associated with Improperly Reprocessed Transrectal Ultrasound–Guided Prostate Biopsy Equipment

Objective.

A hospital discovered a lapse in the reprocessing procedures for transrectal ultrasound-guided prostate biopsy equipment. An investigation was initiated to assess the risks of transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and bacteria during prostate biopsies.

Methods.

We offered testing for HBV, HCV, and HIV infection to patients who had undergone prostate biopsies from January 30, 2003, through January 27, 2006. We reviewed their medical records and obtained information on the reprocessing procedures that were in use at the time for the prostate biopsy equipment.

Setting.

A healthcare facility in Maine.

Results.

Of the 528 patients exposed to improperly reprocessed prostate biopsy equipment, none tested positive for HIV or HCV. Sixteen patients (3%) tested positive for past HBV infection but had no prebiopsy HBV serologic test results available (ie, transmission from improperly reprocessed biopsy equipment was possible), and 11 (2%) had evidence of postbiopsy bacterial infections. The number of cases of HBV and bacterial infections were within reported ranges for this population and were not clustered in time. Review of the reprocessing procedures in use at the time revealed that the manufacturer-recommended brushes for cleaning the reusable biopsy needle guide were never used. Brushes did not come with the equipment and had to be ordered separately.

Conclusions.

Despite the lack of evidence of pathogen transmission in this investigation, it is critical to review the manufacturer's reprocessing recommendations and to establish appropriate procedures to avert potential pathogen transmission and subsequent patient concerns. This investigation provides a better understanding of the risks associated with improperly reprocessed transrectal ultrasound prostate biopsy equipment and serves as a methodologic tool for future investigations.

Impact of differential injury reporting on the estimation of the total number of work-related amputations

BACKGROUND

A capture-recapture analysis was performed to estimate the total number of work-related amputations. We examined the impact of misclassification due to differential injury reporting on the estimate of total number of work-related amputations.

METHODS

Bureau of Labor Statistics' Survey of Occupational Injuries and Illnesses (SOII) samples and workers' compensation records (WC) were used to estimate the total number of work-related amputations. Some of the amputation cases in one data source matched with injuries other than amputations in the other data source. We performed sensitivity analyses reassigning such cases as matched amputations.

RESULTS

Depending on how we treated the cases matched with other injuries, the total number of work-related amputations ranged from 276 to 442 cases, yielding dramatically different capture rates (35-87%).

CONCLUSION

Due to differential classification, estimates of work-related amputations would be biased. Our findings highlight the importance of accurately reporting and classifying work-related injuries and illnesses.

Use of multiple data sources for surveillance of work-related amputations in Massachusetts, comparison with official estimates and implications for national surveillance

BACKGROUND

Accurate surveillance of work-related injuries is needed at national and state levels. We used multiple sources for surveillance of work-related amputations, compared findings with Survey of Occupational Injuries and Illnesses (SOII) estimates, and assessed generalizability to national surveillance.

METHODS

Three data sources were used to enumerate work-related amputations in Massachusetts, 2007-2008. SOII eligible amputations were compared with SOII estimates.

RESULTS

787 amputations were enumerated, 52% ascertained through hospital records only, exceeding the SOII estimate (n = 210). The estimated SOII undercount was 48% (95% CI: 36-61%). Additional amputations were reported in SOII as other injuries, accounting for about half the undercount. Proportionately more SOII estimated than multisource cases were in manufacturing and fewer in smaller establishments.

CONCLUSION

Multisource surveillance enhanced our ability to document work-related amputations in Massachusetts. While not feasible to implement for work-related conditions nationwide, it is useful in states. Better understanding of potential biases in SOII is needed.

Characteristics of diet patterns in metabolically obese, normal weight adults (Korean National Health and Nutrition Examination Survey III, 2005)

BACKGROUND AND AIMS

Metabolically obese normal weight (MONW) subjects are a subgroup of individuals who have a normal weight and body mass index (BMI), but exhibit obesity-related abnormalities. The objective of this study was to analyze the prevalence of metabolic syndrome (MetS) and characteristics of diet patterns in MONW Koreans.

METHODS AND RESULTS

We analyzed the data of 3050 adults > 20 years of age with a normal BMI (18.5~24.9 kg/m(2)) obtained from the Korea National Health and Nutrition Examination Survey III. Anthropometric measurements and information on health behaviors were obtained. The diagnostic criteria for MetS were defined by the International Diabetes Federation consensus. Dietary intake was assessed by the 24-h recall method. The weighted prevalence of MONW was 14.3%. The risk of MONW correlated inversely with the frequency of snacking and positively with the type of snack, particularly those with high carbohydrates. A high carbohydrate diet (≥73.9% of energy intake) compared to a low carbohydrate diet (<59.9% of energy intake) was positively associated with the risk of MONW (OR = 2.54; 95% CI: 1.41, 4.56), whereas a high protein diet (≥17.1% of energy intake) compared to a low protein diet (<12.2% of energy intake) reduced the risk of MONW (OR = 0.60; 95% CI: 0.39, 0.92) in females, but not in males.

CONCLUSIONS

This study suggests that a reduced intake of carbohydrates and carbohydrate snacks were associated with a lower prevalence of MONW in females.

Characterization of lead in US workplaces using data from OSHA's integrated management information system

BACKGROUND

Lead hazards continue to be encountered in the workplace. OSHA's Integrated Management Information System (IMIS) is the largest available database containing sampling results in US workplaces.

METHODS

Personal airborne lead sampling results in IMIS were extracted for years 1979-2008. Descriptive analyses, geographical mapping, and regression modeling of results were performed.

RESULTS

Seventy-nine percent of lead samples were in the manufacturing sector. Lead sample results were highest in the construction sector (median = 0.03 mg/m(3) ). NORA sector, year, OSHA region, number of employees at the worksite, federal/state OSHA plan, unionization, advance notification, and presence of an employee representative were statistically associated with having a lead sample result exceed the PEL.

CONCLUSIONS

Lead concentrations within construction have been higher than any other industry. Lead hazards have been most prevalent in the north and northeastern US. IMIS data can be useful as a surveillance tool and for targeting prevention efforts toward hazardous industries.

The estimated national burden of physical ergonomic hazards among US workers

PURPOSE

To estimate the national burden of physical ergonomic hazards among working adults in the US.

METHODS

We estimated the population prevalence of and the total number of workers who are exposed to physical ergonomic hazards, such as vibration, working in cramped space, kneeling, body bending or twisting, climbing, and repetitive motions using Occupational Information Network (O*NET) data and the Occupational Employment Statistics (OES) from the U.S. Bureau of Labor Statistics (BLS) stratified by occupation title.

RESULTS

Repetitive motion was the most prevalent of all ergonomic hazards (27% of US workers are estimated to be exposed continually). Bending or twisting of the body more than half their time at work was also common, involving over 32 million US workers (25% of US workforce). Kneeling, crouching, stooping, or crawling was another ergonomic hazard that 14 million US workers perform more than half their time at work. Almost 4 million workers climb ladders, scaffolds, poles, etc. for more than half their time at work. We estimate that over 13 million workers (10% of US workforce) were exposed to cramped workspace that requires getting into awkward positions every day. Finally, about 3.5 million workers (2.7% of US workforce) were estimated to be exposed to whole body vibration every day.

CONCLUSION

A large portion of the US work force is exposed to ergonomic hazards known to be associated with musculoskeletal disorders (MSDs). The occupations with the highest prevalence of each ergonomic hazard may be deserving of prompt efforts toward prevention of MSDs.

Work schedules and health behavior outcomes at a large manufacturer

There is evidence that work schedules may influence rates of unhealthy behaviors, suggesting that addressing work schedule challenges may improve health. Health Risk Assessment (HRA) survey responses were collected during 2000-2008 in a multinational chemical and coatings manufacturer. Responses of 26,442 were sufficiently complete for analysis. Rates of smoking, lack of exercise, moderate to high alcohol use, obesity (BMI > or = 30), and short sleep duration were compared by work schedule type (day, night, or rotating shift) and daily work hours (8, 10, or 12 h). Prevalence rate ratios (RRs) were calculated, adjusting for age group, sex, marital/living status, job tenure, and occupational group. The reference group was 8-h day shift employees. Overall prevalence rates were: sleep duration of 6 h or less per night 47%, smoking 17.3%, no exercise 22.0%, BMI > or = 30 28.3%, and moderate to heavy alcohol consumption 22.2%. Statistically significant RRs include the following: Short sleep duration: 10 h rotating shift (RR=1.6), 12 h day and 12 h rotating shifts (RR=1.3); Smoking: 12 h day and rotating shifts (RR=1.6), 10 and 12 h night and 8 h rotating shift (RR=1.4); No exercise: 8, 10, and 12 h rotating shifts (RR=1.2 to 1.3), 12 h day schedules (RR=1.3). Obesity (BMI > or = 30): 8 and 10 h night shifts (RR=1.3 and 1.4, respectively).

Exposure to hazardous workplace noise and use of hearing protection devices among US workers--NHANES, 1999-2004

BACKGROUND

To estimate the prevalence of workplace noise exposure and use of hearing protection devices (HPDs) at noisy work, NIOSH analyzed 1999-2004 data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

A total of 9,275 currently employed workers aged > or =16 years were included in the weighted analysis. Hazardous workplace noise exposure was defined as self-reported exposure to noise at their current job that was so loud that the respondent had to speak in a raised voice to be heard. Industry and occupation were determined based on the respondent's current place and type of work.

RESULTS

Twenty-two million US workers (17%) reported exposure to hazardous workplace noise. The weighted prevalence of workplace noise exposure was highest for mining (76%, SE = 7.0) followed by lumber/wood product manufacturing (55%, SE = 2.5). High-risk occupations included repair and maintenance, motor vehicle operators, and construction trades. Overall, 34% of the estimated 22 million US workers reporting hazardous workplace exposure reported non-use of HPDs. The proportion of noise-exposed workers who reported non-use of HPDs was highest for healthcare and social services (73.7%, SE = 8.1), followed by educational services (55.5%).

DISCUSSION

Hearing loss prevention and intervention programs should be targeted at those industries and occupations identified to have a high prevalence of workplace noise exposure and those industries with the highest proportion of noise-exposed workers who reported non-use of HPDs.

Variability in risk factors for knee injury in construction

This study investigated sources of variance in exposure to risk factors for knee pain in a variety of highway construction trades, operations, and tasks. Over 15,000 discrete observations of leg postures and weights handled were made on 120 construction workers in five construction trades, in nine operations over 79 days. The contributions of trade, operation, task, and worker to the variability in work time spent kneeling, squatting, and carrying loads were evaluated with multilevel random effects models. Construction operation and task explained about 20% to 30% of total variation in kneeling, squatting, and carrying loads. There was a large unexplained component of variance thought to represent day-to-day variability of exposure within task. Reliable assessments of knee exposures require multiple days to accommodate the high variability of exposures among operations and tasks and over time. These sources of variability should be carefully considered in efforts to estimate exposures to knee loading for epidemiologic or intervention studies. Homogenous exposure groups are not easily defined from the readily available organizational features of construction work.

Estimation of compressive forces on lumbar spine from categorical posture data

To combine estimates of trunk posture and force into an integrated measure of load on the low back, continuous variables for body angles were estimated by assuming specified distributions within corresponding posture categories with Monte-Carlo (MC) simulation. The estimated posture angles were compared with reference measurements from the Lumbar Motion Monitor and inclinometers. The lumbar compression estimates, generated from simulated posture angles and from direct measurement, were compared. Trunk flexion showed high correlation between direct measurements and simulated angles, as did L5/S1 compression. The MC approach to extracting continuous posture angles from categorized observations did not appear to introduce large error in the variables used to estimate spinal compressive forces. When instrumentation methods of postural assessment are not feasible, a simulation approach combined with biomechanical modelling could be used to integrate multiple external exposure variables into estimates of compressive forces acting on the low back.

Floodwater exposure and the related health symptoms among firefighters in New Orleans, Louisiana 2005

BACKGROUND

Concerns over increased reports of physical health symptoms thought to be related to floodwater exposure among New Orleans firefighters prompted a health hazard evaluation of firefighters following Hurricane Katrina.

METHODS

A questionnaire assessing health symptoms possibly related to the response to Hurricane Katrina was administered to all New Orleans Fire Department (NOFD) personnel within 3 months of the disaster. Descriptive statistics were compiled and prevalence ratios (PR) were estimated for covariates using generalized linear models with Log link and Poisson distribution.

RESULTS

Of the 525 firefighters who completed the questionnaire (77% participation), 201 (38%) reported one or more new-onset respiratory symptoms, such as sinus congestion (145 [28%]), throat irritation (92 [17%]), and cough (124 [24%]). Skin rash was reported by 258 (49%) of respondents, 414 (79%) reported skin contact with floodwater, and 165 (32%) reported contact with floodwater on multiple days. In multivariate analyses adjusting for age, gender, and smoking, firefighters who had floodwater contact with skin and either nose/mouth or eyes (224, 44%) had an increased rate of new-onset upper respiratory symptoms (PR = 1.9; 95% confidence interval [CI], 1.1, 3.1), and skin rash (PR = 2.1; 95% CI, 1.4, 3.2) compared to those not exposed to the floodwater.

CONCLUSIONS

Response workers involved with floodwater should minimize direct skin and mucosal contact with floodwater if possible through the use of appropriate personal protective equipment, such as goggles, safety glasses with side shields, or full-face shields.

Haemoptysis in patients with a normal chest radiograph: bronchoscopy-CT correlation

The exact role of fibre-optic bronchoscopy (FOB) and CT of the chest in the diagnosis of patients presenting with haemoptysis and a normal or non-localizing chest radiograph has not been clearly defined. A study was designed to evaluate 50 patients presenting with haemoptysis and a normal or non-localizing chest radiograph using FOB and high-resolution computed tomography (HRCT). A definitive diagnosis was established in 17 (34%) patients. The aetiologies included bronchiectasis (24%), bronchial adenoma (6%), tuberculosis (2%) and bronchitis (2%). The diagnosis was made by HRCT in 15 (30%) patients, while FOB was diagnostic in five (10%) patients. The diagnosis was made by HRCT and FOB in all patients with focal airway abnormalities. Therefore, HRCT effectively delineated abnormalities of both the central and peripheral airways. It is concluded that CT should be obtained prior to FOB in all patients presenting with haemoptysis and a normal or non-localizing chest radiograph.

Intervention classifications for nursing practice and the ICNP: cultural considerations for Korean nurses

There are several intervention classifications for nursing practice. Yet, their relevancy and clarity for international use has not been evaluated. Thus, the paper presents a review of 4 major nursing intervention classifications (Saba's Home Health Care Classifications, Omaha's Intervention Scheme, Grobe's Nursing Intervention Lexicon & Taxonomy, and the International Classification for Nursing Practice) for Korean nursing practice. A simple comparison procedure utilized to determine the relevancy and clarity of each overall scheme and specific elements. The findings showed that general concepts for the top level of all the classifications were both relevant and clear. However, specific elements of lower levels became less clear and relevant because of the lack of definitions and cultural differences. In particular, interventions related to psycho-social and environmental components appeared to be either unclear or non-relevant for Korean nursing practice while interventions related to physiological components were found to be very relevant and clear. In conclusion, multiple levels of hierarchical intervention schemes and the absence of definitions impede clarity of intervention classifications. In addition, for international use, an intervention classification needs to be sensitive to cultural relevancy in its elements.