Nancy Beaudet

A Randomized Controlled Trial of Asthma Self-management Support Comparing Clinic-Based Nurses and In-Home Community Health Workers The Seattle-King County Healthy Homes II Project

OBJECTIVE To compare the marginal benefit of in-home asthma self-management support provided by community health workers (CHWs) with standard asthma education from clinic-based nurses. DESIGN Randomized controlled trial. SETTING Community and public health clinics and homes. PARTICIPANTS Three hundred nine children aged 3 to 13 years with asthma living in low-income households. INTERVENTIONS All participants received nurse-provided asthma education and referrals to community resources. Some participants also received CHW-provided home environmental assessments, asthma education, social support, and asthma-control resources. OUTCOME MEASURES Asthma symptom-free days, Pediatric Asthma Caretaker Quality of Life Scale score, and use of urgent health services. RESULTS Both groups showed significant increases in caretaker quality of life (nurse-only group: 0.4 points; 95% confidence interval [CI], 0.3-0.6; nurse + CHW group: 0.6 points; 95% CI, 0.4-0.8) and number of symptom-free days (nurse only: 1.3 days; 95% CI, 0.5-2.1; nurse + CHW: 1.9 days; 95% CI, 1.1-2.8), and absolute decreases in the proportion of children who used urgent health services in the prior 3 months (nurse only: 17.6%; 95% CI, 8.1%-27.2%; nurse + CHW: 23.1%; 95% CI, 13.6%-32.6%). Quality of life improved by 0.22 more points in the nurse + CHW group (95% CI, 0.00-0.44; P = .049). The number of symptom-free days increased by 0.94 days per 2 weeks (95% CI, 0.02-1.86; P = .046), or 24.4 days per year, in the nurse + CHW group. While use of urgent health services decreased more in the nurse + CHW group, the difference between groups was not significant. CONCLUSION The addition of CHW home visits to clinic-based asthma education yielded a clinically important increase in symptom-free days and a modest improvement in caretaker quality of life.

Tuberculosis in Health Care Settings and the Estimated Benefits of Engineering Controls and Respiratory Protection

Intra-institutional spread of tuberculosis (Tb) has re-emerged as a substantial public and occupational health threat. To characterize the person-hours and lifetime risks of Tb-related morbidity and mortality, we performed a risk assessment for health care workers (HCWs) developing Tb-related morbidity and mortality at varying levels of exposure, engineering controls, and respiratory protection. Under average conditions of exposure, one Tb skin-test conversion is estimated to occur for every 2650 person-hours of work by unprotected workers. With higher exposures, a skin-test conversion for an unprotected worker may occur in as few as 3 person-hours. Use of respiratory protection is estimated to reduce risks by the following proportions: surgical mask, 2.4-fold; disposable dust, fume, mist, or disposable high-efficiency particulate air filtering (HEPA) mask, 17.5-fold; elastomeric HEPA cartridge respirator, 45.5-fold; or powered air-purifying respirator (PAPR), 238-fold. Assuming a lifetime exposure of 250 hours, the risk of a skin-test conversion is estimated to be 9%. We conclude that HCWs are at substantial risk for Tb-related morbidity and mortality, and that administrative controls, engineering controls, and respirators offer substantial benefits in risk reduction.

An Evaluation of Factors Affecting Hazardous Waste Workers' Use of Respiratory Protective Equipment

The purpose of this study was to describe the perceptions of a group of hazardous waste workers about their workplace hazards and to understand their beliefs and attitudes about the use of respiratory protective equipment (RPE). There were two phases of data collection: (1) interviews to identify factors that influence respirator use and (2) a written survey to evaluate the importance of these factors. This article describes the findings from the written survey completed by 255 eligible respondents (return rate = 46.5%, 255/548). Subjects used a weighting system to score 18 identified factors that influence the use of RPE. Scores were compared according to type of respirator, frequency of use, and associated health symptoms. The factors that had the most positive influence on respirator use were concern about work exposure, fit-testing, and training. The most negative influences were communication, personal comfort, effect on vision, structural environment, and fatigue. More frequent users (once per month or more) were significantly more likely to view fit-testing, health effects, and effects on vision negatively than were less frequent users. Persons who reported health symptoms associated with respirator use had more negative scores than persons without health symptoms. Workers categorized as laborers were more likely to be frequent respirator users and to wear supplied-air respirators, and were significantly more likely to view vulnerability to disease negatively, than were other worker groups. The findings from this study indicate that respiratory protection programs must extend beyond training and education; to be maximally effective, health professionals must be responsive to the specific concerns of the workers.

Crab allergen exposures aboard five crab-processing vessels.

Aerosolized crab allergens are suspected etiologic agents for asthma among crab-processing workers. The objectives of this study were to characterize crab allergen concentrations and respiratory symptom prevalence among processing workers aboard crab-processing vessels. A cross-sectional survey of five crab-processing vessels was conducted near Dutch Harbor, Alaska. Crab allergen concentrations were quantified during specific work activities with 25 personal air samples collected on polytetrafluoroethylene filters and analyzed by a competitive IgE immunoassay technique. Two standardized respiratory questionnaires were used to assess respiratory symptoms suggestive of bronchitis or asthma in 82 workers. Aerosolized crab allergen concentrations ranged from 79 ng/m3 to 21,093 ng/m3 (mean = 2797 ng/m3, SD = 4576 ng/m3). The highest concentrations were measured at butchering/degilling work stations, which were combined on the smallest vessel. A significant percentage of workers reported development of respiratory symptoms during the crab-processing season. Cough developed in 28% of workers, phlegm in 11% of workers, and wheeze and other asthma-like symptoms developed in 4% of workers. Despite variations in crab allergen levels, respiratory symptom prevalence was similar across all job categories. Substantial concentrations of crab allergen exposure were measured, as well as the potential for wide variability in exposure during crab processing aboard vessels. The high prevalence of reported respiratory symptoms across all job categories suggests potential adverse respiratory effects that should be further characterized by prospective studies using pulmonary function and serology testing, and rigorous exposure characterization.

Childhood Lead Exposure from Battery Recycling in Vietnam.

Background. Battery recycling facilities in developing countries can cause community lead exposure. Objective. To evaluate child lead exposure in a Vietnam battery recycling craft village after efforts to shift home-based recycling outside the village. Methods. This cross-sectional study evaluated 109 children in Dong Mai village, using blood lead level (BLL) measurement, parent interview, and household observation. Blood samples were analyzed with a LeadCare II field instrument; highest BLLs (≥45 μg/dL) were retested by laboratory analysis. Surface and soil lead were measured at 11 households and a school with X-ray fluorescence analyzer. Results. All children had high BLLs; 28% had BLL ≥45 μg/dL. Younger age, family recycling, and outside brick surfaces were associated with higher BLL. Surface and soil lead levels were high at all tested homes, even with no recycling history. Laboratory BLLs were lower than LeadCare BLLs, in 24 retested children. Discussion. In spite of improvements, lead exposure was still substantial and probably associated with continued home-based recycling, legacy contamination, and workplace take-home exposure pathways. There is a need for effective strategies to manage lead exposure from battery recycling in craft villages. These reported BLL values should be interpreted cautiously, although the observed field-laboratory discordance may reflect bias in laboratory results.

Neighborhood-Scale Spatial Models of Diesel Exhaust Concentration Profile Using 1-Nitropyrene and Other Nitroarenes

With emerging evidence that diesel exhaust exposure poses distinct risks to human health, the need for fine-scale models of diesel exhaust pollutants is growing. We modeled the spatial distribution of several nitrated polycyclic aromatic hydrocarbons (NPAHs) to identify fine-scale gradients in diesel exhaust pollution in two Seattle, WA neighborhoods. Our modeling approach fused land-use regression, meteorological dispersion modeling, and pollutant monitoring from both fixed and mobile platforms. We applied these modeling techniques to concentrations of 1-nitropyrene (1-NP), a highly specific diesel exhaust marker, at the neighborhood scale. We developed models of two additional nitroarenes present in secondary organic aerosol: 2-nitropyrene and 2-nitrofluoranthene. Summer predictors of 1-NP, including distance to railroad, truck emissions, and mobile black carbon measurements, showed a greater specificity to diesel sources than predictors of other NPAHs. Winter sampling results did not yield stable models, likely due to regional mixing of pollutants in turbulent weather conditions. The model of summer 1-NP had an R(2) of 0.87 and cross-validated R(2) of 0.73. The synthesis of high-density sampling and hybrid modeling was successful in predicting diesel exhaust pollution at a very fine scale and identifying clear gradients in NPAH concentrations within urban neighborhoods.

Respiratory protective devices: Rates of medical clearance and causes for work restrictions

There is disclosed a respiratory protective device, and a related powered filtering device. Known devices, suffer from a number of problems, such as liability to failure, overworking and lack of fault indication. Accordingly, one aspect of the present invention provides a respiratory protective device (5) providing a powered filtering device (10) comprising a housing (15) having at least one inlet (20) and an outlet (25), pump means (35) being provided between the at least one inlet and the outlet for pumping air therebetween, a filter(s) being provided in association with the inlet(s) and/or outlet, the outlet being connected to a first end (94) of a breathing hose (45), the second end (96) of the breathing hose being connected to a facepiece (100), the powered filtering device further comprising means (110) for controlling the pump means provided at or near the outlet of the housing for controlling air flow between the inlet(s) and the outlet(s) in response to a wearers breathing pattern.BACKGROUND There are no published data on the outcomes and benefits of medical evaluations for the use of respiratory protective devices. We, therefore, conducted a retrospective database and chart review to assess the rates of medical clearance and causes for work restrictions at a Department of Energy complex. METHODS All workers with work restrictions or denied clearance over a one-year period were identified and their medical records abstracted. RESULTS Of the 5,569 workers who received medical evaluation, only 71 (1.3%) received limitations on respirator use documented in their medical record. Of the 65 workers with sufficient medical records for additional analysis, 9 of the 5,569 workers (0.2%) were denied medical clearance, while 56 workers (1.1%) received work restrictions. Pregnancy was the most common cause for denying medical clearance for respirator use. Lung disease, cardiovascular disease, and claustrophobia were the most common causes for work restrictions. Physical examination and spirometry added little to the detection of relevant medical conditions. CONCLUSIONS We conclude that few workers fail medical clearance for respirator use or receive work restrictions. Data on adverse events from respirator use are needed to help design appropriate medical evaluations and uniform criteria for work restrictions or denial of medical clearance.

The Seattle–King County Healthy Homes II Project: A Randomized Controlled Trial of Asthma Self-management Support Comparing Clinic-Based Nurses and In-Home Community Health Workers

OBJECTIVE To compare the marginal benefit of in-home asthma self-management support provided by community health workers (CHWs) with standard asthma education from clinic-based nurses. DESIGN Randomized controlled trial. SETTING Community and public health clinics and homes. PARTICIPANTS Three hundred nine children aged 3 to 13 years with asthma living in low-income households. INTERVENTIONS All participants received nurse-provided asthma education and referrals to community resources. Some participants also received CHW-provided home environmental assessments, asthma education, social support, and asthma-control resources. OUTCOME MEASURES Asthma symptom-free days, Pediatric Asthma Caretaker Quality of Life Scale score, and use of urgent health services. RESULTS Both groups showed significant increases in caretaker quality of life (nurse-only group: 0.4 points; 95% confidence interval [CI], 0.3-0.6; nurse + CHW group: 0.6 points; 95% CI, 0.4-0.8) and number of symptom-free days (nurse only: 1.3 days; 95% CI, 0.5-2.1; nurse + CHW: 1.9 days; 95% CI, 1.1-2.8), and absolute decreases in the proportion of children who used urgent health services in the prior 3 months (nurse only: 17.6%; 95% CI, 8.1%-27.2%; nurse + CHW: 23.1%; 95% CI, 13.6%-32.6%). Quality of life improved by 0.22 more points in the nurse + CHW group (95% CI, 0.00-0.44; P = .049). The number of symptom-free days increased by 0.94 days per 2 weeks (95% CI, 0.02-1.86; P = .046), or 24.4 days per year, in the nurse + CHW group. While use of urgent health services decreased more in the nurse + CHW group, the difference between groups was not significant. CONCLUSION The addition of CHW home visits to clinic-based asthma education yielded a clinically important increase in symptom-free days and a modest improvement in caretaker quality of life.

Pediatric Environmental Health: Perceptions from a Survey Questionnaire

Abstract To expand the base of knowledge regarding perceptions about potential environmental threats to childrens health, a survey was conducted in the Northwest United States. Samples of Head Start parents, PTA presidents, public health officials, school nurses, naturopathic physicians, family practitioners, and pediatricians were mailed a questionnaire inquiring into the nature and degree of concerns about pediatric environmental health. The response rate was 24%. Trends in the data showed disparities in perceptions regarding levels of concern and exposure concerns between respondent categories. Disparities also existed regarding information resources used for childrens environmental health. Recognizing differences in perceptions of childrens environmental health, as demonstrated in these results, may be useful for risk communication and resource allocation, especially in the context of the wide variety of health belief models. Such knowledge may help clarify situations with environmental health risk concerns, including clinical, public health, and educational circumstances.

Medical clearance for respirator use : Sensitivity and specificity of a questionnaire

BACKGROUND OSHA regulations require that workers receive medical clearance prior to respirator use, and recently, a detailed questionnaire has been provided to assist with this purpose. However, there are limited published data on the sensitivity and specificity of self-administered questionnaires for identifying individuals who may safely wear a respirator. METHODS We tested 474 consecutive workers at a Department of Energy complex. After completing the self-administered questionnaire, all workers received a standardized physician evaluation including interview, physical examination, and spirometry. The outcomes of the questionnaire assessment were compared to the outcomes of physician evaluation. RESULTS Data for analysis were available from 413 of workers (87%). All workers received medical clearance; only 10 workers (2.4%) received work restrictions. The questionnaire demonstrated 100% sensitivity in identifying workers who required work restrictions, but had specificity of only 19%. Compared to physician evaluation, the questionnaire had modest sensitivity to the detection of chronic medical conditions. CONCLUSIONS These data suggest that the rates of medical clearance for respirator use are very high, and that a self-administered questionnaire may be appropriate for medical clearance in certain settings. It is recommended that the policy of routine physician evaluation and spirometry for respirator clearance be re-examined.