Health
International Archives of Occupational and Environmental Health | 19 September 2016

Personal Exposure to Benzene and 1,3-Butadiene During Petroleum Refinery Turnarounds and Work in the Oil Harbor

Petroleum refinery workers’ exposure to the carcinogens benzene and 1,3-butadiene has decreased during normal operations. However, certain occupational groups or events at the refineries still involve a risk of higher exposures. The aim of this study was to examine the personal exposure to benzene and 1,3-butadiene at refinery turnarounds and during work in the oil harbor.

Work within the petroleum refinery industry, with potential exposure to open product streams containing higher fractions of benzene, pose a risk of personal benzene exposures exceeding the occupational exposure limits. Refinery workers performing these work tasks frequently, such as contractors, sewage tanker drivers, and oil harbor workers, need to be identified and protected.

Journal of Occupational and Environmental Medicine | 19 September 2016

Is Obesity Associated With Adverse Workers’ Compensation Claims Outcomes?

A number of studies suggested the association between obesity and elevated incidences of workplace injuries and longer lost time from work.Although the association of obesity with injury rates has been reported by many studies, the association of obesity with the adverse development of workers’ compensation claims after injury is not so clear.

In a previous study, the authors found that an elevated body mass index was associated with delayed return to work and increased workers’ compensation costs. The study followed 1,107 claimants for 3 years. All individuals sustained a serious injury and lost time from work.

Controlling for gender, age, marital status, and attorney involvement, the logistic regression odds ratio for return to work by the end of the follow-up period for an overweight or obese individual vs. a normal-weight individual was 2.95 and 3.58, respectively. This study includes an additional year of claimant data, thereby increasing the sample size. the authors also controlled for two additional factors, spinal surgeries and spinal injections, which were found in previous studies to be associated with high workers’ compensation cost and claim duration.

The increased time span and addition of two variables would allow for better characterization of the role of obesity with relation to lost time and costs in workers’ compensation claims.

 

University of Missouri | 8 September 2016

Study Finds Potential Harm to Fertility From Hydraulic Fracturing Chemicals

More than 15 million Americans live within a 1-mile radius of unconventional oil and gas (UOG) operations. UOG operations combine directional drilling and hydraulic fracturing to release natural gas from underground rock. Scientific studies, while ongoing, are still inconclusive on the potential long-term effects fracturing has on human development. Researchers at the University of Missouri released a study that is the first of its kind to link exposure to chemicals released during hydraulic fracturing to adverse reproductive and developmental outcomes in mice. Scientists believe that exposure to these chemicals also could pose a threat to human development.

Nagel

“Researchers have previously found that endocrine-disrupting chemicals mimic or block hormones—the chemical messengers that regulate respiration, reproduction, metabolism, growth, and other biological functions,” said Susan C. Nagel, an associate professor of obstetrics, gynecology, and women’s health in the School of Medicine. “Evidence from this study indicates that developmental exposure to fracking and drilling chemicals may pose a threat to fertility in animals and potentially people. Negative outcomes were observed even in mice exposed to the lowest dose of chemicals, which was lower than the concentrations found in groundwater at some locations with past oil and gas wastewater spills.”

Read the full story here.

Discuss this story on SPE Connect.

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Health Security | 30 August 2016

Public Health Surveillance: At the Core of the Global Health Security Agenda

Global health security involves developing the infrastructure and capacity to protect the health of people and societies worldwide. The acceleration of global travel and trade poses greater opportunities for infectious diseases to emerge and spread. The International Health Regulations (IHR) were adopted in 2005 with the intent of proactively developing public health systems that could react to the spread of infectious disease and provide better containment. Various challenges delayed adherence to the IHR. The Global Health Security Agenda (GHSA) came about as an international collaborative effort, working multilaterally among governments and across sectors, seeking to implement the IHR and develop the capacities to prevent, detect, and respond to public health emergencies of international concern. When examining the recent West African Ebola epidemic as a case study for global health security, both strengths and weaknesses in the public health response are evident. The central role of public health surveillance is a lesson reiterated by Ebola. Through further implementation of the Global Health Security Agenda, identified gaps in surveillance can be filled and global health security strengthened.

As the world becomes more interconnected through globalized travel and trade, the international spread of infectious diseases has become an increasing threat. To address these ever-evolving risks to health, dependence on public health surveillance has become more significant. Effective surveillance can respond not only to emergent infectious disease threats, but also to longer term public health concerns, including drug-resistant organisms and potential bioterrorism. In the wake of the recent West African Ebola epidemic, it is clear that, in the pursuit of global health security, all nations must support each other in developing basic public health infrastructure and shoring up their surveillance capacity.

The GHSA seeks to enhance surveillance worldwide, directly support responses to infectious disease outbreaks, and ultimately improve global health security. The emergence of novel infectious diseases is inevitable, but, through participation in the GHSA, the resulting consequences can be minimized. Surveillance is fundamental to global health security, and the West African Ebola outbreak showed both the devastating consequences of surveillance gaps and how effective surveillance could serve as a firewall against further geographic spread of deadly viruses. The GHSA seeks to fill the gaps in surveillance exposed by Ebola, thereby improving global health security.

SHP | 30 August 2016

Effective Health, Safety, and Wellbeing Processes: Maturity Assessment

Within every health, safety, and wellbeing (HSW) process, there has to be an effective culture, driven by individual behaviors (at all levels), and underpinned by an effective management system/framework with clear expectations and goals to ensure effective HSW performance. Achieving this requires a level of HSW maturity within the organization to accept its limitations, solve its problems, and celebrate its success.

Fig. 1

This is expressed diagrammatically in Fig. 1.

  • Policy—Goals and expectations, an effective roadmap and common understanding of where the organization is headed
  • Process and Systems—An effective set of processes to deliver excellence in HSW performance, right first time, every time
  • Behavioral Safety—Correct individual behaviors with everyone looking after themselves and others to keep healthy and safe
  • Cultural HSW—The organization operating as one, with a clear cultural belief and caring for wellbeing of employees and others

To assure this in an organization is difficult because data is not always available and, when it is, extensive verification and validation is required.

Health & Safety Middle East | 30 August 2016

The High Costs of Hearing Loss

Exposure to excessive noise also entails largely unrecognized costs to organizations by way of increased employee turnover and absenteeism, lowered performance, and possible contribution to accidents. As well as the economic cost for employers, NIHL imposes a severe burden on health and social services and the economy as a whole. Noise exposure is one of the more common health risk factors.

Millions of laborers worldwide are exposed to sound pressure levels capable of producing hearing loss.

Occupational exposure to loud noise can damage the hair cells of the organ of Corti, akin to the body’s microphone, causing progressive and irreversible hearing loss, a condition known as noise-induced hearing loss (NIHL).

To the individual affected, the social handicaps of NIHL are also severe. NIHL is irreversible and leads to communication difficulties, impairment of interpersonal relationships, social isolation, and a very real degradation in the quality of life. The family and others close to the affected person often experience secondary consequences of the condition. While NIHL cannot be fully reversed, the advancement in hearing aid technology can overcome some of the problems. Of those people affected, 20% or more also suffer from tinnitus (ringing in the ears).

The International Journal of Occupational and Environmental Medicine | 15 August 2016

Sickness Absence and Precarious Employment: A Comparative Cross-National Study of Denmark, Finland, Sweden, and Norway

Precarious employment is a major social determinant of health and health inequalities with effects beyond the health of workers. The objective of this study was to investigate the association between precarious employment and sickness absence in four Nordic countries, Denmark, Finland, Norway, and Sweden.

The prevalence of sickness absence was lowest in Sweden (18%), and highest in Finland (28%). Three precarious employment indicators were positively associated with sickness absence; the pattern being largely similar in the total sample. In the sex-disaggregated sample, five precarious employment indicators increased the likelihood of sickness absence; the pattern was heterogeneous, with women generally having significantly higher odds of sickness absence than men. “Low household income” and “sickness presenteeism” were strong predictors of sickness absence among both sexes in most of the four studied countries. Sickness absence varied between the Nordic countries in the sex-disaggregated analyses.

Precarious employment indicators predicted sickness absence in the Nordic countries. Findings emphasize the need to prioritize informed and monitored collective bargaining for all workers, increase working time flexibility, and improving work conditions.

International Journal of Occupational Medicine and Environmental Health | 15 August 2016

Lost-Time Illness, Injury, and Disability and Its Relationship With Obesity in the Workplace: A Comprehensive Literature Review

The objective of this study was to conduct a literature review examining predictors of lost-time injury, illness, and disability (IID) in the workplace, with a focus on obesity as a predictor, and to evaluate the relationship between obesity and lost-time IID. The study objective was also to analyze workplace disability prevention and interventions aimed at encouraging a healthy lifestyle among employees and reducing obesity and IID, as well as to identify research gaps.

The search was conducted in several major online databases. Articles included in the review were published in English in peer-reviewed journals between January 2003 and December 2014 and were found to be of good quality and of relevance to the topic. Each article was critically reviewed for inclusion in this study. Studies that focused on lost-time IID in the workplace were reviewed and summarized. Workers in overweight and obese categories are shown to be at a higher risk of workplace IID, are more likely to suffer from lost-time IID, and experience a slower recovery compared to workers with a healthy body mass index.

Lost-time IID is costly to an employer and an employee; therefore, weight reduction may financially benefit both workers and companies. It was found that some companies have focused on developing interventions that aid reduction of weight and the practice of active lifestyle among their employees.

Occupational & Environmental Medicine | 15 August 2016

Biomechanical and Psychosocial Exposures are Independent Risk Factors for Carpal Tunnel Syndrome: Assessment of Confounding Using Causal Diagrams

Between 2001 and 2010, six research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries to estimate exposure–response relationships. This analysis examined the presence and magnitude of confounding between biomechanical and workplace psychosocial factors and incidence of dominant-hand CTS.

Although attenuation of the relationships between CTS and some biomechanical and work psychosocial exposures was observed after adjusting for confounding, the magnitudes were small and confirmed biomechanical and work psychosocial exposures as independent risk factors for incident CTS.

Occupational Safety and Health Administration | 15 August 2016

NIOSH’s Engineering Controls Database Can Help Employers Reduce Risk of Workplace Illnesses and Injuries

The National Institute for Occupational Safety and Health’s (NIOSH’s) new Engineering Controls Database provides information on effective engineering controls that can protect workers by eliminating or reducing hazardous conditions. It is based on a hierarchy of controls ranked in order of effectiveness. Well-designed engineering controls can be highly effective in protecting workers and frequently lower operating costs over the longer term. The database can be searched by occupation or work process to find a solution that may work to control the exposure in your workplace.

Read more about the database here.

JPT | 5 August 2017

How the Petroleum Industry Can Learn From the Ebola Crisis of 2014

The Ebola crisis of 2014 was one of the worst infectious disease outbreaks in recent history. It also occurred in a region with endemic medical risks and poor medical infrastructure. These two factors make it an important learning exercise for the global petroleum community. This paper reviews the Ebola outbreak from the viewpoint of an onshore and offshore petroleum operator, providing insight into the real threats the outbreak presented by looking past the media hype and diving into the real organizational effects of the outbreak.

Introduction
West Africa experienced the most severe Ebola virus disease (EVD) outbreak ever recorded. The most-affected countries are Liberia (10,672 cases as of 16 ­August 2015), Sierra Leone (13,494 cases), and Guinea (3,786 cases). Other affected countries include Mali, Nigeria, and Senegal in Africa; and Italy, Spain, the United Kingdom, and the United States, although to a much lower level. Pictorial representation of the number of cases and deaths in affected countries as of 5 July 2015 is shown in Fig. 1.

Number of deaths and people affected by Ebola.

The World Health Organization on 6 August 2014 declared this Ebola outbreak in West Africa to be a public health emergency of international concern.

Lessons Learned
The West Africa Ebola outbreak has been the largest, longest, and most complex since the virus was discovered in 1976. It has had the highest number of cases and deaths ever reported for Ebola.

A functional health system is a prerequisite for any coordinated preparedness for and response to any possible outbreak. The 2005 revision to the International Health Regulations (IHR) is a legally binding agreement whose purpose is “to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.” None of the most-affected countries were compliant with the IHR regulations, and this surely delayed the timely identification of the disease, the setting up of contact tracing and adequate surveillance measures, and the early implementation of infectious control measures in healthcare settings.

This epidemic served as a reminder of the possible negative consequences of globalization (i.e., rapid spread of infection across continents and oceans, putting the entire world at risk). The West Africa Ebola outbreak also reconfirmed that infectious diseases cannot be easily cordoned off to one country or continent. Rather, an outbreak will have an immediate and critical global effect if immediate prevention and control measures are not put in place.

In addition, countries with weak health systems and poor health infrastructure cannot withstand the effect of such rapidly spreading epidemics. In such situations, the country’s health systems will collapse, leading to more and more deaths because many patients with other diseases (e.g., malaria and HIV/AIDS) would not approach the clinics for fear of being exposed to the epidemic. This could lead to economic shutdown of the affected countries, leading to humanitarian crises. Thus, there is a significant need to strengthen and restructure basic public health systems in these countries, including primary healthcare facilities, laboratories, surveillance systems, and critical care facilities.

Another important lesson learned is the importance of collaboration with media in order to provide correct information. This is essential to avoid or control the spread of panic among the community. The additional threat to the population’s faith in government and international agencies can be fatal for both sides.

Lessons Learned for Companies Operating in Tropical Hot Spots at Risk of Zoonotic Infections
Companies operating in tropical hot spots—typically at high risk of zoonotic infections—that are interested in business continuity need vigilantly to understand the health and political context in which they operate in order to keep their employees safe and protected.

From a preparedness perspective, companies should undertake a thorough review of the capability of the country’s national health and veterinary system at the beginning of the project itself, supplemented by periodic reviews. A detailed health-impact assessment of the project should be conducted before the start of the project and for each major project expansion. This assessment should include a review of zoonotic infections and not be exclusively based on the epidemiology of the diseases already present in the country. Companies should develop flexible response plans informed by the characteristics of the disease or an outbreak and not merely based on fixed triggering factors. The response to the Ebola epidemic, in fact, could not rely on trigger matrices developed for other possible outbreaks because one single case would require a substantial and immediate response plan.

When coming up with a strategy to protect the premises and its employees, the company should keep in mind that the regular health, safety, and environment (HSE) emergency-response-plan (ERP) triggers will not always be appropriate in such infectious-disease outbreaks. This was one of the biggest stumbling blocks encountered in this Ebola outbreak (i.e., to get health, safety, and environment managers to understand that the response to this infectious disease epidemic is very different from that to any other threat that uses the normal HSE ERP and traditional triggers).

Risks Involved for Oil and Gas Companies: Offshore Suspected Cases
First Scenario. The biggest risk involved for oil and gas companies operating in affected countries is to have a symptomatic Ebola case offshore. It is very likely for a person who is completely asymptomatic, and who travels from an affected country after unprotected exposure, to become symptomatic while offshore. This would cause fear and panic among the rest of the team and expose the medical personnel available offshore until the diagnosis is confirmed either way. In such a scenario, the best prevention and control measure would be to isolate the suspected case. The medical staff members should protect themselves with the correct personal protective equipment but should still minimize physical contact with bodily fluids of the suspected case until help arrives from a specialist team.

The company should ensure that there are dedicated and trained teams available at the project sites that will be able to respond to such offshore emergencies almost immediately. This specialist team should be ready to move the suspected case, most likely by boat (helicopter providers will be reluctant to respond in such cases), and immediate directions should be given to clean and disinfect the offshore facilities as soon as possible.

Second Scenario. The company is operating in a nonaffected country, and people from affected countries are working offshore and there is a suspected case on the rig. The chances are that there will be no systems in place to deal with such a patient. There may be no laboratory facilities available, so even excluding EVD will be complex.

First, preventing this situation from happening should be the main objective. This can be achieved through training of all the workers who travel to and from affected countries. They should understand how to mitigate the risk and why it is so important to inform the employer about any potential contact with an ­Ebola-risk case. They should then be allowed to stay at home for 21 days and monitor their health, before going offshore.

A second important consideration is that no symptomatic individual from an affected country should be allowed to go offshore. Consideration should be given whether the company will allow people from affected countries to go offshore unless they have gone through a 21-day window period (in the case of EVD) outside of the affected country. The situation may turn out to be complex and controversial, but it depends on the rank of the individual or workforce and the level of understanding about the disease.

Conclusion
Although, at the time this paper was written, the current outbreak was still not completely over, systems are now in place in affected countries to ensure that the same uncontrolled spread of EVD among humans seen in 2014 will most likely never happen again. The lessons learned from this outbreak have definitely sensitized the world to the fact that the spread of EVD among humans becomes almost immediately a global threat and cannot remain confined to a country or a continent. The key is to respond rapidly and effectively at the early stages of the spread. This early-response system was already tested in Nigeria and Mali, where medical infrastructure is more or less the same as in the three heavily affected countries. But, because of the rapid response of the Nigerian and Malian governments, supported by the international community and nongovernmental organizations, the ongoing spread among humans was stopped very effectively, with only a few cases reported.

This was the biggest Ebola outbreak ever, with many lives lost, including healthcare workers in the line of duty. How­ever, the long-term benefit from this outbreak is the development of vaccines that will save many more lives in the future. Such an unprecedented and uncontrolled outbreak is highly unlikely to occur again. These vaccines are still going through various test trials but thus far have demonstrated very positive ­results.


PubMed | 27 July 2016

Association Between Unconventional Natural Gas Development in the Marcellus Shale and Asthma Exacerbations

Asthma is common and can be exacerbated by air pollution and stress. Unconventional natural gas development (UNGD) has community and environmental impacts. In Pennsylvania, UNGD began in 2005, and, by 2012, 6,253 wells had been drilled. There are no prior studies of UNGD and objective respiratory outcomes.

A nested case-control study compared patients with asthma with and without exacerbations from 2005 through 2012 treated at the Geisinger Clinic, which provides primary care services to more than 400,000 patients in Pennsylvania. Patients with asthma aged 5 to 90 years (n = 35,508) were identified in electronic health records; those with exacerbations were frequency matched on age, sex, and year of event to those without.

The study identified 20,749 mild, 1,870 moderate, and 4,782 severe asthma exacerbations and frequency matched these to 18,693, 9,350, and 14 ,104 control index dates, respectively.

Residential UNGD activity metrics were statistically associated with increased risk of mild, moderate, and severe asthma exacerbations. Whether these associations are causal awaits further investigation, including more detailed exposure assessment.