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Severe HRI is more likely when personal susceptibilities coexist with work-related and environmental risk factors. Almost all HRIs occur when employers do not adhere to preventive guidelines.

Background: Outbreaks of severe silicosis have affected workers who fabricate artificial stone countertops. Work-related asthma (WRA) has not been a prominent feature of those prior outbreaks.Methods: This report describes an outbreak of WRA and silicosis at a facility that manufactures and fabricates chemical-resistant countertops comprised of sand, epoxy resin, and phthalic anhydride (PA), a known respiratory sensitizer. The multidisciplinary investigation included clinical examinations of workers, an industrial hygiene survey with qualitative and quantitative exposure assessments, and a crosssectional questionnaire.Results: Engineering controls and personal protective equipment were inadequate. Some workers were exposed to PA or silica above permissible exposure limits established by the Occupational Safety and Health Administration (OSHA). Clinical and epidemiologic investigations identified 16 workers with confirmed or suspected WRA. Two years later, after OSHA began to enforce its new silica standards, 12 workers received medical surveillance for silicosis. Of these 12 workers, four (33.3%) were diagnosed with silicosis based on abnormal chest computed tomography examinations.Conclusions: Artificial stone countertop workers can develop asthma or silicosis.Risk of asthma may be highest in workers exposed to asthmagens such as PA and epoxy resins while manufacturing the artificial stone material.

Background Hospital readmissions are common and costly. Our goal was to determine the association between depressive symptoms and readmission within 30 days following hospital discharge in older adults. Methods We analyzed data from a study of 789 persons aged 65 years or older admitted to a 20-bed acute care for elders (ACE) hospital unit from May 2009 to July 2011. Depressive symptoms were recorded within 24-hours of admission to the hospital unit, using the Center for Epidemiologic Studies -Depression (CES-D) Scale. The primary outcome was readmission to hospital within 30 days of discharge. Results The mean age was 77 years; 66% were female, 72% were White, and 59% were unmarried. On average, older patients reported 2.6 comorbid conditions. Sixteen percent were classified with high depressive symptoms (CES-D ≥ 16). The readmission rate within 30 days was 15%. Older patients with high depressive symptoms had more than 1.6 times the odds (OR 1.66; 95% CI: 1.01-2.74) of being readmitted within 30-days, as compared to those with low depressive symptoms (CES-D < 16), after adjustment for age, race/ethnicity, sex, marital status and comorbid conditions. Conclusion High depressive symptoms increased the risk of hospital readmission within 30 days of discharge after adjusting for relevant covariates. In-hospital screening for depressive symptoms may identify older persons at risk for recurrent hospital admissions.