Showing papers in "American Journal of Industrial Medicine in 2019"
TL;DR: The origins of AI, use of ML methods, and emerging AI applications embedded in physical objects like sensor technologies, robotic devices, or operationalized in intelligent DSSs are reviewed.
Abstract: Artificial intelligence (AI) is a broad transdisciplinary field with roots in logic, statistics, cognitive psychology, decision theory, neuroscience, linguistics, cybernetics, and computer engineering. The modern field of AI began at a small summer workshop at Dartmouth College in 1956. Since then, AI applications made possible by machine learning (ML), an AI subdiscipline, include Internet searches, e-commerce sites, goods and services recommender systems, image and speech recognition, sensor technologies, robotic devices, and cognitive decision support systems (DSSs). As more applications are integrated into everyday life, AI is predicted to have a globally transformative influence on economic and social structures similar to the effect that other general-purpose technologies, such as steam engines, railroads, electricity, electronics, and the Internet, have had. Novel AI applications in the workplace of the future raise important issues for occupational safety and health. This commentary reviews the origins of AI, use of ML methods, and emerging AI applications embedded in physical objects like sensor technologies, robotic devices, or operationalized in intelligent DSSs. Selected implications on the future of work arising from the use of AI applications, including job displacement from automation and management of human-machine interactions, are also reviewed. Engaging in strategic foresight about AI workplace applications will shift occupational research and practice from a reactive posture to a proactive one. Understanding the possibilities and challenges of AI for the future of work will help mitigate the unfavorable effects of AI on worker safety, health, and well-being.
116 citations
TL;DR: The present findings can orient further research to assess the effects of heat at workplace and consequently to establish better health policies for managing such exposure in at-risk regions.
Abstract: BACKGROUND Growing evidence indicates that the exposure to high heat levels in the workplace results in health problems in workers. A meta-analysis was carried out to summarize the epidemiological evidence of the effects of heat exposure on the risk of occupational injuries. METHODS A search strategy was conducted to retrieve studies on the effects of climate change on occupational injury risk. Among the 406 identified, 5 time-series and 3 case-crossover studies were selected for meta-analysis. RESULTS Pooled risk estimates for time-series and case-crossover studies combined, and then separated, were 1.005 (95%CI: 1.001-1009), 1.002 (95%CI: 0.998-1.005), and 1.014 (95%CI: 1.012-1.017), respectively. Subgroup analyses found increased risks (not statistically significant) for male gender, age <25 years and agriculture. CONCLUSIONS The present findings can orient further research to assess the effects of heat at workplace and consequently to establish better health policies for managing such exposure in at-risk regions.
63 citations
TL;DR: The respirable dust geometric mean concentration was lower in central Appalachia compared to the rest of the United States, however, the respirable quartz geometricmean concentration and the mean percent quartz content were higher in central Appalachian.
Abstract: Background This study summarized the mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by district, and by occupation) from underground coal mines during 1982-2017. Methods Respirable dust and quartz data collected and analyzed by Mine Safety and Health Administration (MSHA) were summarized by year, coal mining occupation, and geographical area. The older (before August 2016) 2.0 mg/m 3 respirable dust MSHA permissible exposure limit (PEL) was used across all years for comparative purposes. For respirable dust and quartz, geometric mean and percent of samples exceeding the respirable dust PEL (2.0 mg/m 3 or a reduced standard for samples with >5% quartz content) were calculated. For quartz samples, the average percent quartz content was also calculated. Results The overall geometric mean concentration for 681 497 respirable dust samples was 0.55 mg/m 3 and 5.5% of the samples exceeded the 2.0 mg/m 3 PEL. The overall respirable quartz geometric mean concentration for 210 944 samples was 0.038 mg/m 3 and 18.7% of these samples exceeded the applicable standard. There was a decline over time in the percent of respirable dust samples exceeding 2.0 mg/m 3 . The respirable dust geometric mean concentration was lower in central Appalachia compared to the rest of the United States. However, the respirable quartz geometric mean concentration and the mean percent quartz content were higher in central Appalachia. Conclusion This study summarizes respirable dust and quartz concentrations from coal mine inspector samples and may provide an insight into differences in the prevalence of pneumoconiosis by region and occupation.
50 citations
TL;DR: Effective workplace interventions, enhanced surveillance, and improved regulations and enforcement should accompany broader efforts to combat global warming, as this risk has increased with climate change over time.
Abstract: Background Heat is a severe hazard for construction workers and may be worsening with global warming. This study sought to explore heat-related deaths among U.S. construction workers and a possible association with climate change. Methods Heat-related deaths in the Census of Fatal Occupational Injuries from 1992 to 2016 were analyzed. Denominators estimated from the Current Population Survey were matched with demographic and occupational categories in rate calculations. Statistical tests were used to examine heat-related deaths in relation to time, geographic region, and temperature. Results Construction workers, comprising 6% of the total workforce, accounted for 36% (n = 285) of all occupational heat-related deaths from 1992 to 2016 in the U.S. Mean temperatures from June to August increased gradually over the study period. Increasing summer temperatures from 1997 to 2016 were associated with higher heat-related death rates (r = 0.649; 95% confidence interval: 0.290, 0.848). Compared to all construction workers (risk index = 1), statistically significant elevated risk of heat-related death was found among Hispanics (1.21), in particular workers born in Mexico (1.91). Occupations with a high risk index included cement masons (10.80), roofers (6.93), helpers (6.87), brick masons (3.33), construction laborers (1.93) and heating, air conditioning, and refrigeration mechanics (1.60). Conclusions U.S. construction workers are at a high risk of heat-related death, and this risk has increased with climate change over time. Effective workplace interventions, enhanced surveillance, and improved regulations and enforcement should accompany broader efforts to combat global warming. The construction industry can help reduce global warming through increased implementation of green building principles.
37 citations
TL;DR: The need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations is underscored, as several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers.
Abstract: BACKGROUND Thousands of people in the United States continue to die from opioid overdoses every year. Work-related injuries and other factors associated with work may increase exposure to opioids and, subsequently, opioid-related overdose deaths (OROD). This study sought to determine whether OROD rates differed by industry and occupation and explored work-related factors that might contribute to these differences. METHODS We coded industry and occupation information on death certificates for all OROD among Massachusetts residents from 2011 to 2015. We estimated rates of OROD by industry and occupation using Massachusetts employment data. National survey data were used to explore whether work-related factors known to vary by occupation (occupational injury and illness, job insecurity, and paid sick leave) correlate to observed differences in OROD. RESULTS Several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers. Construction workers and fishing workers stood out for having OROD rates many times higher than the average for all workers. Occupation groups with high rates of occupational injuries and illnesses, high job insecurity, and low availability of paid sick leave had higher rates of OROD. CONCLUSIONS These findings underscore the need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as best practices in medical management and return to work following injury, safer prescribing, enhanced access to treatment for opioid use disorders, and overdose prevention education.
36 citations
TL;DR: Results suggest that among the population workload is the primary modifiable risk factor for heat-related illness, and as expected, the ambient temperature was also associated with higher risk.
Abstract: Background The primary aim of this study was to investigate the effects of work rate, hydration status, and clothing on core body temperature (CBT) on California farmworkers. Methods Two hundred and eighty-seven farmworkers were recruited in Summer 2015, with 259 participants having sufficient data for analysis. We collected CBT, ambient temperature, work rate, body weight loss, and clothing worn by each participant throughout the work day and demographic data from a questionnaire. Results Multiple regression with CBT as the outcome was used to determine the adjusted associations between CBT, environmental heat load, and worker characteristics. The multivariate regression model showed statistically significant associations of CBT with work rate (β = .006, 95% CI [0.004, 0.009]) and wet-bulb globe temperature (β = .03, 95% CI [0.017, 0.05]). Conclusion Results suggest that among our population workload is the primary modifiable risk factor for heat-related illness. As expected, the ambient temperature was also associated with higher risk.
31 citations
TL;DR: Situating work-related risk factors within their material context can help to better understand them as determinants of mental illness and identify appropriate targets for social change.
Abstract: BACKGROUND We draw on a relational theoretical perspective to investigate how the social division and structure of labor are associated with serious and moderate mental illness and binge and heavy drinking. METHODS The Panel Study of Income Dynamics and the Occupational Information Network were linked to explore how occupation, the productivity-to-pay gap, unemployment, the gendered division of domestic labor, and factor-analytic and theory-derived dimensions of work are related to mental illness and drinking outcomes. RESULTS Occupations involving manual labor and customer interaction, entertainment, sales, or other service-oriented labor were associated with increased odds of mental illness and drinking outcomes. Looking for work, more hours of housework, and a higher productivity-to-pay gap were associated with increased odds of mental illness. Physical/risky work was associated with binge and heavy drinking and serious mental illness; technical/craft work and automation were associated with binge drinking. Work characterized by higher authority, autonomy, and expertise was associated with lower odds of mental illness and drinking outcomes. CONCLUSIONS Situating work-related risk factors within their material context can help us better understand them as determinants of mental illness and identify appropriate targets for social change.
27 citations
TL;DR: Significantly higher worksite WBGT levels occured compared with regional levels estimated at the airport, with an upward trend in heat warnings over the 7 years and expansion of warnings into the fall season.
Abstract: Background Occupational heat exposure is a serious concern for worker health, productivity, and the economy. Few studies in North America assess how on-site wet bulb globe temperature (WBGT) levels and guidelines are applied in practice. Methods We assessed the use of a WBGT sensor for localized summertime heat exposures experienced by outdoor laborers at an industrial worksite in Ontario, Canada during the warm season (May-October) from 2012 to 2018 inclusive. We further examined informed decision making, approximated workers' predicted heat strain (sweat loss, core temperature), and estimated potential financial loss (via hourly wages) due to decreased work allowance in the heat. Results Significantly higher worksite WBGT levels occured compared with regional levels estimated at the airport, with an upward trend in heat warnings over the 7 years and expansion of warnings into the fall season. The maximum WBGT during warnings related strongly to predicted hourly sweat loss. On average, 22 hours per worker were lost each summer (~1% of annual work hours) as a result of taking breaks or stopping due to heat. This amount of time corresponded to an average individual loss of C$1100 Canadian dollars (~C$220,000 combined for ~200 workers) to workers or the company. The additional losses for an enterprise due to reduced product output were not estimated. Conclusions Worksite observations and actions at the microscale are essential for improving the estimates of health and economic costs of extreme heat to enterprises and society. Providing worksite heat metrics to the employees aids in appropriate decision making and health protection.
27 citations
TL;DR: Improved workplace conditions, improved pain treatment, better treatment of substance use disorders, and treatment of postinjury depression may substantially reduce mortality consequent to workplace injuries.
Abstract: Background Drug overdoses and suicides have been rising since 2000 and are major contributors to a 3-year decline in US life expectancy. Studies suggest that injured workers have elevated rates of depression and opioid use, but no studies have measured excess mortality related to these risks. Materials and methods We linked New Mexico workers' compensation data for 100 806 workers injured in 1994 through 2000 with Social Security Administration earnings and mortality data through 2013 and National Death Index cause of death data. We then estimated the association between receiving lost-time workers' compensation benefits and mortality hazard ratios (HRs) and 95% confidence intervals (CIs) based on Fine and Gray cause-specific subdistribution hazards for common causes of death and for drug-related, suicide, and alcohol-related mortality. Results There was almost a 3-fold increase in combined drug-related and suicide mortality hazard among women (HR = 2.63, 95% CI = 1.91-3.64) and a substantial increase among men (HR = 1.42, 95% CI = 1.13-1.79). Circulatory disease mortality hazard was elevated for men (HR = 1.25, 95% CI = 1.05-1.50). Conclusion Workplace injuries severe enough to require more than a week off work may impair workers' long-term health and well-being. Drug-related deaths and suicides may be important contributors to the long-term excess mortality of injured workers. Improved workplace conditions, improved pain treatment, better treatment of substance use disorders, and treatment of postinjury depression may substantially reduce mortality consequent to workplace injuries.
26 citations
TL;DR: Evidence of the relationship between aspects of physical fitness and occupational injury in emergency responders is extremely limited and more research is required to expand the knowledge.
Abstract: Background Emergency responders have jobs with physical demands that put them at risk of musculoskeletal injuries. Objectives This paper systematically reviews existing literature examining the relationship between fitness and occupational injury in this group. Methods Comprehensive electronic searches were conducted using key words relating to musculoskeletal injury, fitness, and emergency responders. Results Eleven articles included in the review provided limited evidence for the relationship between physical fitness test scores and injury risk. There appears to be a correlation between better aerobic fitness and decreased risk of injury. Conclusions Evidence of the relationship between aspects of physical fitness and occupational injury in emergency responders is extremely limited. More research is required to expand the knowledge in this area and to draw more definitive conclusions.
24 citations
TL;DR: The high demands with limited control and, for some, little support, that these children experience place them at risk and show the possibility of injury and exploitation.
Abstract: BACKGROUND US government child labor policies allow children as young as age 10 to be hired as workers on farms not operated by family members. Children may face substantial health risks in an industry known for high worker morbidity and mortality rates, due to high demands for productivity, and low control and little support because of the organization of the workplace. This paper examines how child farmworkers in North Carolina experience their work situation. METHODS In-depth interviews conducted in 2016 with 30 Latinx child farmworkers, ages 10 to 17, were analyzed using concepts from the demand-control-support model. All had worked as either migrant or seasonal hired farmworkers within the past year. RESULTS Children reported planting, cultivating, and harvesting crops including fruits, vegetables, and tobacco. The crew leader supervisory system, piece-rate pay, and coworker pressure produced significant demands to work quickly and take risks including lifting heavy loads, operating mechanical equipment, and working in excessive heat. Children had little control over work to counter demands they experienced; and they labored in a state of fear of firing, wage theft, and other sanctions. Support was variable, with younger children more likely to experience family and coworker support than older children. CONCLUSIONS The high demands with limited control and, for some, little support, that these children experience place them at risk and show the possibility of injury and exploitation. Future research should systematically document the occupational injury and illness of hired child farmworkers, and consider whether changes in labor policy are warranted.
TL;DR: Study results suggest that exposure to nickel compounds may increase the risk of lung cancer even below its occupational exposure limit and indicate possible associations with other cancer sites.
Abstract: Background Nickel and chromium-VI compounds are carcinogens for lung cancer, although it is still debated if there is an increased risk at low levels of exposure and for other cancers. Methods In a cohort of 2991 Italian electroplaters, a proportion of whom were exposed to low levels of nickel and/or chromium, cumulative exposure to their compounds was obtained by multiplying average concentrations of the metals in each electroplating tank by duration of employment in the company. The association of exposure to compounds with mortality was assessed by multivariable Cox models. Results No cancer site was associated with chromium exposure controlling for nickel, whereas exposure to nickel significantly increased mortality from lung, rectal, and kidney cancers, even after adjusting for exposure to chromium. Conclusions Study results suggest that exposure to nickel compounds may increase the risk of lung cancer even below its occupational exposure limit and indicate possible associations with other cancer sites.
TL;DR: A large, multicomponent study of hired Latinx child farmworkers, and the characteristics of children participating in this study, indicates several important issues for further analysis.
Abstract: Background Although children as young as 10 years can work in agriculture, little research has addressed their occupational health. This paper describes a large, multicomponent study of hired Latinx child farmworkers, and the characteristics of children participating in this study. Methods Survey interviews were conducted in 2017 with 202 Latinx children aged 10-17 years employed in agriculture across North Carolina (NC). Results Most (81.2%) participants were born in the United States, 37.6% were female, and 21.3% were aged 10-13 years. Most (95.1%) were currently enrolled in school. Thirty-six (17.8%) were migrant workers. 34.7% had worked in agriculture for 1 year; 18.3% had worked 4+ years. 33.7% worked piece rate. 57.4% worked in tobacco. Participants in western NC differed in personal and occupational characteristics from those in eastern NC. Conclusions This study has enrolled a large and diverse child farmworker sample. This overview indicates several important issues for further analysis.
TL;DR: This cluster of severe lung disease at a manufacturing facility making industrial machines indicates a previously unrecognized occupational lung disease of yet uncertain etiology that should be considered in manufacturing workers (particularly never-smokers) with airflow obstruction and centrilobular emphysema.
Abstract: Background A cluster of severe lung disease occurred at a manufacturing facility making industrial machines. We aimed to describe disease features and workplace exposures. Methods Clinical, functional, radiologic, and histopathologic features were characterized. Airborne concentrations of thoracic aerosol, metalworking fluid, endotoxin, metals, and volatile organic compounds were measured. Facility airflow was assessed using tracer gas. Process fluids were examined using culture, polymerase chain reaction, and 16S ribosomal RNA sequencing. Results Five previously healthy male never-smokers, ages 27 to 50, developed chest symptoms from 1995 to 2012 while working in the facility's production areas. Patients had an insidious onset of cough, wheeze, and exertional dyspnea; airflow obstruction (mean FEV1 = 44% predicted) and reduced diffusing capacity (mean = 53% predicted); and radiologic centrilobular emphysema. Lung tissue demonstrated a unique pattern of bronchiolitis and alveolar ductitis with B-cell follicles lacking germinal centers, and significant emphysema for never-smokers. All had chronic dyspnea, three had a progressive functional decline, and one underwent lung transplantation. Patients reported no unusual nonoccupational exposures. No cases were identified among nonproduction workers or in the community. Endotoxin concentrations were elevated in two air samples; otherwise, exposures were below occupational limits. Air flowed from areas where machining occurred to other production areas. Metalworking fluid primarily grew Pseudomonas pseudoalcaligenes and lacked mycobacterial DNA, but 16S analysis revealed more complex bacterial communities. Conclusion This cluster indicates a previously unrecognized occupational lung disease of yet uncertain etiology that should be considered in manufacturing workers (particularly never-smokers) with airflow obstruction and centrilobular emphysema. Investigation of additional cases in other settings could clarify the cause and guide prevention.
TL;DR: Reducing noise in the steel factory could be a way of decreasing the risk of hypertension in this population of steelworkers, as measured by self-reported noise exposure and audiometrically measured hearing loss.
Abstract: Background Hazardous exposure to occupational noise may be associated with an increased risk of cardiovascular disease and hypertension. This study was performed to assess the relationship between noise exposure and hypertension prevalence in steelworkers. Methods A cross-sectional survey using self-reported noise exposure and audiometrically measured hearing loss was performed. One thousand eight hundred and seventy-four workers were interviewed. Multiple logistic regression was used to calculate odds ratios for hypertension by noise exposure. Linear regression analysis was used to test associations between noise exposure and systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results Occupational noise-exposed subjects had significantly higher blood pressure levels than nonexposed subjects (SBP: 123.18 ± (standard deviation) 12.44 vs 119.80 ± 12.50 mm Hg; DBP: 77.86 ± 9.34 vs 75.49 ± 8.73 mmHg). The prevalence of hypertension was approximately 5% in the control group without noise exposure or hearing impairment and increased from 6% to 21% across the range of increasing degree of hearing loss and, separately, of cumulative exposure time. Noise exposure (any) was associated with an increase in the prevalence of hypertension (odds ratio, 2.03, 95% confidence interval [CI]: 1.15-3.58). Noise-induced hearing loss and cumulative noise exposure time were positively correlated with BP (hearing loss: SBP: β = .09, 95% CI: 0.04-0.15 mm Hg, DBP: β = .11, 95% CI: 0.06-0.17 mm Hg; cumulative exposure time: SBP: β = .10, 95% CI: 0.04-0.15 mm Hg, DBP: β = .09, 95% CI: 0.04-0.15 mm Hg). Conclusions Noise exposure measured in two different ways was strongly associated with the prevalence of hypertension in steelworkers. Reducing noise in the steel factory could be a way of decreasing the risk of hypertension in this population.
TL;DR: A new WSH 4.0 strategy is argued for which requires WSH professionals to adopt an adaptive and highly responsive approach to promote Total Worker Health in the face of rapid technological advancements and changes in employment relationships.
Abstract: We are on the cusp of the fourth Industrial Revolution which promises to revolutionize the way we live and work. Throughout history, as society and technology progress, so too have our workplace safety and health (WSH) strategies in regard to better knowledge and enhanced regulation. In this paper, we argue for a new WSH 4.0 strategy which requires us to adopt an adaptive and highly responsive approach to promote Total Worker Health in the face of rapid technological advancements and changes in employment relationships. To do so, we propose a multi-pronged strategy comprising (i) adaptive WSH solutions in regard to surveillance, risk assessment, and control measures leveraging on new technologies; (ii) effective multi-stakeholder dialogues for collaborative and sustainable solutions; (iii) an anticipatory WSH governance framework based upon shared values and cooperative responsibility; and (iv) professional development among WSH practitioners. This new WSH 4.0 strategy will enable WSH professionals to remain effective in this coming Industrial Revolution.
TL;DR: Serial FeNO measurements off and at work provide complementary information in the diagnosis of occupational asthma in about one-fifth of cases with suspected OA, especially if specific inhalation challenges are negative or cannot be performed.
Abstract: Background Fractional exhaled nitric oxide (FeNO) before and after specific inhalation challenge has been postulated as an additional tool in the diagnosis of occupational asthma (OA), but little is known about serial FeNO measurements at home and at work. The aim of the present study was to assess the contribution of serial measurements of FeNO off and at work toward the diagnosis of OA. Methods Forty-one subjects with suspected (n = 35) or diagnosed (n = 6) OA performed FeNO measurements once daily during a 2-week holiday and a subsequent 2-week work period. A work-related increase in FeNO by 20 ppb (parts per billion) or more was considered positive. Subjects with negative or doubtful specific inhalation challenge but a FeNO increase of 20 ppb or more were evaluated individually by an overall expert rating taking into account all available information. Results Seven of 35 subjects (20%) with suspected and three of six subjects (50%) with diagnosed OA showed a work-related FeNO increase of 20 ppb or more. Six of the seven with suspected OA were reclassified as having an OA diagnosis by the overall expert rating which also considered these FeNO changes. Conclusions Serial FeNO measurements off and at work provide complementary information in the diagnosis in about one-fifth of cases with suspected OA, especially if specific inhalation challenges are negative or cannot be performed.
TL;DR: The findings suggest the need for OSH programs that specifically target nonstandard workers especially those in manual unskilled occupations, and male unskilled manual workers with nonstandard employment were most vulnerable to OSH problems.
Abstract: BACKGROUND Permanent jobs are in decline world-wide, and are being replaced with temporary, casual, part-time, and contract jobs. We investigated the characteristics and occupational safety and health (OSH) vulnerabilities of workers with nonstandard and standard employment. METHODS We used the Korean Working Conditions Survey of 2017 to compare working conditions and OSH vulnerabilities of workers with standard and nonstandard employment in five major job categories. RESULTS Workers with nonstandard employment were older, less educated, had lower monthly incomes, were employed in smaller businesses, worked fewer hours per week, had shorter work durations, and were more likely to report exposure to physical/chemical and ergonomic hazards, and musculoskeletal and mental symptoms. Among nonstandard workers, the rates of occupational hazards and work-related health problems depended on the type of work performed. In particular, nonstandard male workers who were unskilled manual workers, older, had less education, and earned low wages had a greater risk of working in unstable occupations, greater exposures to occupational hazards, and more musculoskeletal pain (back pain: odds ratio [OR], 2.4; upper extremity pain: OR, 2.1; and lower extremity pain: OR, 1.7) than those performing other types of work. CONCLUSION Male unskilled manual workers with nonstandard employment were most vulnerable to OSH problems. Our findings suggest the need for OSH programs that specifically target nonstandard workers especially those in manual unskilled occupations.
TL;DR: The components of the FPHS studies undertaken and completed thus far, as well as those studies currently underway or planned for the near future are described.
Abstract: The Football Players Health Study at Harvard University (FPHS) is a unique transdisciplinary, strategic initiative addressing the challenges of former players' health after having participated in American style football (ASF). The whole player focused FPHS is designed to deepen understanding of the benefits and risks of participation in ASF, identify risks that are potentially reversible or preventable, and develop interventions or approaches to improve the health and wellbeing of former players. We are recruiting and following a cohort of former professional ASF players who played since 1960 (current n = 3785). At baseline, participants complete a self-administered standardized questionnaire, including initial reporting of exposure history and physician-diagnosed health conditions. Additional arms of the initiative are addressing targeted studies, including promising primary, secondary, and tertiary interventions; extensive in-person clinical phenotyping, and legal and ethical concerns of the play. This paper describes the components of the FPHS studies undertaken and completed thus far, as well as those studies currently underway or planned for the near future. We present our initiatives herein as a potential paradigm of one way to proceed (acknowledging that it is not the only way). We share what we have learned so that it may be useful to others, particularly in regard to trying to make professional sports meet the needs of multiple stakeholders ranging from players to owners, to fans, and possibly even to parents making decisions for their children.
TL;DR: Quantitative data support with quantitative data the conclusion that chrysotile causes mesothelioma and encourage exposure‐response analyses of mesot helioma in other cohorts exposed to chrysOTile.
Abstract: Background While asbestos has long been known to cause mesothelioma, quantitative exposure-response data on the relation of mesothelioma risk and exposure to chrysotile asbestos are sparse. Methods Quantitative relationships of mortality from mesothelioma and pleural cancer were investigated in an established cohort of 5397 asbestos textile manufacturing workers in North Carolina, USA. Eligible workers were those employed between 1950 and 1973 with mortality follow-up through 2003. Individual exposure to chrysotile fibres was estimated on the basis of 3420 air samples covering the entire study period linked to work history records. Exposure coefficients adjusted for age, race, and time-related covariates were estimated by Poisson regression. Results Positive, statistically significant associations were observed between mortality from all pleural cancer (including mesothelioma) and time since first exposure (TSFE) to asbestos (rate ratio [RR], 1.19; 95% confidence interval [CI], 1.06-1.34 per year), duration of exposure, and cumulative asbestos fibre exposure (RR, 1.15; 95% CI, 1.04-1.28 per 100 f-years/mL; 10-year lag). Analyses of the shape of exposure-response functions suggested a linear relationship with TSFE and a less-than-linear relationship with cumulative exposure. Restricting the analysis to years when mesothelioma was coded as a unique cause of death yielded stronger but less precise associations. Conclusions These observations support with quantitative data the conclusion that chrysotile causes mesothelioma and encourage exposure-response analyses of mesothelioma in other cohorts exposed to chrysotile.
TL;DR: Mortality was elevated for all causes, all cancers, cancers of the trachea, bronchus, and lung and lymphatic and hematopoietic system, mesothelioma, chronic obstructive pulmonary disease, asbestosis, transportation injuries, and other injuries, suggesting a possible effect of the opioid epidemic.
Abstract: Background To determine if construction and trades workers employed at U.S. Department of Energy (DOE) nuclear sites facilities are at significant risk for diseases associated with occupational exposures, we compared the mortality experience of participants in the Building Trades National Medical Screening Program (BTMed) to that of the US population. Methods The cohort includes 24,086 BTMed participants enrolled between 1998 and 2016 and 5203 deaths. Cause-specific standardized mortality ratios were calculated based on US death rates. Results Mortality was elevated for all causes, all cancers, cancers of the trachea, bronchus, and lung and lymphatic and hematopoietic system, mesothelioma, chronic obstructive pulmonary disease, asbestosis, transportation injuries, and other injuries, particularly those caused by accidental poisoning, suggesting a possible effect of the opioid epidemic. Conclusions Apart from other injuries, mortality patterns were very similar to those reported in the past in this population. Construction workers employed at DOE sites have a significantly increased risk for occupational illnesses. Risks are associated with employment during all time periods covered including possibly after 1990. The cancer risks closely match the cancers identified for DOE compensation from radiation exposures. The high risk of lung cancer supports the value of early lung cancer detection. Continued medical surveillance is important.
TL;DR: Both available autocodes can be useful tools for assigning SOC codes, allowing linkage of occupational exposures to data containing free-text occupation descriptors, and O*NET exposure values based on SOC code assignment showed strong agreement between manual and autocoded methods.
Abstract: Background Existing datasets often lack job exposure data. Standard Occupational Classification (SOC) codes can link work exposure data to health outcomes via a Job Exposure Matrix, but manually assigning SOC codes is laborious. We explored the utility of two SOC autocoding programs. Methods We entered industry and occupation descriptions from two existing cohorts into two publicly available SOC autocoding programs. SOC codes were also assigned manually by experienced coders. These SOC codes were then linked to exposures from the Occupational Information Network (O*NET). Results Agreement between the SOC codes produced by autocoding programs and those produced manually was modest at the 6-digit level, and strong at the 2-digit level. Importantly, O*NET exposure values based on SOC code assignment showed strong agreement between manual and autocoded methods. Conclusion Both available autocoding programs can be useful tools for assigning SOC codes, allowing linkage of occupational exposures to data containing free-text occupation descriptors.
TL;DR: In this paper, the authors validate the factor structure of the Copenhagen Psychosocial Questionnaire (COPSOQ) in a North American population and dissect the associations between psychosocial factors and workplace psychological health and safety.
Abstract: OBJECTIVES To validate the factor structure of the Copenhagen Psychosocial Questionnaire (COPSOQ) in a North American population and dissect the associations between psychosocial factors and workplace psychological health and safety. METHODS Confirmatory factor analysis and multivariate linear regression were used to determine the associations between COPSOQ dimensions and a global rating of workplace psychological health and safety. Models were stratified by sex, gender roles, and age. RESULTS The COPSOQ factor structure was verified among Canadian workers. Three factors were found to significantly contribute to the global rating of the psychological health and safety for all workers. Few differences were observed across sex, gender roles, and age. CONCLUSIONS This study identified dimensions of the psychosocial work environment that are strongly associated with the global rating of workplace psychological health and safety. Using a standardized questionnaire like the COPSOQ allows for comparisons over time, between different industries, and worker populations.
TL;DR: The many subsectors identified with high prevalences and/or worker risks for HL well above risks in the reference industry need critical attention to conserve worker hearing and maintain worker quality of life.
Abstract: Background The purpose of this study was to estimate the prevalence of hearing loss (HL) among noise-exposed US workers within the Mining, and Oil and Gas Extraction (OGE) sectors. Methods Audiograms of 1.9 million workers across all industries (including 9389 in Mining and 1076 in OGE) from 2006 to 2015 were examined. Prevalence and adjusted risk as compared to a reference industry (Couriers and Messengers) were estimated for all industries combined and the Mining and OGE sectors and subsectors. Results The prevalences of HL in Mining and OGE were 24% and 14%, respectively, compared with 16% for all industries combined. Many Mining and one OGE subsector exceeded these prevalences and most had an adjusted risk (prevalence ratio) significantly greater than the reference industry. Some subsectors, particularly in OGE, could not be examined due to low sample size. The prevalences in Construction Sand and Gravel Mining and Natural Gas Liquid Extraction were 36% and 28%, respectively. Workers within Support Activities for Coal Mining had double the risk of HL than workers in the reference industry. Conclusions The many subsectors identified with high prevalences and/or worker risks for HL well above risks in the reference industry need critical attention to conserve worker hearing and maintain worker quality of life. Administrative and engineering controls can reduce worker hazardous noise exposures. Noise and ototoxic chemical exposure information is needed for many subsectors, as is audiometric testing results for OGE workers. Additional research is also needed to further characterize exposures and improve hearing conservation measures.
TL;DR: Future directions in occupational heat stress management that consider this individual variability are discussed, which can lead to reductions in productivity in more heat-tolerant workers, while compromising safety in lessHeat stress workers who may develop heat-related illness, even in temperate conditions.
Abstract: Heat stress is a deadly occupational hazard that is projected to increase in severity with global warming. While upper limits for heat stress designed to protect all workers have been recommended by occupational safety institutes for some time, heat stress continues to compromise health and productivity. In our view, this is largely explained by the inability of existing guidelines to consider the inter-individual (age, sex, disease, others) and intra-individual (medication use, fitness, hydration, others) factors that cause extensive variability in physiological tolerance to a given heat stress. In conditions that do not exceed the recommended limits, this 'one size fits all' approach to heat stress management can lead to reductions in productivity in more heat-tolerant workers, while compromising safety in less heat-tolerant workers who may develop heat-related illness, even in temperate conditions. Herein, we discuss future directions in occupational heat stress management that consider this individual variability.
TL;DR: Silicosis is a prevalent disease among Medicare beneficiaries aged ≥65, with variation across the country, andMorbidity data from health insurance claims can provide a more complete picture of silicosis burden.
Abstract: INTRODUCTION Existing epidemiologic information on silicosis relies on mortality data. METHODS We analyzed health insurance claims and enrollment information from 49 923 987 fee-for-service (FFS) Medicare beneficiaries aged ≥65 from 1999 to 2014. Three different definitions were developed to identify silicosis cases and results are presented as ranges of values for the three definitions. RESULTS Among FFS beneficiaries, 10 026-19 696 fit the silicosis case definitions (16-year prevalence: 20.1-39.5 per 100 000) with the highest prevalence among North American Natives (87.2-213.6 per 100 000) and those in New Mexico (83.9-203.4 per 100 000). The annual average prevalence had a significant (P < 0.05) 2-5% annual decline from 2005 to 2014. The average annual number of incident cases had a significant 3-16% annual decline from 2007 to 2014. CONCLUSIONS Silicosis is a prevalent disease among Medicare beneficiaries aged ≥65, with variation across the country. Morbidity data from health insurance claims can provide a more complete picture of silicosis burden.
TL;DR: Airflow obstruction and self- reported COPD are associated with both self-reported and JEM-assigned exposures, and significant PORs for airflow obstruction andself-reported COPD respectively were observed withSelf-reported exposure for ≥20 years to mineral dust and exhaust fumes.
Abstract: INTRODUCTION This study examined the association of spirometry-defined airflow obstruction and self-reported COPD defined as self-reported doctor diagnosed chronic bronchitis or emphysema, with occupational exposure among ever-employed US adults. METHODS Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2011-2012, a nationally representative study of the non-institutionalized civilian US population. Reported current and/or longest held job were used to create prevalence estimates and prevalence odds ratios (PORs) (adjusted for age, gender, race, and smoking status) for airflow obstruction and self-reported COPD by occupational exposure, determined using both NHANES participants' self-reported exposures and eight categories of COPD job exposure matrix (JEM) assigned exposures. RESULTS Significant PORs for airflow obstruction and self-reported COPD respectively were observed with self-reported exposure for ≥20 years to mineral dust (POR = 1.44; 95% confidence interval (CI) 1.13-1.85; POR = 1.69; 95% CI 1.17-2.43) and exhaust fumes (POR = 1.65; 95% CI 1.27-2.15; POR = 2.22; 95% CI 1.37-3.58). Airflow obstruction or self-reported COPD were also associated with COPD-JEM assigned high exposure to mineral dust, combined dust, diesel exhaust, vapor-gas, sensitizers, and overall exposure. CONCLUSION Airflow obstruction and self-reported COPD are associated with both self-reported and JEM-assigned exposures.
TL;DR: The increase in two cardiovascular disease risk factors, job strain, and low job control, might partially explain the slowing of the decline in US heart disease and stroke mortality rates.
Abstract: OBJECTIVES To assess changes in work characteristics, socioeconomic status inequalities in changes in work characteristics, and whether US workplaces are becoming more stressful. METHODS We analyzed data from 5361 employed participants from the 2002, 2006, 2010, and 2014 NIOSH Quality of Work Life Surveys, based on representative samples of US workers. We used regression analyses to assess changes in job characteristics, adjusting for age, sex, race/ethnicity, education, work hours, and unemployment rate. For the regression analyses with continuous job characteristics, we created standardized variables allowing for the magnitude of changes to be directly compared between job characteristics. RESULTS Over the period 2002-2014, we observed statistically significant increases in job strain (+0.09 standard deviations (SD), P = 0.02), low job control (+0.10 SD, P = 0.03), and work-family conflict (+0.15 SD, P = 0.001). No significant changes were observed for high job demand, low social support, and low reward. The largest increase in low job control was seen among service workers. CONCLUSIONS The increase in two cardiovascular disease risk factors, job strain, and low job control, might partially explain the slowing of the decline in US heart disease and stroke mortality rates.
TL;DR: The risk of death from liver cirrhosis, as well as from HCC in the largest available series of confirmed cases, increased with VCM exposure.
Abstract: Background Occupational exposure to vinyl chloride monomer (VCM) has been established as a cause of hepatocellular carcinoma (HCC) and liver angiosarcoma (ASL). However, some controversy remains due to conflicting results on liver cirrhosis, and to evidence on HCC based on few confirmed cases. The aim of the study is to clarify the association between VCM exposure and mortality from liver diseases. Methods In a cohort of 1658 workers involved in VCM production and polymerization, Poisson regression was adopted to estimate rate ratios (RR) across categories of VCM exposure for mortality due to ASL (n = 9), HCC (n = 31) confirmed by histological/clinical records, and the combination of deaths from liver cirrhosis and from liver cancer with clinical/histological evidence of cirrhosis (n = 63). Results Cumulative VCM exposure was associated with study outcomes; RRs in the highest compared to the lowest exposure category were: ASL 91.1 (95%Confidence Interval 16.8-497), HCC 5.52 (2.03-15.0), liver cirrhosis 2.60 (1.19-5.67). Conclusions The risk of death from liver cirrhosis, as well as from HCC in the largest available series of confirmed cases, increased with VCM exposure.
TL;DR: The fact that important gender-based differences emerged when interactions among the psychosocial factors and injury were modeled, suggests opportunities for further research and potential interventions to enhance the working environment.
Abstract: Introduction This study aimed to identify psychosocial work factors that may individually or, in combination, influence injury outcomes among aging United States (U.S.) workers. Methods Data from the U.S. Health and Retirement Study (HRS) of 3305 working adults, aged 50 years and above, were used to identify associations between work-related psychosocial factors and injury incidence from 2006 to 2014, using adjusted incidence rate ratios. Results Employees perceiving their work as high in psychological and physical demands/efforts, low in support, and rewards, compared to those in workplaces with low demands, high support, and high rewards, had a risk of injury two times greater. Males, compared with females, had a greater risk for injuries when interactions among several psychosocial work-related factors were modeled. Conclusions The fact that important gender-based differences emerged when interactions among the psychosocial factors and injury were modeled, suggests opportunities for further research and potential interventions to enhance the working environment.