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Home care (HC) aides experience numerous safety hazards in clients' homes; many hazards also put clients at risk. We hypothesized that safety coaching led by nurse managers (NMs) during their initial HC needs assessment could prompt clients to improve safety conditions in their homes. Following a 2-arm proof-of-concept intervention study design, intervention NMs used motivational interviewing (MI), facilitated by a safety handbook and video, to coach clients on home safety improvements. Control arm NMs performed intake assessments with no changes to usual practices. Intervention effectiveness was assessed by NMs and aides. Three HC agencies and two elder services contributed 35 intervention and 23 control homes. NMs coached 97% of clients and reported that 94% were engaged; 63% implemented improvements. NMs' and aides' assessments were consistent; homes with clients reported by NMs as resistant to safety changes had higher aides' hazard scores. Client coaching can be effective for improving HC safety. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Retinal detachment (RD) has been associated with exposure to heavy lifting. Topics include investigated the association between occupational heavy lifting and rhegmatogenous RD in a retrospective cohort study of Swedish construction workers; and Retinal detachment (RD) is a major cause of visual impairment that can lead to blindness if not treated promptly.

Introduction: The demographics of those developing severe coronavirus disease (COVID-19) outcomes are shifting to younger patients. In an observational study utilizing electronic health records from a Massachusetts group medical practice, we identified 5025 patients with confirmed COVID-19 from March 1 to December 18, 2020. Of these, 3870 were under 65 years of age. We investigated the hypothesis that pre-infection metabolic or immunologic dysregulation including polycystic ovary syndrome (PCOS) increased risk of serious COVID-19 outcomes in patients under 65 years of age. Materials and methods: We compared those with COVID-19 related hospitalization or mortality to all other COVID-19 patients, using a case control approach. Using logistic regression and propensity score modeling, we evaluated risk of developing severe COVID-19 outcomes (hospitalization or death) in those with pre-infection comorbidities, metabolic risk factors, or PCOS. Results: Overall, propensity score matched analyses demonstrated pre-infection elevated liver enzymes alanine aminotransferase (ALT) >40, aspartate aminotransferase (AST) >40 and blood glucose ≥215 mg/dL were associated with more severe COVID-19 outcomes, OR = 1.74 (95% CI 1.31, 2.31); OR = 1.98 (95% CI 1.52, 2.57), and OR = 1.55 (95% CI 1.08, 2.23) respectively. Elevated hemoglobin A1C or blood glucose levels were even stronger risk factors for severe COVID-19 outcomes among those aged < 65, OR = 2.31 (95% CI 1.14, 4.66) and OR = 2.42 (95% CI 1.29, 4.56), respectively. In logistic regression models, women aged < 65 with PCOS demonstrated more than a four-fold increased risk of severe COVID-19, OR 4.64 (95% CI 1.98, 10.88). Conclusion: Increased risk of severe COVID-19 outcomes in those < age 65 with pre-infection indicators of metabolic dysfunction heightens the importance of monitoring pre-infection indicators in younger patients for prevention and early treatment. The PCOS finding deserves further investigation. Meanwhile women who suffer from PCOS should be carefully evaluated and prioritized for earlier COVID-19 treatment and vaccination. [ABSTRACT FROM AUTHOR]

Background: Healthy diets have been associated with better cognitive function. Socioeconomic factors including education, poverty, and job complexity may modify the relationship between diet and cognition.Methods: We used adjusted linear mixed models to examine the association between long-term adherence to the Mediterranean-Dietary Approaches to Stop Hypertension - Intervention for Neurodegenerative Delay (MIND) diet and cognitive function over 8 years of follow-up in Puerto Rican adults residing in the Boston, MA area (aged 45-75 years at baseline). We also examined whether the MIND diet-cognition association was confounded or modified by socioeconomic measures.Results: In both cross-sectional and longitudinal analyses the highest, versus lowest, MIND quintile was associated with better cognition function (β = 0.093; 95% CI: 0.035, 0.152; p trend = .0019), but not with cognitive trajectory over 8 years. Education <=8th grade (β = -0.339; 95% CI: 0.394, -0.286; p < .0001) and income-to-poverty ratio <120% (β = -0.049; 95% CI: -0.092, -0.007; p = .024) were significantly associated with lower cognitive function, while higher job complexity (β = 0.008; 95% CI: 0.006, 0.011; p < .0001) was associated with better cognition function. These variables acted as confounders, but not effect modifiers of the MIND-diet-cognitive function relationship.Conclusion: Adherence to the MIND diet was associated with better cognitive function at baseline and over 8 years of follow-up; however, MIND diet was not associated with 8-year cognitive trajectory. More studies are needed to better understand whether the MIND diet is protective against long-term cognitive decline. [ABSTRACT FROM AUTHOR]

Objectives In the USA, deaths from poisonings (especially opioids), suicides, and alcoholic liver disease, collectively referred to as 'deaths of despair', have been increasing rapidly over the past two decades. The risk of deaths from these causes is known to be higher among certain occupations. It may be that specific exposures and experiences of workers in these occupations explain these differences in risk. This study sought to determine whether differences in the risk of deaths of despair were associated with rate of occupational injuries and illnesses, job insecurity, and temporal changes in employment in non-standard work arrangements. Methods Usual occupation information was collected from death certificates of Massachusetts residents aged 16–64 with relevant causes of death between 2005 and 2015. These data were combined with occupation-level data about occupational injuries and illnesses, job insecurity, and non-standard work arrangements. We calculated occupation-specific mortality rates for deaths of despair, categorized by occupational injury and illnesses rates and job insecurity. We calculated trends in mortality according to changes in non-standard work arrangements. Results Workers in occupations with higher injury and illnesses rates and more job insecurity had higher rates of deaths of despair, especially opioid-related deaths. Rates of deaths of despair increased most rapidly for occupations with increasing prevalence of workers employed in non-standard work arrangements. Conclusions The findings suggest occupational factors that may contribute to the risk of deaths of despair. Future studies should examine these factors with individual-level data. In the meantime, efforts should be made to address these factors, which also represent known or suspected hazards for other adverse health outcomes. [ABSTRACT FROM AUTHOR]

Background: Precarious work is a broad definition for non-standard employment, often including unstable and insecure positions where workers permanently experience uncertainty; these types of jobs are growing steadily around the planet. Since the coup d'état in 1973, Chile has experienced a series of structural economic changes framed by neoliberal ideas cemented in the "Constitution of Pinochet." Precarious work in Chile is a direct consequence of these ideas. This multidimensional phenomenon has progressively been entering employment areas where it was not previously present. As a result, there has been a rise in work precarization and its full impact on health is not well known. The goal of this study was to estimate the association of work precariousness with mental health outcomes in Chilean workers.Methods: Data were obtained from the Chilean Survey of Work and Health 2009-2010 (ENETS). Only valid records of salaried workers (excluding hourly-only or commission-only workers) in the private sector without missing values were included (n = 1900). After applying appropriate sampling weights, 1,461,727 workers were represented. Mental health was estimated as anxiety/depression levels using the 12-item General Health Questionnaire (GHQ-12). A multilevel multivariate generalized linear mixed model (GLMM) with negative binomial and log link distribution was used to study the association between precariousness and depression/anxiety.Results: Looking at the overall precariousness scale (range from zero to four), we observed an increase of approximately 34% in the depression/anxiety score (scale range from 0 to 36) for every unit on the precarious work overall scale (Relative Risk = 1.34, 95% CI = 1.28, 1.42) controlling for age, sex, and occupational group.Conclusion: Precarious work was associated with anxiety and depression as measured with the 12-item General Health Questionnaire. Controlling for demographic variables changed neither the direction nor the magnitude of the association. [ABSTRACT FROM AUTHOR]

Background: Precarious work is a broad definition for non-standard employment, often including unstable and insecure positions where workers permanently experience uncertainty; these types of jobs are growing steadily around the planet. Since the coup d'état in 1973, Chile has experienced a series of structural economic changes framed by neoliberal ideas cemented in the "Constitution of Pinochet." Precarious work in Chile is a direct consequence of these ideas. This multidimensional phenomenon has progressively been entering employment areas where it was not previously present. As a result, there has been a rise in work precarization and its full impact on health is not well known. The goal of this study was to estimate the association of work precariousness with mental health outcomes in Chilean workers. Methods: Data were obtained from the Chilean Survey of Work and Health 2009–2010 (ENETS). Only valid records of salaried workers (excluding hourly-only or commission-only workers) in the private sector without missing values were included (n = 1900). After applying appropriate sampling weights, 1,461,727 workers were represented. Mental health was estimated as anxiety/depression levels using the 12-item General Health Questionnaire (GHQ-12). A multilevel multivariate generalized linear mixed model (GLMM) with negative binomial and log link distribution was used to study the association between precariousness and depression/anxiety. Results: Looking at the overall precariousness scale (range from zero to four), we observed an increase of approximately 34% in the depression/anxiety score (scale range from 0 to 36) for every unit on the precarious work overall scale (Relative Risk = 1.34, 95% CI = 1.28, 1.42) controlling for age, sex, and occupational group. Conclusion: Precarious work was associated with anxiety and depression as measured with the 12-item General Health Questionnaire. Controlling for demographic variables changed neither the direction nor the magnitude of the association. [ABSTRACT FROM AUTHOR]

Home health and home care (HH&HC) agencies provide essential medical and supportive services to elders and people with disabilities, enabling them to live at home. Home-based care is an important alternative to facility-based care, especially for infection prevention during the COVID-19 pandemic. The majority of the HH&HC workforce is comprised of aides, who also are vulnerable to COVID-19. There are limited data on the COVID-19 experience of HH&HC agencies, clients and aides. A survey of Massachusetts HH&HC agency managers was conducted June 1 to 30, 2020 to assess the impact of COVID-19 on agencies, clients, and aides early in the pandemic and to identify needs for future pandemic planning. Of the 94 agencies with completed surveys, most (59.6%) provided services to clients with COVID-19 and 3-quarters (73.7%) employed aides who tested positive for COVID-19, were symptomatic, and/or quarantined. Most agencies (98.7%) experienced a decrease in demand for home visits, reflecting clients' concern about infection, family members assuming care duties, and/or aides being unavailable for work. Simultaneously, managers' workloads increased to develop more extensive infection prevention policies, procedures and workforce training and sourcing scarce personal protective equipment (PPE). The COVID-19 pandemic imposed substantial new infection prevention responsibilities on HH&HC agencies, clients, and aides. Specific HH&HC needs for future pandemic planning include complete information on the infection status of clients; ready access to affordable PPE and disinfectants; and guidance, tools, and training tailored for the industry. HH&HC should be incorporated more fully into comprehensive healthcare and public health pandemic planning. [ABSTRACT FROM AUTHOR]

Background: Exposure to COVID‐19 is more likely among certain occupations compared with others. This descriptive study seeks to explore occupational differences in mortality due to COVID‐19 among workers in Massachusetts. Methods: Death certificates of those who died from COVID‐19 in Massachusetts between March 1 and July 31, 2020 were collected. Occupational information was coded and age‐adjusted mortality rates were calculated according to occupation. Results: There were 555 deaths among MA residents of age 16–64, with usable occupation information, resulting in an age‐adjusted mortality rate of 16.4 per 100,000 workers. Workers in 11 occupational groups including healthcare support and transportation and material moving had mortality rates higher than that for workers overall. Hispanic and Black workers had age‐adjusted mortality rates more than four times higher than that for White workers overall and also had higher rates than Whites within high‐risk occupation groups. Conclusion: Efforts should be made to protect workers in high‐risk occupations identified in this report from COVID‐19 exposure. [ABSTRACT FROM AUTHOR]

It remains uncertain whether the hypertension (HT) medications angiotensin‐converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) mitigate or exacerbate SARS‐CoV‐2 infection. We evaluated the association of ACEi and ARB with severe coronavirus disease 19 (COVID‐19) as defined by hospitalization or mortality among individuals diagnosed with COVID‐19. We investigated whether these associations were modified by age, the simultaneous use of the diuretic thiazide, and the health conditions associated with medication use. In an observational study utilizing data from a Massachusetts group medical practice, we identified 1449 patients with a COVID‐19 diagnosis. In our study, pre‐infection comorbidities including HT, cardiovascular disease, and diabetes were associated with increased risk of severe COVID‐19. Risk was further elevated in patients under age 65 with these comorbidities or cancer. Twenty percent of those with severe COVID‐19 compared to 9% with less severe COVID‐19 used ACEi, 8% and 4%, respectively, used ARB. In propensity score‐matched analyses, use of neither ACEi (OR = 1.30, 95% CI 0.93 to 1.81) nor ARB (OR = 0.94, 95% CI 0.57 to 1.55) was associated with increased risk of severe COVID‐19. Thiazide use did not modify this relationship. Beta blockers, calcium channel blockers, and anticoagulant medications were not associated with COVID‐19 severity. In conclusion, cardiovascular‐related comorbidities were associated with severe COVID‐19 outcomes, especially among patients under age 65. We found no substantial increased risk of severe COVID‐19 among patients taking antihypertensive medications. Our findings support recommendations against discontinuing use of renin–angiotensin system (RAS) inhibitors to prevent severe COVID‐19. [ABSTRACT FROM AUTHOR]

Climate change has led to the need for innovation in resilient infrastructure and the social policies which will support those. This requires greater interdisciplinary interactions and knowledge building among emerging professionals. This paper presents a case study of a pilot short course intended to immerse graduate students in the design of resilient infrastructure using place-based and interdisciplinary active team learning. This course helps graduate students bridge the gap between research and practice on the social science and engineering of resilient infrastructure for coastal adaptation. The intellectual framework for the course (the Adaptive Gradients Framework) provides a holistic evaluation of adaptation design proposals and was used to recognize the complexity of social, ecological and engineering aspects and varied social benefits. The course provides a model to move outside rigid boundaries of institutions and disciplines to begin to build, in both students and instructors, the ability to work more effectively on complex social-ecological-engineering problems. Finally, this paper presents a summary of lessons learned from this pilot short course. [ABSTRACT FROM AUTHOR]

Background: Debates over the importance of "lifestyle" versus "environment" contributions to cancer have been going on for over 40 years. While it is clear that cigarette smoking is the most significant cancer risk factor, the contributions of occupational and environmental carcinogens in air, water and food remain controversial. In practice, most cancer prevention messaging focuses on reducing cigarette smoking and changing other personal behaviors with little mention of environmental chemicals, despite widespread exposure to many known carcinogens. To inform decision-making on cancer prevention priorities, we evaluated the potential impact of smoking cessation on cancer rates.Methods: Using cancer incidence data from 612 counties in the SEER database, and county-level smoking prevalences, we investigated the impact of smoking cessation on incidence for 12 smoking-related cancer types, 2006-2016. A multilevel mixed-effects regression model quantified the association between county-level smoking prevalence and cancer incidence, adjusting for age, gender and variability over time and among counties. We simulated complete smoking cessation and estimated the effects on county-level cancer rates.Results: Regression models showed the expected strong association between smoking prevalence and cancer incidence. Simulating complete smoking cessation, the incidence of the 12 smoking-related cancer types fell by 39.8% (54.9% for airways cancers; 28.9% for non-airways cancers). And, while the actual rates of smoking-related cancers from 2006 to 2016 declined (annual percent change (APC) = - 0.8, 95% CI = - 1.0 to - 0.5%), under the scenario of smoking elimination, the trend in cancer incidence at these sites was not declining (APC = - 0.1, 95% CI = - 0.4 to + 0.1%). Not all counties were predicted to benefit equally from smoking elimination, and cancer rates would fall less than 10% in some counties.Conclusions: Smoking prevention has produced dramatic reductions in cancer in the US for 12 major types. However, we estimate that eliminating smoking completely would not affect about 60% of cancer cases of the 12 smoking-related types, leaving no improvement in the incidence trend from 2006 to 2016. We conclude that cancer prevention strategies should focus not only on lifestyle changes but also the likely contributions of the full range of risk factors, including environmental/occupational carcinogens. [ABSTRACT FROM AUTHOR]

Objectives Assess the impact of summer heat exposure (June–September) on residential construction workers in Al-Ahsa, Saudi Arabia by evaluating (i) heart rate (HR) responses, hydration status, and physical workload among workers in indoor and outdoor construction settings, (ii) factors related to physiological responses to work in hot conditions, and (iii) how well wet-bulb globe temperature-based occupational exposure limits (WBGTOELs) predict measures of heat strain. Methods Twenty-three construction workers (plasterers, tilers, and laborers) contributed 260 person-days of monitoring. Workload energy expenditure, HR, fluid intake, and pre- and postshift urine specific gravity (USG) were measured. Indoor and outdoor heat exposures (WBGT) were measured continuously and a WBGTOEL was calculated. The effects of heat exposure and workload on heart rate reserve (HRR), a measure of cardiovascular strain, were examined with linear mixed models. A metric called 'heat stress exceedance' (HSE) was constructed to summarize whether the environmental heat exposure (WBGT) exceeded the heat stress exposure limit (WBGTOEL). The sensitivity and specificity of the HSE as a predictor of cardiovascular strain (HRR ≥30%) were determined. Results The WBGTOEL was exceeded frequently, on 63 person-days indoors (44%) and 91(78%) outdoors. High-risk HRR occurred on 26 and 36 person-days indoors and outdoors, respectively. The HSE metric showed higher sensitivity for HRR ≥30% outdoors (89%) than indoors (58%) and greater specificity indoors (59%) than outdoors (27%). Workload intensity was generally moderate, with light intensity work more common outdoors. The ability to self-pace work was associated with a lower frequency of HRR ≥30%. USG concentrations indicated that workers began and ended their shifts dehydrated (USG ≥1.020). Conclusions Construction work where WBGTOEL is commonly exceeded poses health risks. The ability of workers to self-pace may help reduce risks. [ABSTRACT FROM AUTHOR]

Introduction: Home care (HC) aide is among the fastest‐growing jobs. Aides often work in long‐term care relationships with elders or people with disabilities in clients' homes, assisting with daily activities. The purpose of this mixed‐methods paper is to elucidate aides' experiences around the boundary‐challenging behaviors of clients asking for services beyond aides' job duties and to identify possible interventions. Methods: A cross‐sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post‐survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in‐depth interviews with HC industry and labor representatives. Results: Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47‐2.52 for verbal, PR = 1.81; 95%CI: 1.13‐2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11‐2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89‐1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90‐0.98). Qualitative data showed that clients' requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests. Conclusion: Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care. [ABSTRACT FROM AUTHOR]

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert advisory group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs program. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating, and integrating evidence to identify causes of human cancer. The advancements adopted include the strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals, and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. [ABSTRACT FROM AUTHOR]

The ranking of Allegheny County in the bottom 2 % of SEER counties with regard to the benefit of tobacco control for lung cancer raises a red flag about past and ongoing exposures that may increase cancer risk. Using U.S. Surveillance, Epidemiology and End Results (SEER) cancer incidence and population data for 612 counties [[2]], we simulated the expected effect of eliminating smoking on the rates of 12 types of cancer known to be caused by smoking [[3]]. [Extracted from the article]

Objective: Violence from care recipients and family members, including both verbal and physical abuse, is a serious occupational hazard for healthcare and social assistance workers. Most workplace violence studies in this sector focus on hospitals and other institutional settings. This study examined verbal abuse in a large home care (HC) aide population and evaluated risk factors.Methods: We used questionnaire survey data collected as part of a larger mixed methods study of a range of working conditions among HC aides. This paper focuses on survey responses of HC aides (n=954) who reported on verbal abuse from non-family clients and their family members. Risk factors were identified in univariate and multivariable analyses.Results: Twenty-two per cent (n=206) of aides reported at least one incident of verbal abuse in the 12 months before the survey. Three factors were found to be important in multivariable models: clients with dementia (relative risk (RR) 1.38, 95% CI 1.07 to 1.78), homes with too little space for the aide to work (RR 1.52, 95% CI 1.17 to 1.97) and predictable work hours (RR 0.74, 95% CI 0.58 to 0.94); two additional factors were associated with verbal abuse, although not as strongly: having clients with limited mobility (RR 1.35, 95% CI 0.94 to 1.93) and an unclear plan for care delivery (RR 1.27, 95% CI 0.95 to 1.69). Aides reporting verbal abuse were 11 times as likely to also report physical abuse (RR 11.53; 95% CI 6.84 to 19.45).Conclusions: Verbal abuse is common among HC aides. These findings suggest specific changes in work organisation and training that may help reduce verbal abuse. [ABSTRACT FROM AUTHOR]

Objectives Excessive heat exposure poses significant risks to workers in hot climates. This study assessed the intensity and duration of heat stress exposure among workers performing residential construction in southeastern Saudi Arabia (SA) during the summer, June–September 2016. Objectives were to: identify work factors related to heat stress exposure; measure environmental heat exposure at the construction sites; assess the heat stress risk among workers using the wet bulb globe temperature (WBGT) index; and determine if temperature-humidity indices can be appropriate alternatives to WBGT for managing heat stress risk at the construction sites. Methods Worksite walkthrough surveys and environmental monitoring were performed, indoors and outdoors, at 10 construction sites in Al-Ahsa Province. A heat stress exposure assessment was conducted according to the American Conference of Governmental Industrial Hygienists (ACGIH®) guidelines, which uses the WBGT index. WBGT measurements from two instruments were compared. Alternative heat stress indices were compared to the WBGT: the heat index (HI) and humidex (HD) index. Results Construction workers were exposed to excessive heat stress, indoors and outdoors over a large part of the work day. Complying with a midday outdoor work ban (12–3 p.m.) was not effective in reducing heat stress risk. The highest intensity of exposure was outdoors from 9 a.m. to 12 p.m.; a period identified with the highest hourly mean WBGT values (31–33°C) and the least allowable working time according to ACGIH® guidelines. Comparison of the alternative indices showed that the HI is more reliable than the HD as a surrogate for the WBGT index in the climate studied. Conclusion The extreme heat exposure represents a serious risk. The severity of heat stress and its impact are projected to increase due to climate change, emphasizing the need for immediate improvement of the current required protective measures and the development of occupational heat stress exposure guidelines in SA. [ABSTRACT FROM AUTHOR]

Purpose: We conducted external comparisons for the prevalence of asthma, hypertension, diabetes, and cancer among World Trade Center (WTC) general responders using the National Health Interview Survey (NHIS) as the reference, along with internal comparisons for the incidence of asthma. Methods: Standardized Morbidity Ratios (SMRs) were calculated for the prevalence of the health conditions, and risk ratios (RRs) for asthma incidence. Results: Relative to the NHIS, asthma prevalence was in excess in responders over the study years (age‐adjusted SMRs = 1.3‐2.8). Hypertension prevalence began to exceed expected from 2006 while diabetes was lower than expected. An upward trend towards excess cancer prevalence was observed. Internal comparisons showed elevated asthma incidence among protective service and utility workers compared to construction workers; while those who arrived at the WTC site in the morning of 9/11 had a lower asthma risk than those who arrived in the afternoon. Conclusions: The use of NHIS data as a reference population demonstrates and reconfirms several important patterns of excess risk in WTC responders. External comparisons are an alternative for disaster cohorts without an established comparison group. [ABSTRACT FROM AUTHOR]

The article supports a 2022 study which called for a halt in asbestos production and use due to its link to higher mortality rates from asbestos-related diseases (ARD). Topics discussed include asbestos' causation of its own distinct diseases, and control technologies' deterioration of effectiveness due to neglect or cost cutting. Also noted is the basic message that eliminating a hazard is the best way to control it.

Objectives: To investigate the association between occupational lifting and the risk of rhegmatogenous retinal detachment (RRD) using data from a large population of men.Methods: We used data from a national cohort of 49 321 Swedish men conscripted for compulsory military service in 1969-1970. We collected information on surgically treated RRD from the National Patient Register and we followed up the cohort between 1991 and 2009 at ages 40-60 years. Exposure to occupational lifting was assessed by applying a job exposure matrix to occupational data from the 1990 census. Incidence rate ratios (IRRs) and 95% CIs were estimated through Poisson regression models adjusted by degree of myopia, income and education level.Results: We observed 217 cases of RRD in 7 80 166 person-years. In univariate analyses we did not observe an association between occupational lifting and RRD. However, after adjustment for myopia and socioeconomic factors, we found an increased risk of RRD (IRR 2.38, 95% CI 1.15 to 4.93) for subjects in the highest category of exposure compared with those in the lowest one. The incidence rate of RRD among subjects lifting heavy loads at least twice per week, aged between 50 years and 59 years, and affected by severe myopia was as high as 7.9 cases per 1000 person-years, compared with an overall rate of 0.28.Conclusions: Our study supports the hypothesis that heavy occupational lifting is a risk factor for RRD. Information on myopia degree and socioeconomic status is necessary when studying the association between occupational lifting and RRD. [ABSTRACT FROM AUTHOR]

Cancer incidence is rising among adolescents (“teens”). The causes of the increase are unknown but studying incidence patterns and trends may produce insights into etiology. Using data from the US National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program we described trends of cancer incidence among teens (15–19 year olds). We reviewed and summarized incidence patterns for histologic cancer groups and the most frequently diagnosed sites of cancer among teens during 2008–2012 reported by the SEER Cancer Statistics Review. We calculated annual incidence rates for the years 1975–2012 and used linear regression analysis to evaluate trends and calculate rates of change. Incidence for all sites combined increased annually by 0.67% for males and 0.62% for females during the period 1975 through 2012 –resulting in more than a 25% increase over 38 years. The biggest annual incidence increases occurred in non-Hodgkin lymphoma (NHL) (2.16% females; 1.38% males), thyroid cancer (2.12% females; 1.59% males), acute myeloid leukemia (AML) (1.73% females) and testicular cancer (1.55% males). Incidence rates for most histologic groups and sites showed steady long term increases over the 38 years of data. Despite improvements in survival, rising incidence trends mean growing numbers of young adults are undergoing painful and costly cancer treatments. A concerted research program is vital to investigate causes of steadily rising teen cancer rates. [ABSTRACT FROM AUTHOR]

A systematic literature review was performed to identify all peer-reviewed literature quantifying the association between short-term exposures of particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2), and sulfur dioxide (SO2) and COPD-related emergency department (ED) visits, hospital admissions (HA), and mortality. These results were then pooled for each pollutant through meta-analyses with a random effects model. Subgroup meta-analyses were explored to study the effects of selected lag/averaging times and health outcomes. A total of 37 studies satisfied our inclusion criteria, contributing to a total of approximately 1,115,000 COPD-related acute events (950,000 HAs, 80,000 EDs, and 130,000 deaths) to our meta-estimates. An increase in PM2.5of 10 ug/m3was associated with a 2.5% (95% CI: 1.6–3.4%) increased risk of COPD-related ED and HA, an increase of 10 ug/m3in NO2was associated with a 4.2% (2.5–6.0%) increase, and an increase of 10 ug/m3in SO2was associated with a 2.1% (0.7–3.5%) increase. The strength of these pooled effect estimates, however, varied depending on the selected lag/averaging time between exposure and outcome. Similar pooled effects were estimated for each pollutant and COPD-related mortality. These results suggest an ongoing threat to the health of COPD patients from both outdoor particulates and gaseous pollutants. Ambient outdoor concentrations of PM2.5, NO2, and SO2were significantly and positively associated with both COPD-related morbidity and mortality. [ABSTRACT FROM PUBLISHER]

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) contribute greatly to increased morbidity, mortality and diminished quality of life. Recent studies report moderately strong positive associations between exposures to several air pollutants and COPD-related emergency department (ED) visits and hospital admissions (HA). Studies that use clinically defined exacerbations rather than counting ED visits and HA may be more sensitive to environmental triggers like air pollution, but very few such studies exist. Participants in a COPD disease management group living in an area of low air pollution and who were followed closely for the earliest signs of an exacerbation provided an opportunity to study associations between air pollution and COPD exacerbation. Methods: Associations between short term exposures to air pollutants, including sulfur dioxide (SO2), nitrogen dioxide (NO2), and particulate matter < 2.5 microns (PM2.5), and COPD exacerbation were assessed among 168 patients residing in central Massachusetts, a region with air pollution levels well below USEPA National Ambient Air Quality Standards (NAAQS). Case-crossover analyses and multivariate conditional logistic regression were used to estimate associations between 7-day average concentrations of each air pollutant, as measured at central site monitors, and COPD exacerbation experienced in the patients'homes during the period 2012–2013, while controlling for temperature and self-reported influenza. Results: We found that short-term exposures to SO2 were associated with an increase in COPD exacerbation risk (odds ratio (OR) = 2.45, 95 % CI: 1.75–3.45 per 1 ppb increase) after adjustment for PM2.5. Short-term exposures to NO2 concentrations showed a weaker association, (OR = 1.17, 95 % CI: 1.05–1.30 per 1 ppb increase) after adjustment for PM2.5. An unexpectedly modest negative association was seen for short-term exposures to PM2.5. Conclusions: Despite living in an area with air pollution concentrations below current USEPA NAAQS, these COPD patients appeared to suffer increased risk of COPD exacerbation following short-term exposures to increased concentrations of SO2 and NO2. An unexpected negative association with PM2.5 may result from the complex air chemistry of low level PM in this region. [ABSTRACT FROM AUTHOR]

Background We aimed to investigate the role of vascular risk factors in the genesis of rhegmatogenous retinal detachment (RRD) using data from a large cohort of Swedish conscripts. Methods We used data from a nationwide cohort of 49 321 Swedish men born during 1949-1951, conscripted for compulsory military service in 1969-1970 with nearly complete follow-up to 2009. Information on surgically treated RRD between 1973 and 2009 was collected from the National Patient Register. We fitted Cox regression models stratified on myopia degree and including blood pressure levels, body mass index and cigarette smoking. Population attributable fractions of RRD were estimated through maximum likelihood methods. Results We observed 262 cases of RRD in 1 725 770 person-years. At multivariate analysis, the number of cigarettes per day showed a reverse association with the risk of RRD (p for trend 0.01). Conscripts with obesity presented a higher risk compared with normal subjects (adjusted HR 2.51, 95% CI 1.02 to 6.13). We found weak evidence of an association between blood pressure and RRD (HR for men with hypertension compared with normotension 1.41, 95% CI 0.93 to 2.13). All the observed associations were stronger when the analysis was restricted to non-myopic conscripts. In particular, the HR for hypertension was 2.33 (95% CI 1.30 to 4.19) compared with normotension. If this association is causal, we estimated that 42.0% of RRD cases (95% CI 11.5% to 62.0%) occurring among non-myopics are attributable to elevated blood pressure. Conclusions Vascular risk factors may be important determinants of RRD, particularly among non-myopics. Further investigations on the role of hypertension and obesity are needed. [ABSTRACT FROM AUTHOR]

Objectives: In countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA.Methods: HC aides were recruited for a survey via agencies that employ aides and schedule their visits with clients, and through a labour union of aides employed directly by clients or their families. The questionnaire included detailed questions about the most recent HC visits, as well as about individual aides' OSH experiences.Results: The study population included 1249 HC aides (634 agency-employed, 615 client-employed) contributing information on 3484 HC visits. Hazards occurring most frequently related to musculoskeletal strain, exposure to potentially infectious agents and cleaning chemicals for infection prevention and experience of violence. Client-hired and agency-hired aides had similar OSH experiences with a few exceptions, including use of sharps and experience of verbal violence.Conclusions: The OSH experience of HC aides is similar to that of aides in institutional healthcare settings. Despite OSH challenges, HC aides enjoy caring for others and the benefits of HC work should be enhanced. Quantification of HC hazards and benefits is useful to prioritise resources for the development of preventive interventions and to provide an evidence base for policy-setting. [ABSTRACT FROM AUTHOR]

Kriebel, D.L.; Geiman, J.D., and Henderson, G.R., 2015. Future flood frequency under sea-level rise scenarios. The effect of sea-level rise (SLR) on exceedance probabilities for annual flooding at coastal locations is explored in this paper. We assess four future SLR scenarios given by the U.S. Army Corps of Engineers and how these SLR scenarios affect monthly flooding statistics. Focusing on one case site, Annapolis, Maryland, we fit the probability density function of the monthly maximum tide gauge record with a Pareto-tail distribution. Random sampling from this distribution is then performed on top of the various future SLR scenarios. Exceedance probabilities for a storm tide to exceed the coastal flood stage, the elevation of which has already been established in a previous paper, are then calculated from the interpolated Pareto cumulative distribution. We illustrate that even mild increases in mean sea level acceleration lead to drastically higher exceedance probabilities of coastal flooding. [ABSTRACT FROM AUTHOR]

Kriebel, D.L. and Geiman, J.D., 2014. A coastal flood stage to define existing and future sea-level hazards. This paper explores the possible definition of a generic coastal flood stage (FS), an elevation at which significant flooding of local infrastructure is initiated, for regional or nationwide use in flood hazard analysis. By using monthly National Oceanic and Atmospheric Administration tidal gauge data from several coastal locations, a coastal FS based on the statistics of extreme high water events is proposed. This statistical FS is then compared to moderate and major FSs established by the National Weather Service with good agreement. Once adopted, the FS serves as a less ambiguous reference elevation or threshold to which the flooding potential of future storm events and sea-level rise can be compared and allows for consistent comparison between different sites. [ABSTRACT FROM AUTHOR]

Over the last decade, sustainability science has been at the leading edge of widespread efforts from the social and natural sciences to produce use-inspired research. Yet, how knowledge generated by sustainability science and allied fields will contribute to transitions toward sustainability remains a critical theoretical and empirical question for basic and applied research. This article explores the limitations of sustainability science research to move the field beyond the analysis of problems in coupled systems to interrogate the social, political and technological dimensions of linking knowledge and action. Over the next decade, sustainability science can strengthen its empirical, theoretical and practical contributions by developing along four research pathways focused on the role of values in science and decision-making for sustainability: how communities at various scales envision and pursue sustainable futures; how socio-technical change can be fostered at multiple scales; the promotion of social and institutional learning for sustainable development. [ABSTRACT FROM AUTHOR]

Developing nations bear a substantial portion of the global burden of injury. Public health surveillance models in developing countries should recognize injury risks for all levels of society and all causes and should incorporate various groups of workers and industries, including subsistence agriculture. However, many developing nations do not have an injury registration system; current data collection methods result in gross national undercounts of injuries, failing to distinguish injuries that occur during work. In 2006, we established an active surveillance system in Vietnam's Xuan Tien commune and investigated potential methods for surveillance of work-related injuries. On the basis of our findings, we recommend a national model for work-related injury surveillance in Vietnam that builds on the existing health surveillance system. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between external beam radiotherapy (EBRT) for prostate cancer and mesothelioma using data from the US Surveillance, Epidemiology, and End Results (SEER) cancer registries. Methods: We analyzed data from the SEER database (1973-2009). We compared EBRT versus no radiotherapy. Incidence rate ratios (IRR) and 95 % confidence intervals (95 % CI) of mesothelioma among prostate cancer patients were estimated with multilevel Poisson models adjusted by race, age, and calendar year. Confounding by asbestos was investigated using relative risk of mesothelioma in each case's county of residence as a proxy for asbestos exposure. Results: Four hundred and seventy-one mesothelioma cases (93.6 % pleural) occurred in 3,985,991 person-years. The IRR of mesothelioma was increased for subjects exposed to EBRT (1.28; 95 % CI 1.05, 1.55) compared to non-irradiated patients, and a population attributable fraction of 0.49 % (95 % CI 0.11, 0.81) was estimated. The IRR increased with latency period: 0-4 years, IRR 1.08 (95 % CI 0.81, 1.44); 5-9 years, IRR 1.31 (95 % CI 0.93, 1.85); ≥10 years, IRR 1.59 (95 % CI 1.05, 2.42). Despite the fairly strong evidence of association with EBRT, the population attributable rate of mesothelioma was modest-3.3 cases per 100,000 person-years. The cumulative incidence of mesothelioma attributable to EBRT was 4.0/100,000 over 5 years, 24.5/100,000 over 10 years, and 65.0/100,000 over 15 years. Conclusions: Our study provides evidence that EBRT for prostate cancer is a small but detectable risk factor for mesothelioma. Patients should be advised of risk of radiation-induced second malignancies. [ABSTRACT FROM AUTHOR]

Background: Autism and Autism Spectrum Disorder (ASD) are complex neurodevelopmental disorders. Susceptibility is believed to be the interaction of genetic heritability and environmental factors. The synchronous rises in autism/ASD prevalence and paracetamol (acetaminophen) use, as well as biologic plausibility have led to the hypothesis that paracetamol exposure may increase autism/ASD risk. Methods: To explore the relationship of antenatal paracetamol exposure to ASD, population weighted average autism prevalence rates and paracetamol usage rates were compared. To explore the relationship of early neonatal paracetamol exposure to autism/ASD, population weighted average male autism prevalence rates for all available countries and U.S. states were compared to male circumcision rates - a procedure for which paracetamol has been widely prescribed since the mid-1990s. Prevalence studies were extracted from the U.S. Centers for Disease Control and Prevention Summary of Autism/ASD Prevalence Studies database. Maternal paracetamol usage and circumcision rates were identified by searches on Pub Med. Results: Using all available country-level data (n = 8) for the period 1984 to 2005, prenatal use of paracetamol was correlated with autism/ASD prevalence (r = 0.80). For studies including boys born after 1995, there was a strong correlation between country-level (n = 9) autism/ASD prevalence in males and a country's circumcision rate (r = 0.98). A very similar pattern was seen among U.S. states and when comparing the 3 main racial/ethnic groups in the U.S. The country-level correlation between autism/ASD prevalence in males and paracetamol was considerably weaker before 1995 when the drug became widely used during circumcision. Conclusions: This ecological analysis identified country-level correlations between indicators of prenatal and perinatal paracetamol exposure and autism/ASD. State level correlation was also identified for the indicator of perinatal paracetamol exposure and autism/ASD. Like all ecological analyses, these data cannot provide strong evidence of causality. However, biologic plausibility is provided by a growing body of experimental and clinical evidence linking paracetamol metabolism to pathways shown to be important in autism and related developmental abnormalities. Taken together, these ecological findings and mechanistic evidence suggest the need for formal study of the role of paracetamol in autism. [ABSTRACT FROM AUTHOR]

Progress toward a more sustainable society is usually described in a "knowledge-first" framework, where science characterizes a problem in terms of its causes and mechanisms as a basis for subsequent action. Here we present a different approach—A Sustainability Solutions Agenda (SSA)—which seeks from the outset to identify the possible pathways to solutions. SSA focuses on uncovering paths to sustainability by improving current technological practice, and applying existing knowledge to identify and evaluate technological alternatives. SSA allows people and organizations to transition toward greater sustainability without sacrificing essential technological functions, and therefore does not threaten the interests that depend on those functions. Whereas knowledge-first approaches view scientific information as sufficient to convince people to take the right actions, even if those actions are perceived as against their immediate interests, SSA allows values to evolve toward greater attention to sustainability as a result of the positive experience of solving a problem. [ABSTRACT FROM AUTHOR]