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Supplemental Digital Content is available in the text, Objective: To estimate the association between weather and COVID-19 fatality rates during US stay-at-home orders. Methods: With a county-level longitudinal design, this study analyzed COVID-19 deaths from public health departments’ daily reports and considered exposure as the 18 to 22 day-period before death. Models included state-level social distancing measures, Census Bureau demographics, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2.5 concentrations, and U.V. light index. Results: A 1 °F increase in the minimum temperature was associated with 1.9% (95% CI, 0.2% to 3.6%) increase in deaths 20 days later. An ozone concentration increase of 1 ppb (part per billion) decreased daily deaths by 2.0% (95% CI, 0.1% to 3.6%); ozone levels below 38 ppb negatively correlated with deaths. Conclusions: Increased mobility may drive the observed association of minimum daily temperature on COVID-19 deaths.

Objective To identify the primary health conditions that cause presenteeism, and to estimate the economic cost of lost productivity due to presenteeism in Japan. Methods We conducted an Internet survey among 10,000 Japanese workers. Participants were asked to answer the health condition most affecting their work. Presenteeism was evaluated using the Quantity and Quality methods, and we estimated an annualized cost per capita and nation. Results The common health conditions most interfering with work were neck pain or stiff shoulders, low back pain, and mental illnesses. The annualized costs of presenteeism per capita for each were $414.05, $407.59, and $469.67, respectively. The estimated national costs for each were all above $27 billion. Conclusions Mental illnesses and musculoskeletal symptoms were the leading causes of presenteeism in Japan, and the economic burden of presenteeism was considerably large.

Objective Flexible work arrangements such as telework are gaining importance. Although telework is accompanied by advantages for employees such as increased flexibility, current research reveals associations between home-based telework and self-endangering behavior such as sickness presenteeism. As empirical evidence is still scarce, we explore the relationship between home-based telework and sickness presenteeism across Europe. Methods We perform multilevel analyses including 25,465 individuals who responded to the 6th wave of the European Working Conditions Survey 2015. Results Home-based telework is positively related to sickness presenteeism. The results are quite robust across different measures of sickness presenteeism and to several sensitivity analyses. Conclusion Although sickness presenteeism can be functional for specific illnesses, organizations should be aware of possible risks related to home-based telework. They should design telework in a way that it reduces triggers for self-endangering behavior.

Objective: To assess the cost-effectiveness and return-on-investment (ROI) of the Dynamic Work (DW) Intervention, a worksite intervention aimed at reducing sitting time among office workers.Methods: In total, 244 workers were randomized to the intervention or control group. Overall sitting time, standing time, step counts, quality-adjusted life years (QALYs), and costs were measured over 12 months. The cost-effectiveness analysis was performed from the societal perspective and the ROI analysis from the employers’ perspective.Results: No significant differences in effects and societal costs were observed between groups. Presenteeism costs were significantly lower in the intervention group. The probability of the intervention being cost-effective was 0.90 at a willingness-to-pay of 20,000€/QALY. The probability of financial savings was 0.86.Conclusion: The intervention may be considered cost-effective from the societal perspective depending on the willingness-to-pay. From the employer perspective, the intervention seems cost-beneficial.

Objectives: To examine the mediating role of unhealthy behaviors and body mass index (BMI) in the relation between high physical workload and self-rated health in male construction workers. Methods: Longitudinal data over 2010 to 2018 were used of 30,224 male construction workers in The Netherlands. Smoking, lack of physical activity, and alcohol consumption were self-reported. BMI was based on measured body weight and height. Multilevel modeling path analyses were used to determine the mediating role of unhealthy behaviors in the relation between physical workload and poor health. Results: A direct effect of high physical workload on poor health adjusted for unhealthy behaviors and BMI was found (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.38 to 1.68). Indirect effects of the unhealthy behaviors and BMI in the relation between high physical workload and poor health were small (OR varying from 0.96 to 1.04). Conclusion: The pathway of high physical workload and poor health through unhealthy behaviors and BMI was not supported. Conflict of interest statemen

Supplemental Digital Content is available in the text, Objective: To examine whether low leadership quality predicts long-term sickness absence (LTSA) in Denmark. Methods: Using Cox models, we estimated the association between exposure to low leadership quality and onset of register based LTSA (more than or equal to 6 weeks) during 12-months follow-up among 53,157 employees without previous LTSA. Results: During 51,155 person-years, we identified 2270 cases of LTSA. Low leadership quality predicted LTSA with a dose–respone pattern after adjustment for confounders. The hazard ratio (HR) of LTSA in the lowest compared with the highest quartile of leadership quality was 1.61 (95% CI: 1.43 to 1.82). Further, change from high to low leadership quality over time predicted risk of LTSA (HR = 1.42, 95% CI: 1.02 to 1.97) compared with persistent high leadership quality. Conclusions: Exposure to low leadership quality is a risk factor of LTSA in the Danish workforce.

International audience; No abstract available

Objectives To evaluate the alteration of protein of programmed cell death 5 (PDCD5) in peripheral blood mononuclear cells (PBMC) and DNA methylation caused by hexavalent chromium exposure. Methods There were 112 workers and 56 controls in this study. The chromium in RBC and urine, PBMC with PDCD5+, DNA methylation, urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and score of DNA damage were measured. Results In chromate exposed workers, the percent of PBMC with PDCD5+, urine 8-OHdG, and score of DNA damage were significantly higher, whereas global DNA methylation was significantly lower. The binary logistic regression and generalized linear mixed model analysis showed that the percent of PBMC with PDCD5+ was significantly associated with global DNA hypomethylation. Conclusions The aberrant DNA hypomethylation plays an important role in PBMC apoptosis of occupational hexavalent chromium exposure.

Objective: This study investigates the associations between Effort–Reward–Imbalance (ERI), Overcommitment (OC), Job–Demand–Control (JDC), and Organizational Injustice (OIJ) with employee well-being, absenteeism, and presenteeism, as well as the costs incurred.Methods: Cross-sectional data from 1440 German pharmaceutical company employees assessing job stress, employee well-being, absenteeism, and presenteeism were used. Linear regression and interval regression analyses assessed separate and independent associations and sample-specific costs were estimated.Results: All four stressors were related to employee well-being, presenteeism, and absenteeism when analyzed separately. OIJ showed the strongest independent association with absenteeism (coef. = 0.89; P < 0.01), whereas OC was most strongly independently associated with lower well-being (coef. = −0.44; P < 0.01) and higher presenteeism (coef. = 0.28; P < 0.01). Absenteeism costs per employee/year were higher than presenteeism costs.Conclusions: Occupational health interventions reducing job stress will have strong potential for productivity raise and lower costs.

Supplemental Digital Content is available in the text, Objective: Identify early biomarkers and mechanisms of acute kidney injury in workers at risk of developing chronic kidney disease of unknown origin (CKDu). Methods: We assessed cross-shift changes in kidney function and biomarkers of injury in 105 healthy sugarcane workers. We obtained pre-harvest clinical data as well as daily environmental, clinical, and productivity data for each worker. Results: The average percent decline in cross-shift estimated glomerular filtration rate (eGFR) was 21.8% (standard deviation [SD] 13.6%). Increasing wet bulb globe temperature (WBGT), high uric acid, decreased urine pH, urinary leukocyte esterase, and serum hyperosmolality were risk factors for decline in kidney function. Conclusions: Sugarcane workers with normal kidney function experience recurrent subclinical kidney injury, associated with elevations in biomarkers of injury that suggest exposure to high temperatures and extreme physical demands.

OBJECTIVE: To investigate the costs of low-back pain associated sick leave of workers in the Netherlands from 2015 to 2017. METHODS: We used longitudinal data form a large occupational health service regarding sick leave (registered by occupational physicians). Costs of sick leave due to low-back pain were estimated using the human capital approach, considering society and company perspectives. RESULTS: A total of 7901 low-back pain episodes from 7161 unique workers were analyzed. We estimated an average episode of low-back pain sick leave was 129.42 days in duration and costed €16,191. The total extrapolated sick leave costs were estimated to be €244.7 million in 2017. CONCLUSIONS: Low-back pain remains to be a persistent problem in the working population, as it causes workers to take sick leave for considerable periods of time with considerable associated economic consequences.

OBJECTIVE To estimate the incremental absenteeism-related wage loss associated with multimorbidity and examine the influence of paid sick leave policy (PSLP) on multimorbidity-associated absenteeism wage loss. METHODS We used the Medical Expenditure Panel Survey (MEPS) 2015 data. Two-part generalized linear models (GLM) were employed, using binomial distribution and gamma distribution with a log link. RESULTS Nationally, multimorbidity was associated with a $9 billion incremental absenteeism-related wage loss annually among working adults. Absenteeism-related wage loss was higher among those with multimorbidity than those without multimorbidity. The incremental annual absenteeism-related wage loss associated with multimorbidity was lower in settings that offered paid sick leave than that did not offer paid sick leaves. CONCLUSION Multimorbidity is associated with higher absenteeism-related wage loss. Paid sick leave policies can reduce the impact of multimorbidity on absenteeism-related wage loss.

Objective This study sheds light on the pathways leading to an increase in workers stress levels and the resulting effects on job performance during a pandemic. Methods Path analyses were conducted on a sample of 459 Canadian workers using MPlus software. These analyses allowed us to determine whether the association between potential stressors during lockdown and job performance was mediated by workers' stress. Results The results revealed four significant indirect associations. Work-life balance dissatisfaction, gender (women), and marital tensions were indirectly associated with lower job performance because of their positive associations with stress. Teleworking was associated with higher job performance because of its negative association with stress. Conclusions The results suggest that specific stressors are worth targeting with interventions to ensure job performance.

OBJECTIVE: We measured the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies among surgeons and anesthesiologists and associated antibody status with coronavirus disease 2019 (COVID-19) clinical illness. METHODS: A cross-sectional study of SARS-CoV-2 IgG seroprevalence with a survey assessing demographics, SARS-CoV-2 exposure risk, and COVID-19 illness. The primary outcome was the period prevalence of SARS-CoV-2 IgG antibodies associated with COVID-19 illness. RESULTS: One hundred forty three surgeons and anesthesiologists completed both serology and survey testing. We found no significant relationships between antibody status and clinical role (anesthesiologist, surgeon), mode of commuting to work, other practice settings, or place of residence. SARS-CoV-2 IgG seroprevalence was 9.8%. Positive IgG status was highly correlated with presence of symptoms of COVID-19 illness. CONCLUSIONS: These results suggest the relative safety of surgeons and anesthesiologists where personal protective equipment (PPE) is available and infection control protocols are implemented.

Objective There is scarce evidence revealing an association between job stress and cardiometabolic lifestyle modification behaviors among workers. Methods A cross-sectional, correlation study was conducted among workers in high-risk and low-risk workplaces by work characteristics. Results Workers in high-risk workplaces had significantly higher job stress levels than low-risk workplaces. Higher job stress was significantly associated with lower cardiometabolic lifestyle modification behaviors (β = -0.14, p = .001). This significant association was evident only for high-risk workplaces in total job stress (β = -0.16, p = .001), including job demand (β = -0.16, p = .005) and job insecurity (β = -0.11, p = .026). Conclusions Strategies for alleviating job stress should be prioritized to high-risk workplaces, and these efforts may concomitantly contribute to cardiometabolic risk reduction.

Objectives In few retrospective studies, prolonged time-to-pregnancy (TTP) was observed for women exposed to pesticides especially in flower production. The present study investigated time-to-pregnancy in the AGRICAN cohort. Methods Analyses were performed on 616 women reporting a pregnancy (2005 to 2017), and data on agricultural activities performed before the last pregnancy was retrospectively collected. Fecundability odds ratios (fOR) were estimated using a discrete time analogue of Cox proportional hazard model adjusted on maternal and paternal age, body mass index (BMI), and alcohol consumption. Results A decrease in fecundability was non-significantly associated with farm work (adjusted fOR = 0.86; 95% confidence interval [CI]: 0.71 to 1.05). Decreases were also observed for nightwork (afOR = 0.75; 95% CI: 0.49 to 1.15) and exposure to vibrations (afOR = 0.68; 95% CI: 0.43 to 1.09). Conclusion Women working on a farm before conception appeared to experience a longer TTP. Negative associations were suggested for some agricultural activities and working conditions.

Objective to evaluate the cardiorespiratory fitness and other fitness-related measures, and to analyze the differences among age groups. Methods This study was conducted on 104 firefighters. Maximal oxygen uptake (VO2 max) was assessed using the Shuttle Test and fitness was evaluated using appropriate physical tests. Results Mean VO2 max was 45.7 ml/kg/min and 60.6% of firefighters were over the minimum accepted standpoint to do effective work, however, the VO2 max decreased with increasing age. 35.6% of the firefighters were overweight. Age, weight, and total body fat were found to be significant predictors of VO2 max level in this population, with total body fat as strongest predictor. Conclusion Healthy habits-based interventions tailored by age groups should be promoted, to improve cardiorespiratory fitness and body composition for safe work and to improve firefighters' health.

OBJECTIVE To document the effects of wildland firefighter (WLFF) critical training (CT) on physiologic markers of muscle damage and acute overreaching. METHODS Eighteen male and three female WLFFs were studied during an 11-day CT. Upper-body (US), lower-body (LS) muscle soreness and body weight (BW) were collected daily. Blood was collected on days 1, 4, 8, and 11 to measure creatine kinase (CK), lactate dehydrogenase (LDH), cortisol, and testosterone. Skinfolds were taken on days 1 and 11 to estimate body fat (BF) and lean body weight (LBW). RESULTS CT resulted in a significant depression in BF and elevation in LBW, while main effects of time were seen in US, LS, CK, LDH, cortisol, and testosterone/cortisol ratio (P

OBJECTIVE There is increasing recognition of the value of integrating efforts to promote worker health with existing occupational health and safety activities. This paper aimed to identify facilitators, barriers and recommendations for implementing integrated worker health approaches. METHODS Thirteen stakeholders from different job sectors participated in a workshop that targeted key issues underlying integrated worker health approaches in their own and other organizations. Included were participants from human resources, occupational health and safety, government, and unions. Thematic analysis and an online ranking exercise identified recommendation priorities and contributed to a conceptual framework. RESULTS Participants highlighted the importance of planning phases in addition to implementation and evaluation. Themes highlighted organizational priorities, leadership buy-in, external pressures, training, program promotion and evaluation metrics. CONCLUSIONS Findings provide practical directions for integrating worker health promotion and safety and implementation steps.

Objective Reducing sedentary behavior (SB) is an important public health concern. The purpose of this study was to explore motivation to acquire a standing desk and strategies for using a standing desk through one-on-one interviews. Methods Thirty-seven university employees (89% staff; 51% women) participated in the study. Data were collected using a semi-structured interview guide and brief demographic questionnaire. Results Data analysis yielded five themes about motivation to acquire a standing desk: (1) pain management; (2) health risk; (3) movement opportunity; (4) workspace flexibility; and (5) productivity and three themes about typical use strategy: (1) task-dependent; (2) time-dependent; and (3) threshold. Conclusions Motivating factors for using a standing desk should be considered when encouraging standing desk use. Interventions should provide realistic strategies to establish a sit-stand routine that address employees' unique job demands and preferences.

OBJECTIVE Identify a risk threshold for sudden incapacitation for safety critical positions in transportation industries supporting medical fitness for duty standards. METHODS Systematic literature searches were performed examining acceptable risk criteria for medically related incapacitation using PubMed Central and Google Scholar databases. Websites for professional societies and national and international governmental agencies were also accessed. Article abstracts were reviewed and exhaustive searches were performed. RESULTS International regulatory bodies have adopted definitions of acceptable risk typically with a threshold of 1% to 2% absolute risk of sudden incapacitation per annum. Several "risk-of-harm" models have been proposed that incorporate factors modulating an absolute risk constant derived from epidemiological studies. CONCLUSION A 1% absolute annual risk of sudden incapacitation should be adopted as the threshold for determining medical fitness for duty among employees in safety critical positions in transportation industries.

Objective This study aimed to determine the prevalence of hormone-related cancers (HRCs) among Saskatchewan rural dwellers and explore associated risk factors. Methods Data were analyzed from the Saskatchewan Rural Health Study (SRHS), which was a prospective cohort (2010 to 2014). Completed questionnaires were obtained from 4624 (2797) households, with information about 8261 (4867) individuals more than or equal to 18 years at baseline (follow-up). The crude prevalence of HRCs was calculated using appropriate formulae. Adjusted prevalence was calculated using logistic regression based on the generalized estimating equation (GEE). Results Crude prevalence of HRCs was 3.0% at the baseline. Variables significantly associated with HRCs were: exposure to radiation comprising ultraviolet radiation from sunlight as well as ionizing radiation (odds ratio [OR] 3.39; 95% confidence interval [CI]: 2.23, 4.84), previous history of cancer in sibling (OR = 1.51, 95% CI: 1.11, 2.07) and in father (OR = 1.37; 95% CI = 1.01, 1.86). Conclusions The study informs the Saskatchewan Health Region for health care resource allocation.

Objective Determine compliance with and effectiveness of California regulations in reducing farmworkers' heat-related illness (HRI) risk and identify main factors contributing to HRI. Methods In a cross-sectional study of Latino farmworkers, core body temperature (CBT), work rate, and environmental temperature (WBGT) were monitored over a work shift by individual ingestible thermistors, accelerometers, and weather stations, respectively. Multiple logistic modeling was used to identify risk factors for elevated CBT. Results Although farms complied with Cal/OSHA regulations, worker training of HRI prevention and hydration replacement rates were insufficient. In modeling (AOR [95% CI]) male sex (3.74 [1.22 - 11.54]), WBGT (1.22 [1.08 - 1.38]), work rate (1.004 [1.002 - 1.006]), and increased BMI (1.11 [1.10 - 1.29]) were all independently associated with elevated CBT. Conclusion Risk of HRI was exacerbated by work rate and environmental temperature despite farms following Cal/OSHA regulations.

OBJECTIVE Ergonomic office redesigning possibly improves physical activity (PA) and sedentary behavior (SB); however, its impact on cardiometabolic risk has not yet been determined. This study aimed to examine the effect of office relocation on cardiometabolic risk factors. METHODS Annual health check-up data of 95 office workers from four offices in Tokyo, Japan, who relocated to an office with activity-based working (ABW) and height-adjustable desk (HAD) and a propensity-score matched control-cohort were analyzed. PA and SB on weekdays were measured only in the relocation group before and 10 months after relocation. RESULTS Significant interactions were observed for waist circumference, high-density lipoprotein cholesterol, and glycosylated hemoglobin (HbA1c). HbA1c changes showed a significant negative association with moderate-to-vigorous-intensity PA. CONCLUSION An ABW office with HAD improves cardiometabolic risk factors in office workers, possibly through changes in PA and SB.

Objective: Rotating shift is known to disrupt circadian rhythms. The 12/24 shift system, with frequent day-night rotations and the ergonomic shift system (ESS), with 90% less rotations were compared for their impacts on oxidative stress, inflammation, and platelet activation by using pentraxin 3 (PTX3), urinary 15-isoprostane F2t, and 11-dehydrotromboxane B-2 (11-DTB2). Methods: All tests were performed by enzyme linked immunosorbent assay (ELISA). Unpaired t test and Pearson correlation analysis were employed. Results: Two hundred twenty 12/24 and 198 ESS workers were included. Plasma PTX3 and urinary 15-isoprostane F2t levels were not different between groups. Urinary 11-DTB2 in 12/24 workers were found significantly higher compared with ESS workers (P < 0.0001). A weak but significant correlation was found between urinary 15-isoprostane F2t and urinary 11-DTB2 levels (r = 0.17, P = 0.001). Conclusions: 12/24 rotating shift was found to cause platelet activation disturbances.

OBJECTIVE To describe if health complaints relate to health behavior in terms of sickness absence (SA) and sickness presence (SP) and to examine how complaints and health behavior predicts the risk for future long-term sickness absence (LTSA). METHODS Data originates from work environment surveys 2001 to 2013 and SA registers 2002 to 2016 of 1838 nurses, 7430 care assistants, and 40,515 individuals in all other occupations. Descriptive and regression analyses were conducted. RESULTS Physical complaints and high SA in combination with high SP increased the risk of LTSA among nurses and care assistants. Nurses' high SP and care assistants' high SA elevated the LTSA risk. CONCLUSIONS Strategies to reduce the reasons behind physical health complaints among health care workers are warranted. SP among nurses and SA among care assistants should be considered in the organization of their job demands.

Supplemental Digital Content is available in the text, Objective: Examine the effect of a universal facemask policy for healthcare workers (HCW) and incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity. Methods: Daily number of symptomatic HCW tested, SARS-CoV-2 positivity rates, and HCW job-descriptions were collected pre and post Universal HCW facemask policy (March 26, 2020). Multiple change point regression was used to model positive-test-rate data. SARS-CoV-2 testing and positivity rates were compared for pre-intervention, transition, post-intervention, and follow-up periods. Results: Between March 12 and August 10, 2020, 19.2% of HCW were symptomatic for COVID-19 and underwent SARS-CoV-2 testing. A single change point was identified ∼March 28–30 (95% probability). Before the change point, the odds of a tested HCW having a positive result doubled every 4.5 to 7.5 days. Post-change-point, the odds of a tested HCW having a positive result halved every 10.5 to 13.5 days. Conclusions: Universal facemasks were associated with reducing HCW's risk of acquiring COVID-19.

Occupational disparities in mortality are a concern in public health. Understanding these disparities is important for identifying high-risk occupations for intervention and occupational factors that may be contributing to high risk for primary prevention. Using data from death certificates is a useful strategy for tracking occupational disparities in mortality. There are a number of challenges associated with working with this data. This paper describes how to access death certificate data, code occupational information from these death certificates, calculate mortality rates by occupation, and combine death certificate data with data from other sources. Limitations of existing death certificate occupation data are described along with recommendations about how to improve the collection of occupation information for death certificates. Finally, a proposal for the development of a national occupational mortality surveillance system is presented.

Background There is a compelling need to identify agricultural workers at risk for heat related illness (HRI). Methods Data from Florida agricultural workers (N = 221) were collected over 3 summer workdays (2015 to 2017) to examine risk factors for exceeding NIOSH-recommended core temperature (Tc) thresholds (38 °C [Tc38] and 38.5 °C [Tc38.5]) using generalized linear mixed models. Results On an average workday, 49% of participants exceeded Tc38 and 10% exceeded Tc38.5. On average, participants first exceeded both thresholds early in the day; the Tc38 threshold mid-morning (10:38 AM), and Tc38.5 about a half hour later (11:10 AM). Risk factors associated with exceeding Tc38 included years working in US agriculture, body mass index, time performing moderate-to-vigorous physical activity, increasing heat index, and field crop work. Conclusions The high prevalence of core temperatures exceeding recommended limits emphasizes the serious need for mandated HRI prevention programs for outdoor workers.

OBJECTIVE To assess the economic burden of tenosynovial giant cell tumor (TGCT) among US employed workforce. METHODS Patients with TGCT medical claims (N = 1395) and matched controls (1:10) without TGCT claims (N = 13,950) were identified from the OptumHealth Care Solutions, Inc. database (January 1, 1999 to March 31, 2017). Adjusted regression models were used to compare healthcare resource utilization, time lost from work, and associated costs between cohorts. RESULTS In patients with TGCT, the rates of inpatient admissions, emergency room visits, outpatient visits, and work loss days were 2.8, 1.5, 2.2, and 2.6 times those of matched controls, respectively (all P

Introduction Research on the effect of occupation on cardiovascular health (CVH) among older women is limited. Methods Each of the seven American Heart Association's CVH metrics was scored as ideal (1) or non-ideal (0) and summed. Multivariable logistic regression was used to estimate the odds of poor overall CVH (CVH score of 0 to 2) comparing women employed in each of the top 20 occupational categories to those not employed in that category, adjusting for age, marital status, and race/ethnicity. Results (1) Bookkeeping, accounting, and auditing clerks; (2) first-line supervisors of sales workers; (3) first-line supervisors of office and administrative support workers; and (4) nursing, psychiatric, and home health aides were more likely to have poor overall CVH compared to women who did not work in these occupations. Conclusions Several commonly held occupations among women were associated with poor CVH.

Objective To evaluate a proactive, voluntary screening program designed to identify employees with emerging mental health risk and engage them in care. Methods Risk was proactively identified through online screening of 344 participants. At-risk participants were offered a mental health care concierge to provide support, develop a care plan, and connect to care. Results Risk for common mental health conditions was identified in 244 (71%) participants, of whom 66 (27%) connected with a care concierge. Compared with participants who did not connect to a care concierge, those who did were more likely to report a financial crisis (68.2% vs 50.8%) and less likely to report verbal abuse (9.1% vs 19.6%) and difficulty meeting daily needs (12.1% vs 25.1%). Conclusion Implementation of this screening program identified employees at risk for mental health conditions and facilitated connection to care.

Objective To assess the prevalence and determinants of sun protection behaviours among outdoors workers at work and leisure in Alberta, Canada. Methods We collected outdoor workers' demographics, skin cancer risk factors, job information, and sun habits at work and leisure using self-completed questionnaires. For both settings, we compared use of specific behaviours and modelled determinants of sun protection behaviour scores. Results At work, wearing a sleeved shirt (81% often/always) and hat (73%) were most prevalent, while seeking shade (12%) and applying sunscreen (36%) were least prevalent. Workers had higher sun protection scores at work than leisure. Hours spent outdoors was a strong determinant for both models. Additional leisure model predictors were eye colour, sex, skin type, and job group. Conclusions Differences in behaviours across settings were observed and should be considered when developing solar UVR exposure reduction initiatives.

OBJECTIVE It is unclear whether clerical or labor-type work is more associated with risk for developing work-related carpal tunnel syndrome (WrCTS). METHODS National employment, demographic, and injury data were examined from the Bureau of Labor Statistics databases for the years 2003 to 2018. Injuries for clerical and labor industries were compared using linear regression, two-group t test, and one-way analysis of variance (ANOVA) analysis. RESULTS WrCTS injuries are decreasing over time (B = -1002.62, P

OBJECTIVES: To identify important background information on pooled tested of employees that employers workers, and health authorities should consider. METHODS: This paper is a commentary based on the review by the authors of pertinent literature generally from preprints in medrixiv.org prior to August 2020. RESULTS/CONCLUSIONS: Pooled testing may be particularly useful to employers in communities with low prevalence of COVID-19. It can be used to reduce the number of tests and associated financial costs. For effective and efficient pooled testing employers should consider it as part of a broader, more comprehensive workplace COVID-19 prevention and control program. Pooled testing of asymptomatic employees can prevent transmission of SARS-CoV-2 and help assure employers and customers that employees are not infectious.

PURPOSE Medical students across the United Kingdom helped the National Health Service (NHS) with the increased workload caused by the COVID-19 pandemic. This study was conducted to better understand the implications of COVID-19 on the intricate relationship between the psychological wellbeing of students and working within the NHS. METHOD This was a cross-sectional, national UK study analyzing the self-reported pandemic anxiety scale (PAS) of participants during the pandemic, using an online questionnaire. RESULTS 25.2% of participants worked within the NHS. Working significantly reduced anxiety levels of participants. Concerns around the training and information provided on personal protective equipment (PPE) (odds ratio [OR] 2.57, 95% confidence interval [CI] OR: 1.93, 3.43) (P

Objective Access to healthcare, a national priority, may be better understood through medical surveillance programs like the World Trade Center Health Program (WTCHP). Methods Measures of healthcare access and utilization for 1159 9/11 rescue and recovery workers ("responders") at the Rutgers Clinical Center of Excellence (CCE) were assessed using negative binomial modeling of the Benefits Eligibility Assessment Screening Tool and compared with 174 9/11 responders in the 2017 New York City Community Health Survey (NYCCHS) using z-testing. Results Approximately 10.8% of Rutgers CCE respondents lacked at least one aspect of healthcare access. Problems accessing healthcare and basic needs were positively associated with CCE utilization and differed between Rutgers CCE and NYCCHS respondents. Conclusions Some 9/11 responders bridge healthcare access gaps via participation in the WTCHP. Surveillance survey tools may help to identify healthcare disparities.

Supplemental Digital Content is available in the text, Objectives: Define the seroprevalence and risk factors for SARS-CoV-2 antibodies in Arapahoe County, Colorado first responders (eg, law enforcement, human services, fire departments). Methods: Two hundred sixty four first responders were enrolled June to July 2020. SARS-CoV-2 seropositivity was defined as detection of immunoglobulin G (IgG) antibodies to both spike receptor binding domain and nucleocapsid in venous blood by validated enzyme-linked immunosorbent assay. We compared risk factors for being seropositive versus seronegative. Results: 4% (11/264) were SARS-CoV-2 seropositive. Seropositive participants were significantly more likely to have lung disease (% seropositive, % seronegative; P-value) (36%, 8%; P = 0.01), prior SARS-CoV-2/COVID-19 testing (36%, 8%; P ≤ 0.01), a prior positive result (18%, less than 1%), and to believe they previously had COVID-19 (64%, 15%; P

Objectives This study examined the relationship between emotional labor and general health status in a nationally representative sample of South Korean service and sales workers. Methods Data were obtained from the 2007 to 2009 Korea National Health and Nutrition Examination Survey. A total of 1907 subjects were included in the analysis. Multiple logistic regression was performed to determine the relationship between emotional labor and perceived health status (PHS). Results The adjusted odds ratio (95% confidence interval) of poor PHS was 1.869 (1.464 to 2.391) among high emotional labor group, compared with the low emotional labor group as the reference. Perceived stress accounted for 35.57% of the variance in the relationship between high emotional labor and poor PHS. Conclusions Emotional labor was associated with increased risk of poor PHS.

Over the decades, the workers' compensation system has provided many injured workers with a significant guarantee of both medical and financial support when they have been injured on the job. To be effective, workers' compensation systems at a minimum should include principles that require the addressing of medical causation, determination of an individual's functional ability both pre- and post-injury to include activity restrictions, return-to-work capability and disability, meeting jurisdiction-specific reporting requirements of the workers' compensation reporting requirements, and having knowledge of other perspectives of the various authorities and jurisdictions present in the United States. ACOEM lays out a description of various aspects of workers' compensations systems in the United States, with recommendations for minimal standards and best practices. This paper limits itself to the discussion of jurisdictions within the United States and ACOEM strongly recommends that providers consult directly with the states in which they are working as there are state variations in workers' compensation.

Objective The practice of parallel multiple jobs has increasingly become a global trend. However, the effects of parallel multiple jobs on physical and mental health have not been well understood. Method Data come from China Health and Retirement Longitudinal Study published by CHARLS in 2015. The agricultural population aged 45 years old and above are selected through stratified random sampling (N = 10,118). Robust regression method is used to give robust estimation. Results U-shape relations are found. The modest increase in the number of parallel multiple jobs can alleviate the difficulty in physical activities functioning and can reduce mental health problems. However, these beneficial effects could turn detrimental with the number of parallel multiple jobs beyond the modest level, leading to work overload. Conclusion Parallel multiple jobs could be considered a double edge sword for physical and mental health.

OBJECTIVE: To examine the effect of bridging social capital through sports programs on the job insecurity - well-being relationship. METHODS: A total of 473 Korean employees participated in a cross-sectional survey in May 2020. Using structural equation modeling, we tested the following hypotheses: (a) job insecurity will partially mediate the relationship between perceived threat and well-being and (b) social capital through sports programs will moderate the relationship between job insecurity and well-being. Socioeconomic status was used as a control variable for well-being. RESULTS: The hypothesized relationships in the structural model were all significant (P 

OBJECTIVE To evaluate clinical parameters, markers of kidney function, and skeletal muscle damage in a group of sugarcane cutters during harvesting season. METHODS Seventeen volunteers were assessed for anthropometrics and cardiorespiratory fitness. Blood and urine samples were collected 48-hours after the last work session. Blood was analyzed for glucose, creatine kinase, cholesterol, and a complete hemogram. Urine and blood samples were also analyzed for markers related to kidney function. RESULTS Volunteers were young (26 ± 6 y), had low body fat (13 ± 5%), and good cardiorespiratory fitness (41 ± 6 mL/kg/min). Classical markers of kidney function (eGFR, creatinine, cystatin C) were within the normal range. However, ten volunteers presented elevated resting serum creatine kinase (221 ± 68 U/L). CONCLUSION Manual sugarcane harvesting is associated with sustained skeletal muscle damage which may increase the risk for kidney injury in Brazilian sugarcane cutters.

Objective To characterize changes in opioid, gabapentin, and pregabalin utilization patterns and cost trends between 2008 and 2018 in a Louisiana workers' compensation claims population and explore the role of gabapentinoids as alternative analgesics during the opioid epidemic. Method Filled prescriptions for gabapentinoids and opioids were studied for 11 years in a cohort of 18,737 claimants. Results The proportion of claimants prescribed gabapentin increased 2-fold (8.9% to 18.9%) and average drug cost per claimant decreased 22% ($612 to $480). The proportion of claimants prescribed pregabalin decreased approximately 80% (11.7% to 2.5%) and average drug cost per claim increased 224% ($911 to $2,952). Proportion of claimants prescribed opioids decreased 20% (80% to 64.2%) and average drug cost per claim decreased 46% ($691 to $371). Conclusions Utilization increased substantially for gabapentin and decreased for pregabalin and opioids.

OBJECTIVE To investigate the association between sex-obesity intersection and labor inactivity and whether education modifies this relationship in a national health survey. METHODS Cross-sectional study using the database of 43,456 participants from the Brazilian National Health Survey. Logistic Regression analyses were performed. RESULTS To be women with or without obesity was associated with higher frequency of labor inactivity in comparison to non-obese men. Among men, only those with central obesity had a higher rate of inactivity than non-obese men, especially those with incomplete elementary school. CONCLUSIONS The double burden of judgment (sexism and fatphobia) suffered by obese women can lead to socioeconomic inequalities which may strength poorness and/or exclusion. Thus, there are urgent measures for empowerment and equity in the labor market.

OBJECTIVE This study aimed to clarify when and how long intensive monitoring should be performed after return to work (RTW) of employees experiencing common mental disorders using landmark analysis. METHODS We conducted a retrospective survey of workers who experienced sickness absences (SAs) during 36 months after RTW. Sustainability rates of attendance among the following groups were compared before and after the landmark (18 months): one SA episode (Group 1), two SA episodes (Group 2), and three or more SA episodes (Group 3). RESULTS Before the landmark, sustainability in Group 1 was higher than in the other groups, with no significant differences among groups after the landmark. Sustainability rate of attendance tended to be lower before than after the landmark in each group. CONCLUSIONS Intensive monitoring is suggested in the first 18 months after RTW.

Objectives To investigate the effect of sex on the risk of silicosis and to explore any interaction between cigarette smoking and sex in the development of silicosis. Methods The cohort was selected from eight Chinese pottery factories. Diagnoses of silicosis were based on 1986 Chinese pneumoconiosis Roentgen diagnostic criteria. Data on cigarette smoking were collected by face-to-face interviews in 1989 and 2003. Results Eight thousand eight hundred and eighty seven dust-exposed workers were included. Men had a 77% higher incidence of silicosis than women. At lower pack-years of smoking, men were 72% more at risk than women. The latency period was found to be longest in female never-smokers and shortest in female ever-smokers. Conclusions Men had a higher risk of developing silicosis than women. Cigarette smoking increased the risk in both sexes, more so in women.

Objective: To pilot a multi-component intervention to sit less and move more, with (SLAMM+) and without (SLAMM) height-adjustable workstations, in contact centre call agents.\ud Methods: Agents were individually randomised to SLAMM or SLAMM+ in this 10-month, parallel, open-label, pilot trial. Mixed-methods assessed response, recruitment, retention, attrition and completion rates, adverse effects, trial feasibility and acceptability, preliminary effectiveness on worktime sitting, and described secondary outcomes.\ud Results: The participant recruitment rate, and randomisation, data collection and interventions were mostly acceptable. Refinements to organisation recruitment were identified. High staff turnover negatively impacted retention and completion rates. The multi-component intervention with height adjustable workstations has potential to reduce sitting time at work.\ud Conclusions: The demonstrated findings will help prepare for a future randomised controlled trial designed to assess the effect of the interventions.

Objective: Examine atherosclerotic cardiovascular disease (ASCVD) risk scores by age and weight status in career firefighters. Methods: Medical examinations for firefighters more than or equal to 40 years (n = 644) were examined. ASCVD 10-year risk scores were calculated from sex- and race-specific equations and were reported by three age (40 to 44.9, 45 to 49.9, more than or equal to 50 years) and weight (normal, overweight, obese) categories. Results: Mean risk scores were 1.8%, 3.5%, and 6.2% for firefighters 40 to 44.9, 45 to 49.9, and more than or equal to 50 years, respectively. The association of weight status with increased ASCVD risk was higher (P

OBJECTIVE: To evaluate serum concentrations of polyfluoroalkyl substances (PFAS) in male firefighters and association with cardiometabolic markers. METHODS: Serum PFAS were evaluated in 38 Arizona firefighters and 49 participants from the 2009–2010 National Health and Nutrition Examination Survey (NHANES). Cardiometabolic markers including carotid intima-medial thickness (CIMT) were measured in the firefighters. RESULTS: Firefighters had elevated perfluorohexane sulfonic acid (PFHxS) and lower perfluorononanoic acid (PFNA) and perfluoroundecanoic acid (PFUA) compared to NHANES participants; for nine of the other 12 PFAS the values were not significantly different. There were significant negative associations among firefighters between perfluorodecanoic acid (PFDeA) and total cholesterol and PFUA and interleukin-6. PFAS concentrations were not associated with CIMT. CONCLUSION: PFHxS levels were elevated and PFNA and PFUA levels were decreased in firefighters compared to NHANES subjects. Serum PFAS concentrations were not associated with increased cardiometabolic risk measures in this population of firefighters.