Search

Agricultural workers, designated as "essential" at the start of the COVID-19 pandemic, work in harsh labor conditions, and now have the added challenge of continuing to work during the COVID-19 pandemic. The aim of this study was to assess agricultural workers' COVID-19 related history, employer-based safety measures, individual preventive practices, and COVID-19 vaccination uptake. A questionnaire study was conducted among agricultural workers in Central Florida about COVID-19 during the month of June 2020 and again in July 2021. Among 92 agricultural workers in June 2020, 47% were obese; 11% had had a COVID-19 nasal test; 87% were able to social distance at work and 34% reported employer provided face masks; 15% reported not willing to get the COVID-19 vaccine and 25% were unsure. 40% could self-isolate if they contracted COVID-19. In a follow-up visit in July 2021, 53% of participants reported receiving a COVID-19 vaccine. Agricultural workers are particularly vulnerable to COVID-19 due to existing health risk factors and lack of essential protective resources. Occupational health protections social safety net programs are urgently needed to prevent infections in vulnerable workers, and reduce community spread, and increase COVID-19 vaccination rates.

With the recent impact by the COVID‐19 pandemic, nursing research has gone through unexpected changes across the globe. The purpose of this special report is to present the commonalities in the impact of the COVID‐19 pandemic on nursing research across four countries, including the United States, South Korea, Japan, and Taiwan, and one region, that is, Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. To identify the commonalities, seven researchers/leaders from the five countries/regions had discussions through 3 days of an international workshop. The content for this discussion paper derived from: (a) the exemplars/cases of the COVID‐19 impact on the research process, (b) researchers/leaders' presentations on the COVID‐19 impact, and (c) memos from the workshop. The materials were analyzed using a simple content analysis. The commonalities included: (a) “a heavy emphasis on teaching and fluctuating productivity,” (b) “increased funding opportunities and governmental support,” (c) “gendered experience complicated by professional differences,” (d) “delays and changes/modifications in research process,” (e) “limited research settings and difficulties in getting access,” and (f) “increased online dissemination activities with positive changes in the image of nursing.” With all collective wisdom that nurse researchers have obtained during the COVID‐19 pandemic, nursing research will evolve again for the successful future of the nursing discipline.

Globally, there is increasing recognition that agricultural workers are at risk for chronic kidney disease of unknown etiology (CKD u). Recurrent heat exposure, physical exertion, dehydration, muscle damage, and inflammation are hypothesized to contribute to the development of CKD u, but the relative importance of these processes and the interactions among them remain unclear. Moreover, there is a need to identify biomarkers that could distinguish individuals who are at greatest risk for kidney damage to target preventative interventions for CKD u. In this study, we evaluated dehydration and markers of inflammation, muscle damage, and renal function in agricultural workers at a non-workday baseline assessment. Urine specific gravity and kidney function were measured before and after work shifts on three subsequent days, and heat index, core body temperature, and heart rate were monitored during the work shifts. A combination of direct comparisons and machine learning algorithms revealed that reduced levels of uromodulin and sodium in urine and increased levels of interleukin-6 and C-reactive protein in serum were indicative of dehydration at baseline, and that dehydration, high body mass index, reduced urine uromodulin, and increased serum interleukin-6, C-reactive protein, and lipopolysaccharide-binding protein at baseline were predictive of acute kidney injury on subsequent workdays. Our findings suggest a method for identifying agricultural workers at greatest risk for kidney injury and reveal potential mechanisms responsible for this process, including pathways overlapping in dehydration and kidney injury. These results will guide future studies confirming these mechanisms and introducing interventions to protect kidney health in this vulnerable population.

Introduction: Agricultural workers perform intense labor outside in direct sunlight and in humid environmental conditions exposing them to a high risk of heat-related illness (HRI). To implement effective cooling interventions in occupational settings, it is important to consider workers’ perceptions. To date, an analysis of agricultural workers’ experience and perception of cooling devices used in the field while working has not been published. Methods: Qualitatively data from 61 agricultural workers provided details of their perceptions and experiences with cooling interventions. Results: The participants in the bandana group reported the bandana was practical to use at work and did not interfere with their work routine. Cooling vest group participants agreed that the vest was effective at cooling them, but the practicality of using the vest at work was met with mixed reviews. Conclusion: The findings of this qualitative study support and extend existing research regarding personal cooling and heat prevention research interventions with vulnerable occupational groups. Personal cooling gear was well received and utilized by the agricultural workers. Sustainable heat prevention studies and governmental protection strategies for occupational heat stress are urgently needed to reduce the risk of heat-related morbidity, mortality, and projected climate change health impacts on outdoor workers.

The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities."

Background COVID-19 has tested the capacity of every nursing school, but its impact has varied according to the size, location, and baseline infrastructure of each school. This makes the pandemic an important lens through which to study crisis management principles, such as flexibility and scalability (the ability to expand and reduce efforts based on situational demands). Purpose This article provides a roadmap for academic crisis management, modeled on the National Incident Management System (NIMS). It is tailored to the unique needs of nursing schools and applies COVID-19 as a case study. Methods The authors explore the elements of the NIMS that were deployed within 1 top-ranked school of nursing during COVID-19. Results and conclusions The article includes best practices, tips, and resources to help academic nurse leaders and educators navigate large-scale or unprecedented crises, such as COVID-19.

Background Adverse health effects among agricultural workers due to chronic heat exposure have been characterized in the literature as not only due to high ambient temperatures but also due to intensive manual labor in hot and humid conditions. The aim of this study was to use biomonitoring equipment to examine the effectiveness of selected cooling devices at preventing agricultural workers from exceeding the core body temperature threshold of 38.0°C (Tc38) and attenuating heat-related illness symptoms. Methods A convenience sample of 84 agricultural workers in Florida was randomized to one of four groups: (a) no intervention, clothing as usual; (b) cooling bandana; (c) cooling vest; and (d) both the cooling bandana and cooling vest. Biomonitoring equipment worn by the participants included core body temperature monitor and an accelerometer to capture physical activity. Findings A total of 78 agricultural workers completed one intervention workday trial. Compared with the control group, the bandana group had lower odds of exceeding Tc38 (odds ratio [OR] = 0.7, 90% confidence interval [CI] = [0.2, 3.2]) and the vest group had higher odds of exceeding Tc38 (OR = 1.8, 90% CI = [0.4, 7.9]). The simultaneous use of cooling vest and bandana showed an effect little different from the control group (OR = 1.3, 90% CI = [0.3, 5.6]). Conclusion/Application to Practice This is the first field-based study to examine cooling intervention among agricultural workers in the United States using biomonitoring equipment. This study found that using a bandana while working in a hot agricultural environment has the potential to be protective against exceeding the recommended Tc38 threshold.

Shaping the Future of Veterans’ Health Care Members of the U.S. military are at risk for a range of combat-related injuries and hazardous exposures, and some chronic health problems can arise years...

Facing the onset of the COVID-19 pandemic and increasing outbreaks among farmworkers and food processing workers across the nation, the Oregon Occupational Health and Safety Administration (OR OSHA) issued temporary regulations, in contrast to optional recommendations, in late spring. These regulations aimed to reduce the risk of COVID-19 transmission among farmworkers, but made compromises that may fail to reduce the risk of further outbreaks among Oregon's agricultural workers, particularly those living in agricultural labor housing. Instead of considering the scientific literature that called for attention to space and length of time for social distancing among unrelated persons in indoor areas, the agency accepted the 6-foot social distancing rule of thumb and allowed even shorter distances between beds with the installation of plastic or plywood barriers. The 6-foot distance (or less with a barrier) between people sleeping next to each other in poorly ventilated housing has proved disastrous. Additionally, testing for migrant and seasonal farmworkers is neither uniform nor thorough, and little data have been collected to assess the success of existing testing efforts. New regulations must be adopted for farm labor housing that limit occupancy to at most two unrelated individuals for a room of 200 square feet; include expanded specification on the provision of fresh air in shared living spaces; and support increased access to testing, surveillance testing, and alternative safe housing at labor housing sites for identified cases.

Background In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry. Purpose The purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs. Methods Deans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education. Findings This paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition. Discussion This paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.

Nursing leaders from Emory School of Nursing and Emory Healthcare have established an academic-practice partnership aimed at realizing the American Association of Colleges of Nursing’s (AACN’s) 2016 New Era Report recommendations. This paper outlines the partnership’s initiatives and shares results from baseline and follow-up self-assessments, performed in 2017 and 2019, respectively. Self-assessments, completed by Emory nursing leaders, involved ranking Emory’s success in implementing New Era Report recommendations on a scale of 1 to 3. These scores were then used to calculate mean performance in each area and progress made over time. The authors discuss challenges, accomplishments, and strategies for future initiatives.

To estimate the impact of hydration interventions on postworkday hydration status and incidence of acute kidney injury (AKI).Thirty agricultural workers were first monitored on a workday without any interventions. On the intervention workday, the same workers were randomized to one of two groups: 169 ounces (oz) (5 L) of plain water (n = 16) or 169 oz (5L) of water with electrolytes (n = 14).No participants in the electrolyte group had an estimate glomerular filtration rate (eGFR) at the end of the workday of less than 90 mL/min/1.73 m2 or met the criteria for AKI in comparison to the water group (eGFR90: 15%; AKI: 23%) or the control group (eGFR90: 28%; AKI: 18%).The study showed that drinking water with electrolytes may lower the risk for development of AKI among agricultural workers.

To examine the health status of Hispanic agricultural workers in Florida and Georgia. Health data from agricultural workers in the Farm Worker Family Health Program (June 2019) and research studies in Florida (May 2015 and May 2019) were examined. Data from 728 agricultural workers were collected through sociodemographic questionnaire and clinical data. In the Florida sample, 83% were overweight or obese, 70% elevated blood pressure, 60% met the definition of prediabetes. In Georgia, 64% were overweight or obese and 67% had elevated blood pressure. Weak correlations were observed between BMI and systolic blood pressure (unadjusted r = 0.20), diastolic blood pressure (unadjusted r = 0.19), and glucose (unadjusted r = 0.14). Adjusting for age and gender did not show statistically significant correlation between BMI and systolic and diastolic blood pressure or glucose. While BMI has been shown to be strongly associated with high blood pressure and impaired glucose, we found a weak correlation among agricultural workers. Given the common and high use of pesticides and elevated rates of hypertension, impaired glucose, and adiposity in agricultural workers, the public health impact of this relationship may require and lead to occupational reform that protects the health of agricultural workers. Future studies should assess occupational and environmental factors and lifestyle differences between agricultural workers and the general population to better understand these discrepancies in health status.

With expected increases in extreme weather, there may be a greater risk of injury from extreme heat in outdoor worker populations. To plan for future adaptation measures, studies are needed that can characterize workers’ physiologic responses to heat in outdoor settings such as agriculture. The objective of this study was to characterize occupational heat exposure, key vulnerability factors (e.g., gender, energy expenditure), and physiologic heat stress response in a sample of fernery workers. Forty-three fernery workers over 86 workdays were examined regarding heat-related illness (HRI) during the summer months of 2012 and 2013. The key outcome measure was whether a participant’s body core temperature (Tc) reached or exceeded 38.0°C (100.4ºF; Tc38). Participants’ Tc exceeded 38.0°C on 49 (57%) of the workdays, with 30 of 40 participants reaching or exceeding Tc38 on at least one workday. Adjusting for sex, there was a 12% increase in the odds of Tc38 for every 100 kilocalories of energy expended (OR: 1.12; 95% Confidence Interval [CI]: [1.03, 1.21]). Adjusting for energy expenditure, females had 5 times greater odds of Tc38 compared with males (OR: 5.38; 95% CI: [1.03, 18.30]). These findings provide evidence of elevated Tc in Florida fernery workers, indicating an increased risk of occupational HRI, and the need for policy and interventions to address this health risk.

For the past two decades, agricultural workers in regions of Central America have reported an epidemic of chronic kidney disease of undetermined etiology (CKDu) that is not associated with established risk factors of chronic kidney disease. Several hypotheses have emerged, but the etiology of CKDu remains elusive and controversial. The aim of this literature review was to describe the potential risk factors of CKDu in Mesoamerica and implications for the U.S. agricultural worker population. PubMed and CINAHL databases were searched for articles published between 2000 and 2018 that examined CKDu in Mesoamerica; 29 original studies were included in this review. CKDu is a multifactorial disease that is often asymptomatic with hallmark characteristics of elevated serum creatinine and blood urea nitrogen (BUN), low glomerular filtration rate, electrolyte abnormalities, and non-nephrotic proteinuria. Reducing the global prevalence of CKDu will require more robust studies on causal mechanisms and on interventions that can reduce morbidity and mortality in vulnerable populations.

High-quality primary care is the foundation of the health care system. It provides continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels.Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country's primary care services a public concern.Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care puts forth an evidence-based plan with actionable objectives and recommendations for implementing high-quality primary care in the United States. The implementation plan of this report balances national needs for scalable solutions while allowing for adaptations to meet local needs.

Introduction: This study examined the perceived competence of Clinical Research Coordinators (CRCs) using several conceptual frameworks. Accurate self-assessment of one’s professional competence is a critical component in the career navigation process and contributes to (a) identifying and securing professional development (training), (b) leveraging professional strengths, and (c) integrating self-knowledge into a comprehensive career plan. Method: A survey design gathered responses from a sample of 119 CRCs in a southeastern region of the USA Two conceptual frameworks were used to represent aspects of CRC professional competence: the eight Joint Task Force (JTF) competence domains, and perceptions of strengths and training needs from a list of 12 task categories. Results: The JTF domain with the lowest competence level was Development and Regulations, while the highest was Communication. Perceived competence increased incrementally with years of experience. Top strengths involved direct patient interaction and data management. Tasks in need of training included project management and reporting issues. Variations in responses were based on years of experience as a CRC. Conclusion: Our results demonstrate an association between the self-reported strengths and training needs of CRCs and experience. This information can contribute to the self-directed career navigation of CRCs.

(1) Polybrominated diphenyl ethers (PBDEs) were widely produced in the United States until 2004 but remain highly persistent in the environment. The potential for PBDEs to disrupt normal neuroendocrine pathways resulting in depression and other neurological symptoms is largely understudied. This study examined whether PBDE exposure in pregnant women was associated with antenatal depressive symptomatology. (2) Data were collected from 193 African American pregnant women at 8–14 weeks gestation. Serum PBDEs and depressive symptoms were analyzed and a mixture effect was calculated. (3) Urban pregnant African American women in the Southeastern United States had a high risk of depression (27%) compared to the National average. Increased levels of PBDEs were found. BDE-47 and -99 exposures are significantly associated with depressive symptomatology in the pregnant cohort. The weighted body burden estimate of the PBDE mixture was associated with a higher risk of mild to moderate depression using an Edinburgh Depression Scale cutoff score of ≥10 (OR = 2.93, CI 1.18, 7.82). (4) Since antenatal depression may worsen in postpartum, reducing PBDE exposure may have significant clinical implications.

Background Since its founding, professional nursing has applied an environmental lens to healing. Methods This CANS 2020 Keynote article describes the history of nursing environmental science and nurses important contributions to the US Environmental Justice Movement. Starting with Florence Nightingale's Notes on Nursing, which established Environmental Theory, the paper introduces key figures throughout nursing history who have studied and advocated for environmental health and justice. Findings The paper emphasizes that nursing has always been about environmental health and that, regardless of specialty or practice setting, all nurses are called to incorporate environmental science and translation into their research and practice. Conclusion This call to action is especially critical today in the context of urgent issues like climate change, environmental racism and racial health disparities, emerging infectious diseases like COVID-19, and chemical exposures in the home and workplace (among others).

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.

Background As global temperatures rise, increasing numbers of individuals will work in hot environments. Interventions to protect their health are critical, as are reliable methods to measure the physiological strain experienced from heat exposure. The physiological strain index (PSI) is a measure of heat strain that relies on heart rate and core temperature but is challenging to calculate in a real-world occupational setting. Methods We modified the PSI for use in field settings where resting temperature and heart rate are not available and used the modified physiological strain index (mPSI) to describe risk factors for high heat strain (mPSI ≥ 7) experienced by agricultural workers in Florida during the summers of 2015 through 2017. mPSI was calculated for 221 workers, yielding 465 days of data. Results A higher heat index (β = 0.185; 95% CI: 0.064, 0.307) and higher levels of physical activity at work (0.033; 95% CI: 0.017, 0.050) were associated with a higher maximum mPSI. More years worked in US agriculture (-0.041; 95% CI: -0.061, -0.020) were protective against a higher maximum mPSI. Out of 23 workdays that a participant experienced a maximum mPSI ≥ 7, 22 were also classified as strained by at least one other measure of high heat strain (core temperature [Tc] >38.5°C, sustained heart rate >(180 - age), and mean heart rate > 115 bpm). Conclusions This study provides critical information on risk factors for elevated heat strain for agricultural workers and suggests a practical approach for using PSI in field-based settings.

Nurses are well-positioned to be groundbreaking researchers, scientists, leaders, and innovators to improve the health and well-being of individuals, families, and communities. Nurse scientists are needed to contribute to scientific discoveries that inform effective strategies to improve patient care and outcomes and to inform future policies. Thoughtful consideration is required about the preparation of nurse scientists to ensure they are equipped with the knowledge and skill sets to meet the needs of society. Evolving health needs and priority areas of inquiry along with an ever-increasing array of sophisticated methodologies and centrality of interdisciplinary teams to solve complex problems should drive how we prepare PhD students. This paper reflects a panel and subsequent dialogue with nurse leaders at the PhD summit held at the University of Pennsylvania in October 2019. Three aspects of PhD education and the advancement of nursing science are discussed 1) examining important elements to support nurse scientist development; 2) identifying key gaps in science that the discipline needs to address in educating the next generation of nurse scientists; and 3) preparing nurse scientists for the competitive funding environment.

Background The purpose of this systematic review is to examine cooling intervention research in outdoor occupations, evaluate the effectiveness of such interventions, and offer recommendations for future studies. This review focuses on outdoor occupational studies conducted at worksites or simulated occupational tasks in climatic chambers. Methods This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Embase, and Web of Science were searched to identify original research on intervention studies published in peer-reviewed journals that aimed at reducing heat stress or heat-related illness from January 2000 to August 2020. Results A systematic search yielded a total of 1042 articles, of which 21 met the inclusion criteria. Occupations with cooling intervention studies included agriculture (n = 5), construction (n = 5), industrial workers (n = 4), and firefighters (n = 7). The studies focused on multiple types of cooling interventions cooling gear (vest, bandanas, cooling shirts, or head-cooling gel pack), enhanced heat dissipation clothing, forearm or lower body immersion in cold water, water dousing, ingestion of a crushed ice slush drink, electrolyte liquid hydration, and modified Occupational Safety and Health Administration recommendations of drinking water and resting in the shade. Conclusion Current evidence indicates that using multiple cooling gears along with rest cycles may be the most effective method to reduce heat-related illness. Occupational heat-related illnesses and death may be mitigated by targeted cooling intervention and workplace controls among workers of vulnerable occupational groups and industries.

In 2015, Ethiopia's first PhD in nursing program was established in collaboration between the Addis Ababa University (AAU) and Emory University Schools of Nursing. Eleven students have entered the program since its inception, six have successfully defended their proposals, one has graduated, and two have received Fogarty Global Health Fellowships. This paper describes the evolution of this international partnership and the innovative processes and mechanisms involved in program implementation; the authors address the description of the program, central implementation challenges, notable outcomes, and student achievements. One key implementation challenge has been that, although nursing is one of the largest healthcare workforces in Ethiopia, nurses remain underutilized and undervalued in the workplace. This treatment is due, in part, to limited professional regulations, leading some of the PhD students to apply their leadership skills to advocate for national practice reform. According to students, the PhD program has been a means not only to improve nursing research capacity and education in Ethiopia, but also to generate the regulations necessary for graduates to practice according to their degree. While the opportunity to generate knowledge is vitally important, students also value the chance to transform the profession of nursing.

Objectives To analyze the predictors of health care utilization among respondents to the National Agricultural Worker Survey. Specifically, we hypothesized that English proficiency would predict utilization of health care services within the last 2 years. Methods Using the 2015-2016 National Agricultural Worker Survey, we performed a secondary data analysis to analyze the predictors of health care utilization within the last 2 years in the United States' agricultural worker population. Data were cleaned and analyzed using decision tree analysis, which produced a classification tree model that was trained on 90% of the data and validated on 10%. Results Exposure to English was not a predictor of health care utilization in our classification tree. The first major partition that predicted utilization was insurance status. Additional partitions were on age, gender, hypertension diagnosis, and public aid. Conclusions By partitioning on insurance status and use of public aid, the decision tree provided evidence that systemic factors are key determinants of health care utilization in the agricultural worker community. This highlights the importance of agencies that connect agricultural workers with resources that provide insurance and improve access to health care. This is especially important given that agricultural workers are one of the highest risk groups for occupational injury or death in the United States.

Recent findings suggest that laboring in hot occupational environments is related to kidney damage in agricultural workers. We examined hydration status and kidney function in 192 Florida agricultural workers.Blood and urine samples were collected over 555 workdays during the summers of 2015 and 2016. Urine-specific gravity (USG), serum creatinine, and other kidney function markers were examined pre- and post-shift on each workday. Multivariable mixed modeling was used to examine the association of risk factors with hydration status and acute kidney injury (AKI).Approximately 53% of workers were dehydrated (USG ≥1.020) pre-shift and 81% post-shift; 33% of participants had AKI on at least one workday. The odds of AKI increased 47% for each 5-degree (°F) increase in heat index.A strikingly high prevalence of dehydration and AKI exists in Florida agricultural workers.

Background Farmworkers working in hot and humid environments have an increased risk for heat-related illness (HRI) if their thermoregulatory capabilities are overwhelmed. The manifestation of heat-related symptoms can escalate into life-threatening events. Increasing ambient air temperatures resulting from climate change will only exacerbate HRI in vulnerable populations. We characterize HRI symptoms experienced by farmworkers in three Florida communities. Methods A total of 198 farmworkers enrolled in 2015–2016 were asked to recall if they experienced seven HRI symptoms during the previous work week. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between selected sociodemographic characteristics and reporting three or more symptoms. Latent class analysis was used to identify classes of symptoms representing the HRI severity range. We examined sociodemographic characteristics of the farmworkers across the latent classes. Results The mean age (±SD) of farmworkers was 38.0 (±8) years; the majority were female (60%) and Hispanic (86%). Most frequently reported symptoms were heavy sweating (66%), headache (58%), dizziness (32%), and muscle cramps (30%). Females had three times the odds of experiencing three or more symptoms (OR = 2.86, 95% CI 1.18–6.89). Symptoms fell into three latent classes, which included mild (heavy sweating; class probability = 54%), moderate (heavy sweating, headache, nausea, and dizziness; class probability = 24%), and severe (heavy sweating, headache, nausea, dizziness, muscle cramps; class probability = 22%). Conclusions Farmworkers reported a high burden of HRI symptoms that appear to cluster in physiologic patterns. Unrecognized accumulation of symptoms can escalate into life-threatening situations if untreated. Our research can inform interventions to promote early recognition of HRI, on-site care, and appropriate occupational health policy. Administrative or engineering workplace controls may also reduce the manifestation of HRI. Clinical Relevance This study advances the current knowledge of HRI symptoms in farmworkers and moves beyond reporting individual symptoms by utilizing latent class analysis to identify how symptoms tend to co-occur together in this population. It acknowledges multiple symptoms occurring as a result of occupational heat exposure and highlights the importance of symptom recognition.

Purpose To review factors that impact the effect of hot environments on the human body in order to develop a conceptual model of human biological response. Methods The organizing concept for the model development was the multilevel integration of three major factors, exposure to heat, sensitivity and adaptive capacity, and the heat stress response. Exposure of a vulnerable occupational group was used to illustrate the components of the model. Findings Components of this framework include the hazard (environmental heat stress), vulnerability factors (workplace exposure, sensitivity and adaptive capacity), and the heat stress response. The combination of the vulnerability factors of workplace exposure (work intensity, duration), sensitivity (age, gender, etc.), and adaptive capacity (hydration, clothing, work hygiene) mediate a worker's heat stress response to the hazard. A worker's heat stress response can be classified as progressing towards two outcomes: physiologic equilibrium or physiologic disequilibrium. Conclusions This framework provides a starting point for the design and development of studies of heat-related illness (HRI) in farmworker and other vulnerable populations exposed to rising global temperatures. Clinical Relevance Identification of vulnerability factors to HRI, informs research designs which will lead to the development of public health interventions.

Human exposure to endocrine disrupting chemicals (EDCs) has become common as a result of widespread application of these chemicals to the food supply, environmental contamination, and occupational exposures (Caserta et al., 2011). However, relatively little is known about the effects of EDCs such as ethylene thiourea (ETU) in developing fetuses and the lasting implications of this disruption on human development from birth through adulthood. Of highest concern are chronic, low-dose exposures among industrial and agricultural workers. Current knowledge regarding the significance of endocrine thyroid signaling on normal human development raises serious concerns about the possible deleterious effects of EDCs in the developing fetus, children, and mature adults. Occupational health nurses are critical in identifying women and families at increased risk of ETU exposure and mitigating early exposures in pregnancy.

The objective of this study was to assess work-related hygiene practices and the frequency and location of skin rashes due to cutaneous contact with crop-associated materials (e.g., pesticides) for female nursery and fernery workers in Central Florida. A cross-sectional, community-based participatory research study of 237 female nursery and fernery workers between the ages of 19 and 43 years with significant cutaneous contact with foliage crops was conducted using a self-report questionnaire and a skin rash chart assessment tool. Of the 237 farmworkers surveyed, 37.1% ( n = 88) reported a rash on at least one area of their bodies. Women who were pregnant during the study were 4.7 times more likely to report more than 30% total body surface area (TBSA) covered by rash compared with non-pregnant fernery workers ( p = .045; 95% confidence interval [CI] [1.04, 21.35]). Further research is needed to better understand the development of skin rashes among farmworkers, to generate effective prevention strategies.

The objective of this study was to determine the feasibility of field-based biomonitoring of heat-related illness (HRI) phenomena in Florida farmworkers. The authors determined feasibility through participant interviews regarding acceptability, data capture, recruitment and retention, and observed barriers and challenges to implementation.Study participants were employed in fernery operations in northeast Central Florida where ornamental ferns are grown and harvested in a seasonally high-heat environment. In this pilot, a total of 43 farmworkers participated during summers 2012 and 2013 and measurements included body core temperature, heart rate, energy expenditure, urine and blood osmolality, and self-reported HRI symptoms.Data capture was approximately 90%. Participants reported that the study methods were nonobtrusive to their work, and that they were comfortable with study measures.These results open possibilities for characterizing HRI utilizing physiologic biomonitoring in vulnerable occupational groups.

Affordable measurement of core body temperature (Tc) in a continuous, real-time fashion is now possible. With this advance comes a new data analysis paradigm for occupational epidemiology. We characterize issues arising after obtaining Tc data over 188 workdays for 83 participating farmworkers, a population vulnerable to effects of rising temperatures due to climate change. We describe a novel approach to these data using smoothing and functional data analysis. This approach highlights different data aspects compared with describing Tc at a single time point or summaries of the time course into an indicator function (e.g., did Tc ever exceed 38 °C, the threshold limit value for occupational heat exposure). Participants working in ferneries had significantly higher Tc at some point during the workday compared with those working in nurseries, despite a shorter workday for fernery participants. Our results typify the challenges and opportunities in analyzing Big Data streams from real-time physiologic monitoring.