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Little is known about occupational SARS-CoV-2 exposures and COVID-19 outcomes. We established a Doctor’s First Reports of Occupational Injury or Illness (DFR)-based surveillance system to study cases of work-related COVID-19 exposures and disease. The surveillance data included demographics, occupation, industry, exposure, and illness, details including hospitalization and lost work. We classified workers into ‘healthcare’, non-healthcare ‘public-facing’, or ‘other’ worker groups, and rural–urban commuting areas (RUCAs). We describe worker exposures and outcomes overall by worker group and RUCA. We analyzed 2848 COVID-19 DFRs representing workers in 22 detailed occupation groups and 19 industry groups. Most DFRs were for workers in metropolitan RUCAs (89%) and those in healthcare (42%) and public-facing (24%) worker groups. While DFRs were from 382 unique worksites, 52% were from four hospitals and one prison. Among 1063 DFRs with a suspected exposure, 73% suspected exposure to a patient or client. Few DFRs indicated hospitalization (3.9%); however, the proportion hospitalized was higher among nonmetropolitan (7.4%) and public-facing (6.7%) workers. While 56% of DFRs indicated some lost work time, the proportion was highest among public-facing (80%) workers. Healthcare and prison workers were the majority of reported occupational COVID-19 exposures and illnesses. The risk of COVID-19 hospitalization and lost work may be highest among nonmetropolitan and public-facing workers.

Objective This study examined the effect of 12 months of aerobic and resistance exercise versus usual care on changes in body composition in postmenopausal breast cancer survivors taking aromatase inhibitors (AIs). Methods The Hormones and Physical Exercise study enrolled 121 breast cancer survivors and randomized them to either supervised twice-weekly resistance exercise training and 150 min/wk of aerobic exercise (N = 61) or a usual care (N = 60) group. Dual-energy X-ray absorptiometry scans were conducted at baseline, 6 months, and 12 months to assess changes in body mass index, percent body fat, lean body mass, and bone mineral density. Results At 12 months, the exercise group relative to the usual care group had a significant increase in lean body mass (0.32 vs. −0.88 kg, P = 0.03), a decrease in percent body fat (−1.4% vs. 0.48%, P = 0.03), and a decrease in body mass index (−0.73 vs. 0.17 kg/m2, P = 0.03). Change in bone mineral density was not significantly different between groups at 12 months (0.001 vs. −0.006 g/cm2, P = 0.37). Conclusions A combined resistance and aerobic exercise intervention improved body composition in breast cancer survivors taking AIs. Exercise interventions may help to mitigate the negative side effects of AIs and improve health outcomes in breast cancer survivors.

Up to 50 % of postmenopausal breast cancer survivors taking aromatase inhibitors (AIs) experience AI-associated arthralgias, or joint pain, which causes many to stop taking AIs and may inhibit exercise, despite known health benefits. We thus evaluated exercise adherence and factors associated with better exercise adherence in breast cancer survivors experiencing AI-induced arthralgia in the (HOPE) year long randomized controlled trial. We included 61 HOPE women randomized to exercise (150 min/week of moderate-intensity aerobic exercise and twice-weekly supervised strength training). Our main outcomes were aerobic exercise measured with daily activity logs, attendance at supervised exercise sessions, and changes in cardiorespiratory fitness, measured maximal oxygen consumption (VO2max). We examined means and standard deviations (SDs) for exercise adherence by demographic and medical characteristics and used the t test for mean differences. We also examined predictors of adherence using linear regression. On average, at the end of the year long trial, women reported 119 (SD 78) min/week of moderate-intensity aerobic exercise and participated in 70 % of supervised exercise training sessions. After adjustment for other factors that influence adherence, at 6 months postrandomization, only baseline VO2max was associated with higher aerobic exercise levels and at 12 months, only older age predicted better supervised exercise training attendance. Breast cancer survivors taking AIs and experiencing arthralgia are able to initiate and maintain a year long exercise program, regardless of other factors that influence activity levels. Breast cancer survivors can exercise at levels that have been shown to improve AI-associated arthralgia.

Purpose Arthralgia occurs in up to 50% of breast cancer survivors treated with aromatase inhibitors (AIs) and is the most common reason for poor AI adherence. We conducted, in 121 breast cancer survivors receiving an AI and reporting arthralgia, a yearlong randomized trial of the impact of exercise versus usual care on arthralgia severity. Patients and Methods Eligibility criteria included receiving an AI for at least 6 months, reporting ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory (BPI), and reporting < 90 minutes per week of aerobic exercise and no strength training. Participants were randomly assigned to exercise (150 minutes per week of aerobic exercise and supervised strength training twice per week) or usual care. The BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were completed at baseline and at 3, 6, 9, and 12 months. Intervention effects were evaluated using mixed-model repeated measures analysis, with change at 12 months as the primary end point. Results Over 12 months, women randomly assigned to exercise (n = 61) attended 70% (± standard deviation [SD], 28%) of resistance training sessions and increased their exercise by 159 (± SD, 136) minutes per week. Worst joint pain scores decreased by 1.6 points (29%) at 12 months among women randomly assigned to exercise versus a 0.2-point increase (3%) among those receiving usual care (n = 60; P < .001). Pain severity and interference, as well as DASH and WOMAC pain scores, also decreased significantly at 12 months in women randomly assigned to exercise, compared with increases for those receiving usual care (all P < .001). Conclusion Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors.

This study examined the effect of 12 months of aerobic and resistance exercise versus usual care on changes in body composition in postmenopausal breast cancer survivors taking aromatase inhibitors (AIs).The Hormones and Physical Exercise study enrolled 121 breast cancer survivors and randomized them to either supervised twice-weekly resistance exercise training and 150 min/wk of aerobic exercise (N = 61) or a usual care (N = 60) group. Dual-energy X-ray absorptiometry scans were conducted at baseline, 6 months, and 12 months to assess changes in body mass index, percent body fat, lean body mass, and bone mineral density.At 12 months, the exercise group relative to the usual care group had a significant increase in lean body mass (0.32 vs. -0.88 kg, P = 0.03), a decrease in percent body fat (-1.4% vs. 0.48%, P = 0.03), and a decrease in body mass index (-0.73 vs. 0.17 kg/mA combined resistance and aerobic exercise intervention improved body composition in breast cancer survivors taking AIs. Exercise interventions may help to mitigate the negative side effects of AIs and improve health outcomes in breast cancer survivors.

Several adverse pregnancy outcomes were reported among female laboratory workers in a North American aluminum smelter. To determine whether these outcomes were associated with any occupational exposure at the plant, a cross-sectional survey was undertaken.Rates of miscarriage, premature singleton birth, and major congenital anomaly occurring during employment were compared with a reference group comprised of all pregnancies that occurred before employment.Among female workers, the excess of congenital anomalies among female laboratory workers that defined the initial cluster was observed, but no specific pattern was found.On the basis of these analyses, the increase in congenital anomalies could not be attributed to occupational exposures at the smelter nor could potential exposure likely explain the diverse anomalies described.

This study examined whether externally rated job demand and control were associated with depression diagnosis claims in a heavy industrial cohort. The retrospective cohort sample consisted of 7,566 hourly workers aged 18–64 years who were actively employed at 11 US plants between January 1, 1996, and December 31, 2003, and free of depression diagnosis claims during an initial 2-year run-in period. Logistic regression analysis was used to model the effect of tertiles of demand and control exposure on depression diagnosis claims. Demand had a significant positive association with depression diagnosis claims in bivariate models and models adjusted for demographic (age, gender, race, education, job grade, tenure) and lifestyle (smoking status, body mass index, cholesterol level) variables (high demand odds ratio = 1.39, 95% confidence interval: 1.04, 1.86). Control was associated with greater risk of depression diagnosis at moderate levels in unadjusted models only (odds ratio = 1.47, 95% confidence interval: 1.12, 1.93), while low control, contrary to expectation, was not associated with depression. The effects of the externally rated demand exposure were lost with adjustment for location. This may reflect differences in measurement or classification of exposure, differences in depression diagnosis by location, or other location-specific factors.

Occupational exposures account for 20% of obstructive lung disease (OLD)—including asthma and chronic obstructive pulmonary disease (COPD).1,2 Although many workplaces have spirometry surveillance programs to detect early disease, their efficacy is unclear. Indeed, while several regulatory agencies recommend respiratory surveillance for workers exposed to different respiratory toxicants, such as asbestos, silica, cadmium, and coke oven emissions, these guidelines do not dictate mandatory intervention.3-14 Spirometric airflow obstruction (AO) often goes undiagnosed. In the general population, data from the Third National Health and Nutrition Examination Survey demonstrate that over 10% of the US population has undiagnosed AO. The presence and magnitude of undiagnosed AO in the occupational setting is unclear. Early disease identification may precipitate important interventions. For example, asymptomatic smokers with mild to moderate AO in the Lung Health Study randomized to an aggressive smoking cessation campaign experienced decreased pulmonary function decline and mortality.15,16 Similarly, identifying relatively asymptomatic workers with AO may instigate workplace modifications, such as enhanced engineering controls and substitution of less toxic chemicals. Disease detection may lead to increased worker compliance with respiratory protection or removal of workers from toxic environments.17-19 We study the presence of health care for OLD among US workers employed in an aluminum production company and assess whether those with AO have received care. Workers in the primary aluminum industry may have increased risk for OLD due to exposure to respiratory toxicants such as particulate matter, coal tar pitch volatiles, sulfur dioxide, and particulate fluoride.20-28 A recent publication from this cohort demonstrated an increased asthma incidence associated with fluoride exposure.29 In this cross sectional analysis, we use spirometric surveillance and insurance claims databases to examine whether workers in these aluminum production facilities with AO have received health care for OLD. We also examine whether workers with more severe AO are more likely to receive care.

OBJECTIVE: This study was designed to determine whether injury risk among manufacturing workers was related to hours worked during the previous week. METHODS: A case-crossover design was utilized to contrast hours worked prior to an injury shift with those worked prior to a non-injury shift for hourly workers. Paired t-tests were used to determine significance of the difference. Conditional logistic regression was used to assess dose-response. RESULTS: Hours worked prior to injury significantly exceeded hours during the control week. Workers who worked more than 64 hr in the week before the shift had an 88% excess risk compared to those who worked 40 hr or fewer, P < 0.05. CONCLUSION: The study provides evidence that injury risk is related to time worked during the previous week. Control of overtime in manufacturing may reduce risk of worker injury. Language: en

The objective of the study was to determine if female workers in a heavy manufacturing environment have a higher risk of injury compared with males when performing the same job and to evaluate sex differences in type or severity of injury. By use of human resources and incident surveillance data for the hourly population at 6 US aluminum smelters, injuries that occurred from January 1, 1996, through December 21, 2005, were analyzed. Multivariate logistic regression, adjusted for job, tenure, and age category, was used to calculate odds ratios and 95% confidence intervals for female versus male injury risk for all injuries, recordable injuries, and lost work time injuries. The analysis was repeated for acute injuries and musculoskeletal disorder-related injuries separately. Female workers in this industry have a greater risk for sustaining all forms of injury after adjustment for age, tenure, and standardized job category (odds ratio = 1.365, 95% confidence interval: 1.290, 1.445). This excess risk for female workers persisted when injuries were dichotomized into acute injuries (odds ratio = 1.2) and musculoskeletal disorder-related injuries (odds ratio = 1.1). This study provides evidence of a sex disparity in occupational injury with female workers at higher risk compared with their male counterparts in a heavy manufacturing environment.

Absenteeism, when studied by researchers in occupational medicine, human resources, social epidemiology, and labor economics, encompasses several distinct issues: 1) An indirect cost of disease and injury, 2) lost productivity, and 3) an indicator of social disengagement. 1 Although many researchers have focused on health and medical reasons for absenteeism, others have emphasized personal and social factors. Chadwick-Jones2 proposes that the choice to attend work is the result of 1) the individual act of choice between alternative activities, 2) a withdrawal or escape from surveillance, or 3) an individual or group’s resistance to an inflexible system. Goodman3 further classifies absenteeism as either 1) an approach-avoidance behavior (which includes the Steers and Rhodes attendance model4), 2) the result of a decision process, 3) the outcome of an adjustment process, 4) a habit, 5) a consequence of an apparently unrelated event, or 6) a unique phenomenon. More remarkable than these diverse interpretations, is that the measure of absenteeism has also been variably defined, in part, to fit the various needs and objectives of divergent interested parties and researchers, and in part, due to the available sources of information. Consumers of absenteeism research are myriad and include government agencies looking to reduce absenteeism rates by changing wage replacement and social insurance programs; disability carriers looking to maximize profit while still meeting the standard of care of return to work; employers looking to minimize absenteeism by local administrative controls and policies; physicians tasked with determining the timeline for return to work; and labor economists working to optimize economic incentives to encourage attendance. As a result, each of these consumers have measured and predicted absenteeism using their own metrics, each with its own unique definition, numerator, and denominator. Commonly used absenteeism outcomes include hours absent,5–8 days absent2,9–17, and duration of absence spells2,10,13,15,18–21 either as the sole measure of absenteeism or in some combination. The metrics previously used in these studies has been recently and comprehensively reviewed.22,23 In addition to the confusion brought about by competing absenteeism metrics, further difficulty arises due to the often overlooked distinction between absenteeism (defined as time missed from work when one is scheduled to work) and sickness absence. Sickness absence (aka “sick-leave”), a popular term in Europe, has been defined, in research and in practice, as absence from work due to sickness.24 Research on sickness absence has been facilitated by the fact that most national social insurance programs require medical certification to qualify for benefits10,18,25. However, while it is often assumed that absence measured in these registries is due to ill health, researchers have shown poor correlation between actual illness and physician certification of illness for the purposes of obtaining wage replacement.26 Because the majority of administrative rules only allow for approved absence due to illness, most absences will then be reported by the employee as due to sickness. Given the divergent (yet complimentary) research fields in absenteeism, it is our opinion that a standardized measure of absenteeism is needed to help translate findings across disciplines. Moreover, due to the competing definitions currently in use for an “absence day”, “sick-listed period”, “sick-day”, “long-term”, and “short-term absences” etc., it is our belief that a standardized, cross-discipline measure of absenteeism can be accomplished only by using a straightforward and readily calculated measure based solely on hours worked and hours not worked. There are two main objectives of this article: 1) To introduce and demonstrate the calculation of a metric (the Work Lost Rate [WLR]) that can be easily derived from hourly payroll data, and 2) show how the WLR compares to other measures of absenteeism (absence days and duration of absence spell) that are currently in use. We hope that the WLR will be included in all studies that utilize payroll data, not as a replacement of existing measures of absenteeism, but as a standard metric which will facilitate interdisciplinary research and collaboration on absenteeism or sickness absence.

To determine whether beryllium-related disease exists among aluminum smelter workers.A total of 1278 employees from four aluminum smelters determined to have significant beryllium exposure based on 5 years of sampling were invited to participate in medical surveillance that included a respiratory symptoms questionnaire, spirometry, and blood beryllium lymphocyte proliferation test.Of these, 734 employees participated in the program. Beryllium exposure from 965 personal samples ranged from 0.002 to 13.00 microg/m time-weighted average, with a median of 0.05 microg/m, geometric mean of 0.05 microg/m, and arithmetic mean of 0.22 microg/m. Only two employees had confirmed beryllium sensitization (0.27%).There is evidence of beryllium sensitization among aluminum smelter workers. When compared with beryllium-exposed workers in other industries, aluminum smelter workers had lower rates of sensitization. The low beryllium sensitization rate observed may be related to work practices and the properties of the beryllium found in this work environment.

Exposures to respiratory irritants encountered in aluminum smelters in Europe, Australia, and New Zealand have been suggested as the cause of "potroom asthma." However, there remains disagreement in North America regarding the existence of this entity. This study was designed to assess whether asthma occurs excessively among potroom workers and if so, delineate dose-response relationships for possible causal risk factors. The asthma incidence ratio between potroom and nonpotroom workers after adjusting for smoking was 1.40. Although bivariate analyses showed a relationship between asthma incidence and exposure to total fluoride, gaseous fluoride, particulate fluoride, sulfur dioxide, and smoking, only the effects of gaseous fluoride (relative risk [RR] = 5.1) and smoking (RR = 7.7) remained significant in a multivariate model. Potroom asthma appears to occur at the studied U.S. aluminum smelters at doses within regulatory guidelines.

The most recent U.S. Census reported that Hispanics are now the nation's largest minority group. At the same time, increasing attention has focused on the inherent heterogeneity of the U.S. Hispanic population. Such a rapidly growing but heterogeneous minority poses potential challenges to population-based research. To understand those challenges better, we first considered the history of the demographers' question: "Who is Hispanic?" We then considered the implications of differing Hispanic identity criteria for disease surveillance. Although relevant to political and socioeconomic considerations, the Hispanic ethnic category may not be specifically useful for understanding most disease processes. For epidemiologic studies, there is need for more transparent criteria to classify subpopulations. Those criteria must be regularly subjected to analysis and validation.

9536 Background: We recently reported that exercise reduced AI-associated arthralgias. This analysis examined potential mechanisms mediating the effect on exercise on arthralgia, specifically weigh...

TPS669 Background: A substantial number of breast cancer survivors who are taking aromatase inhibitors (AIs) complain of side effects including arthralgias. Given the efficacy of AIs, it is essential that we identify approaches to mitigate arthralgias. We are conducting an NCI-funded trial is to examine the impact of a year-long exercise intervention in 180 breast cancer survivors taking an AI and experiencing at least mild arthralgias. Outcomes include severity of arthralgias, endocrine-related quality of life, % body fat, bone mass, and serum markers of inflammation. The purpose of this abstract is to present preliminary recruitment and adherence results. Methods: Women are being recruited via the Connecticut Tumor Registry and Rapid Case Ascertainment Shared Resource of Yale Cancer Center into the Hormones and Physical Exercise (HOPE) Study. Participants are randomly assigned to exercise (n = 90) or usual care (n = 90). The exercise intervention includes supervised resistance and unsupervised aerobic exercise sessions over 12 months. Data are collected at baseline, 3-, 6-, 9 and 12-months. Results: Study recruitment began in April 2010 and will continue through December 2012. As of January 1, 2012, we have received 1605 names of potentially eligible women. Of these 1605, 777 women are waiting to be screened (e.g., letter mailed to patient or on hold because recently diagnosed), 244 women could not be screened (e.g., unable to contact by phone), and 584 women have completed a telephone screening. Of the 584 women screened, 24% were ineligible because of discontinuing AIs because of arthralgias or chose not to take AIs primarily because of this potential side effect; another 36% were ineligible for various reasons; 24% were not interested; 11% were randomized (n = 65 women); and 5% are undergoing baseline visits (n = 29). On average, women are 62 yrs old and have been taking an AI for 1.8 yrs. Twenty-three women have completed the trial, with high exercise adherence rates (attendance to supervised sessions = 82% ). Conclusions: A growing number of women are choosing to not take AIs or are discontinuing AIs because of side effects. Our study may prove beneficial for the growing number of women diagnosed with hormone receptor-positive breast cancer each year.