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Abstract Objective Many work in injury prone awkward positions that require adequate flexibility and strength in trunk stabilizer muscle groups. Performance on a functional movement screen (FMS) that assessed those factors was conducted and an intervention was designed. Methods A battery of FMS tests were performed on 433 firefighters. We analyzed the correlation between FMS performance and injuries and other selected parameters. An intervention to improve flexibility and strength in trunk stabilizer or core muscle groups through a training program was evaluated. Results The intervention reduced lost time due to injuries by 62% and the number of injuries by 42% over a twelve month period as compared to a historical control group. Conclusion These findings suggest that core strength and functional movement enhancement programs to prevent injuries in workers whose work involves awkward positions is warranted.

Objective: Our objective was to develop an organized system to assess individual and group exposure to animal hazards on a college campus. Main points: The scope and complexity of college health services continue to expand as campuses confront unforeseen exposures and disease entities. Of great concern are students and faculty who are exposed to potentially life threatening and other serious conditions during their academic work. Conclusion: A college health service developed an effective animalhazard surveillance questionnaire that could be scanned and analyzed for individual and group exposure to hazards and the presence or absence of protective measures. The college then provided appropriate preventive services. [ABSTRACT FROM AUTHOR]

Contact dermatitis, the most common occupational skin disease, is characterized by clearly demarcated areas of rash at sites of exposure. The rash improves on removal of the offending agent. In allergic contact dermatitis, even minute exposures to antigenic substances can lead to a skin rash. Common sensitizing agents include nickel and members of the Rhus genus (e.g., poison ivy, poison oak). Severe skin irritants tend to cause immediate red blisters or burns, whereas weaker irritants produce eczematous skin changes over time. An occupational cause should be suspected when rash occurs in areas that are in contact with oil, grease, or other substances. Direct skin testing (patch or scratch) or radioallergosorbent testing may help to identify a specific trigger. Skin cancer can have an occupational link in workers with prolonged exposure to sunlight and certain chemicals, although it can take decades for lesions to develop. In workers with occupational skin disease, workplace changes and protective measures are important to prevent future exposure. [ABSTRACT FROM AUTHOR]

Firefighters work at maximal levels of exertion. Fitness for such duty requires adequate aerobic capacity (maximum oxygen consumption [Vo2max]). Aerobic fitness can both improve a worker's ability to perform and offer resistance to cardiopulmonary conditions. Inactive firefighters have a 90% greater risk of myocardial infarction than those who are aerobically fit. Participants (101 firefighters) completed a questionnaire that asked them to rank their fitness level from 0 to 7; e.g., Level 0 was low fitness: 'I avoid walking or exertion, e.g., always use elevator, drive whenever possible.' The level of activity rating increased to Level 7: 'I run over 10 miles per week or spend 3 hours per week in comparable physical activity.' Each participant then completed two measures of Vo2max: a 5-minute step test and a submaximal treadmill test. There was no association between the firefighters' self-perception of their level of fitness and their aerobic capacity as measured by either step test or submaximal treadmill. Because of the critical job demands of firefighting and the negative consequences of inadequate fitness and aerobic capacity, periodic aerobic capacity testing with individualized exercise prescriptions and work--community support may be advisable for all active-duty firefighters. [ABSTRACT FROM AUTHOR]

Emergency medical system (EMS) workers frequently use sharp devices in injury-prone circumstances that involve limited visibility, confined spaces, rapidly moving vehicles, and uncooperative victims. This study examined the efficacy of an automatic self-retracting lancet in reducing needlestick injuries and related direct and indirect costs. Subjects were 477 active-duty EMS workers. Counseling, laboratory testing (hepatitis B and C, hepatic function enzymes, and human immunodeficiency virus), antiviral prophylaxis, and immunizations were provided according to US Public Health Service guidelines. Baseline and biennial laboratory testing for hepatitis B and C and liver function enzymes were conducted. After the introduction of a spring-loaded automatic-retracting type glucometer lancet device, needlestick injuries decreased from 16 per 954 EMS worker-years to 2 per 477 EMS worker-years. The annualized cost of treatment declined from $8276 to $2068. The change to a self-retracting device decreased the number of needlestick injuries and was cost-effective with a minimal increase in device cost (annualized $366 per year). [ABSTRACT FROM AUTHOR]

Because smallpox may be a weapon, immunization programs have been restarted and research continues with vaccinia (smallpox vaccine). Ocular complications occur in 5 to 9% of those who contract smallpox and in 10 to 20 per million vaccinia recipients through self-inoculation or from contact with vaccinated individuals. Both variola virus (smallpox) and vaccinia virus (smallpox vaccine) are orthopoxviruses that can cause conjunctival and eyelid infections, cornea ulceration, keratitis, iritis, optic neuritis, and loss of vision. Clinicians should maintain a high index of suspicion for smallpox vaccine-associated reactions in vaccinia researchers, the immunized, and their close contacts. A researcher sprayed vaccinia in her eye. Timely irrigation may have prevented a viral infection. The possibility that this individual had self-immunized herself with smallpox vaccine via the conjunctiva and preventive measures are discussed. Greater precautionary measures need to be taken to prevent laboratory accidents. Antiviral ophthalmic medication and vaccinia-immune globulin medication are treatment options. [ABSTRACT FROM AUTHOR]

Firefighters are exposed to carcinogens and have elevated cancer rates. We hypothesized that occupational exposures in firefighters would lead to DNA methylation changes associated with activation of cancer pathways and increased cancer risk. To address this hypothesis, we collected peripheral blood samples from 45 incumbent and 41 new recruit non-smoking male firefighters and analyzed the samples for DNA methylation using an Illumina Methylation EPIC 850k chip. Adjusting for age and ethnicity, we performed: 1) genome-wide differential methylation analysis; 2) genome-wide prediction for firefighter status (incumbent or new recruit) and years of service; and 3) Ingenuity Pathway Analysis (IPA). Four CpGs, including three in the YIPF6, MPST, and PCED1B genes, demonstrated above 1.5-fold statistically significant differential methylation after Bonferroni correction. Genome-wide methylation predicted with high accuracy incumbent and new recruit status as well as years of service among incumbent firefighters. Using IPA, the top pathways with more than 5 gene members annotated from differentially methylated probes included Sirtuin signaling pathway, p53 signaling, and 5' AMP-activated protein kinase (AMPK) signaling. These DNA methylation findings suggest potential cellular mechanisms associated with increased cancer risk in firefighters., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Firefighters have elevated cancer incidence and mortality rates. MicroRNAs play prominent roles in carcinogenesis, but have not been previously evaluated in firefighters., Methods: Blood from 52 incumbent and 45 new recruit nonsmoking firefighters was analyzed for microRNA expression, and the results adjusted for age, obesity, ethnicity, and multiple comparisons., Results: Nine microRNAs were identified with at least a 1.5-fold significant difference between groups. All six microRNAs with decreased expression in incumbent firefighters have been reported to have tumor suppressor activity or are associated with cancer survival, and two of the three microRNAs with increased expression in incumbent firefighters have activities consistent with cancer promotion, with the remaining microRNA associated with neurological disease., Conclusion: Incumbent firefighters showed differential microRNA expression compared with new recruits, providing potential mechanisms for increased cancer risk in firefighters.

Background: Firefighting is a hazardous profession and firefighters suffer workplace injury at a higher rate than most US workers. Decreased physical fitness is associated with injury in firefighters. A physical fitness intervention was implemented among Tucson Fire Department recruit firefighters with the goals of decreasing injury and compensation claims frequency and costs during the recruit academy, and over the subsequent probationary year., Methods: Department injury records were analysed and described by body part, injury type and mechanism of injury. Injury and workers' compensation claims outcomes from the recruit academy initiation through the 12-month probationary period for the intervention recruit class were compared with controls from three historical classes., Results: The majority of injuries were sprains and strains (65.4%), the most common mechanism of injury was acute overexertion (67.9%) and the lower extremity was the most commonly affected body region (61.7%). The intervention class experienced significantly fewer injuries overall and during the probationary year (p=0.009), filed fewer claims (p=0.028) and experienced claims cost savings of approximately US$33 000 (2013) from avoided injury and reduced claims costs. The estimated costs for programme implementation were $32 192 leading to a 1-year return on investment of 2.4%., Conclusions: We observed reductions in injury occurrence and compensation costs among Probationary Firefighter Fitness (PFF-Fit) programme participants compared with historical controls. The initiation of the PFF-Fit programme has demonstrated promise in reducing injury and claims costs; however, continued research is needed to better understand the programme's potential effectiveness with additional recruit classes and carryover effects into the recruit's career injury potential., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Purpose: This study sought to develop a comprehensive measure of fitness that is predictive of injury risk and can be used in the fire service to assess individual-level health and fit-for-duty status., Methods: A retrospective occupational cohort of 799 career fire service employees was observed over the years 2005-2009. An equally weighted score for comprehensive fitness was calculated based on cardiovascular fitness, muscular strength, endurance, flexibility, and body composition. Repeated measures survival analyses were used to estimate the risk of any injury, sprain or strain, and exercise-related injuries in relation to comprehensive fitness., Results: A well-distributed comprehensive fitness score was developed to distinguish three tiers of overall fitness status. Intraclass correlations identified flexibility, total grip strength, percent body fat, and resting heart rate as the most reliable fitness metrics, while push-ups, sit-ups, and aerobic capacity demonstrated poor reliability. In general, individuals with a lower comprehensive fitness status had an increased injury risk of injury as compared to the most fit individuals. The risk of any injury was 1.82 (95% CI 1.06-3.11) times as likely for the least fit individuals, as compared to individuals in the top fire fitness category, increasing to 2.90 (95% CI 1.48-5.66) when restricted to sprains and strains., Conclusions: This 5-year analysis of clinical occupational health assessments enabled the development of a relevant metric for relating comprehensive fitness with the risk of injury. Results were consistent with previous studies focused on cardiorespiratory fitness, but also less susceptible to inter-individual variability of discrete measurements.

Background: Formalized risk management (RM) is an internationally accepted process for reducing hazards in the workplace, with defined steps including hazard scoping, risk assessment, and implementation of controls, all within an iterative process. While required for all industry in the European Union and widely used elsewhere, the United States maintains a compliance-based regulatory structure, rather than one based on systematic, risk-based methodologies. Firefighting is a hazardous profession, with high injury, illness, and fatality rates compared with other occupations, and implementation of RM programs has the potential to greatly improve firefighter safety and health; however, no descriptions of RM implementation are in the peer-reviewed literature for the North American fire service., Methods: In this paper we describe the steps used to design and implement the RM process in a moderately-sized fire department, with particular focus on prioritizing and managing injury hazards during patient transport, fireground, and physical exercise procedures. Hazard scoping and formalized risk assessments are described, in addition to the identification of participatory-led injury control strategies. Process evaluation methods were conducted to primarily assess the feasibility of voluntarily instituting the RM approach within the fire service setting., Results: The RM process was well accepted by the fire department and led to development of 45 hazard specific-interventions. Qualitative data documenting the implementation of the RM process revealed that participants emphasized the: value of the RM process, especially the participatory bottom-up approach; usefulness of the RM process for breaking down tasks to identify potential risks; and potential of RM for reducing firefighter injury., Conclusions: As implemented, this risk-based approach used to identify and manage occupational hazards and risks was successful and is deemed feasible for U.S. (and other) fire services. While several barriers and challenges do exist in the implementation of any intervention such as this, recommendations for adopting the process are provided. Additional work will be performed to determine the effectiveness of select controls strategies that were implemented; however participants throughout the organizational structure perceived the RM process to be of high utility while researchers also found the process improved the awareness and engagement in actively enhancing worker safety and health.

Background Although firefighting and emergency medical services are high-risk professions, few studies have identified the aetiology of injury in the fire service beyond the fireground. Methods Data were collected for work-related injuries in a medium-sized metropolitan fire department. In a descriptive study, the factors explored included the nature of injury, agent, mechanism, body location, environment, abbreviated injury scale (AIS), functional capacity index (FCI) and lost time status. Results From 2004 to 2009, the annual injury incidence rate averaged 17.7 per 100 employees. One-third of all injuries (32.9%) resulted from physical exercise activities, while patient transport, training drills and fireground operations resulted in 16.9%, 11.1% and 10.2% of injuries, respectively. For all job operations, sprains and strains were the most prevalent type of injury (40.2-85.2%), followed by contusions and lacerations (7.7-26.1%). The third most common injury was related to the conventional hazards of the individual job operation. Most injuries (n=862, 95.6%) were minor in severity, while 4.3% of injuries were classified as having some impedance of normal function (FCI 3). Moderate injuries (AIS 2) were infrequent, but comprised a greater proportion of fireground injuries (8.7%) than the other activities (1.0-4.1%); however, lost time injuries were more frequent for patient transport (46.1%) than other operations (22.0-29.1%). Conclusions Physical exercise, patient transport and training activities were responsible for a greater percentage of injuries than fireground operations. Focused efforts to improve the characterisation of risks during these more diverse set of work processes should help guide the development of salient strategies for injury prevention.

Objective: Heart disease is the leading cause of firefighter line-of-duty deaths. The study objectives were to identify early atherosclerotic disease through ultrasound measurement of carotid intima-media thickness (CIMT) and risk factors predicting increased CIMT and carotid plaque., Methods: Following ultrasound evaluation of 597 Phoenix and Tucson firefighters, logistic regression was used to identify risk factors for mean CIMT greater than 75th percentile and for carotid plaque., Results: Age, low-density lipoprotein cholesterol (LDL-C) of 100 mg/dL or more, and high-density lipoprotein cholesterol were significant independent predictors of increased CIMT. Age, hypertension, LDL-C, and plasma soluble P-selectin were significant predictors of carotid plaque., Conclusions: This study supports an emphasis on traditional risk factors for atherosclerotic disease in firefighters, in particular maintaining LDL-C less than 100 mg/dL. Plasma soluble P-selectin may help identify firefighters at increased risk for carotid plaque.

It was with considerable irony that tribal leaders began a collaboration with the University of Arizona and the Arizona Department of Health Services for training in public health preparedness, as the tribes had an extended prior history of responding to a host of hazards caused by the dominant culture. The objective of the training was to ensure that Native American communities were adequately informed and trained to implement coordinated response plans for a range of potential public health emergencies on tribal lands and in surrounding communities. This commentary outlines how cultural competency (including public prayer by an elder during the training), respect for tribal sovereignity, solicitation of historical examples of indigenous preparedness, and incorporation of tribal community networks were essential to the success of this program.Tribal Public Health Preparedness and Response: Homeland Security Since 1492.

More than 65,000 work-related eye injuries and illnesses, causing significant morbidity and disability, are reported in the United States annually. A well-equipped eye tray includes fluorescein dye, materials for irrigation and foreign body removal, a short-acting mydriatic agent, and topical anesthetics and antibiotics. The tray should be prepared in advance in case of an eye injury. Eye patching does not improve cornea reepithelialization or discomfort from corneal abrasions. Blunt trauma to the eye from a heavy object can cause a blow-out fracture. Sudden eye pain after working with a chisel, hammer, grinding wheel, or saw suggests a penetrating globe injury. Chemical eye burns require immediate copious irrigation. Nontraumatic causes of ocular illness are underreported; work-related allergic conjunctivitis increasingly has been recognized among food handlers and agriculture workers who are exposed to common spices, fruits, and vegetables. The patient's history of eye injury guides the diagnosis. Primary prevention and patient counseling on proper eye protection is essential because over 90 percent of injuries can be avoided with the use of eye protection. As laser use increases in industry and medical settings, adequate personal protection is needed to prevent cataracts. Outdoor workers exposed to significant ultraviolet rays need sun protection and safety counseling to prevent age-related macular degeneration. Contact lenses do not provide eye protection, and physicians should be familiar with guidelines for the use of contacts in the workplace.

In the United States today, there remains a need to train physicians with expertise in occupational medicine and its corollary, environmental medicine. To determine whether preventive medicine residency training programs provide trainees with skills and knowledge in occupational and environmental medicine, we conducted a survey among directors of general preventive medicine and combined general preventive medicine/public health programs in the United States that listed such emphases in the Directory of Preventive Medicine Residency Programs in the United States and Canada. Of the programs surveyed, over 50% included occupational and environmental medicine training opportunities. Individuals who have trained in these settings have obtained employment in positions related to this training, and some have obtained certification. Our findings suggest that preventive medicine training programs may provide an avenue for training and certification in occupational and environmental medicine.

Musculoskeletal disorders of the workplace include the acute, cumulative and chronic injuries or illnesses of the soft tissues which are caused by mechanical stress, strain, sprain, vibration, inflammation, or irritation. The successful management of occupational musculoskeletal disorders must account for workplace conditions (ergonomics and work practices), psychosocial factors, diagnostic uncertainties, and the need for active modalities (exercises and a progressive increase in activities of daily living), rather than passive (bed rest and traction). Although most occupational musculoskeletal disorders respond to conservative measures such as ice or heat, protective devices such as, neutral splints for carpal tunnel syndrome, nonsteroidal anti-inflammatory drugs, and progressive strengthening, resolution may take months. Prevention is often more important than treatment, and may entail workplace revisions and special worker training. Worker selection programs--strength testing, pre-placement radiographs, and inquiries about prior low back pain--have poor predictive value.

Most of the 2.5 million Americans who seek medical attention for burns each year can be successfully managed as outpatients. Mainstays of treatment are proper wound cleaning, unroofing and debriding of most blisters, and topical chemoprophylaxis for all second- and third-degree burns. Early surgical evaluation for possible excision and grafting is necessary for third-degree burns, deep second-degree burns and infected burns. Systemic antibiotic therapy alone is insufficient for infected burns. Hospitalization is mandated for most fire-related inhalation injuries.

After Canada, Mexico is the most popular destination for Americans traveling outside the United States. As a developing country, Mexico presents numerous health hazards to American visitors, including the prevalent travelers' diarrhea (turista), from which 40% will suffer, and the less common typhoid, dengue, rabies, malaria, taeniasis, cysticercosis, and trichinosis. Environmental hazards, including sun, heat, high altitude, motion sickness, and accidents, also threaten the unwary traveler. In the event of illness or injury, Americans may find medical facilities unfamiliar and less well equipped than those in the United States. Utilizing both an individualized risk assessment for each traveler and readily available references, physicians, in partnership with local public health agencies, can develop comprehensive preventive health plans for their patients traveling to Mexico.

Travel, especially if it is international, often means major changes for the family. Family physicians should assess the epidemiologic risk and psychosocial significance of travel or relocation in light of the family's life-cycle stage and antecedent health. Using core references, which are kept current in partnership with public health agencies, family physicians are able to provide comprehensive immunization, medications, and patient education for all travel risks. Families are given medical record summaries and recommended sources of care at their destination. Eight weeks after their return patients are reassessed for newly acquired illness and helped to integrate the perspectives gained during the travel into the family's future dynamics. Taking advantage of growing travel medicine opportunities, family medicine educators should base the care of travelers and teaching of residents on defined competence priorities. Travelers' health provides a mutually rewarding model of shared care with public health consultants in the community medicine curriculum.