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Background Between 2001 and 2010, five research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries and collected detailed subject-level exposure information with follow-up of

Background: While there is evidence that COVID-19 vaccination protects against development of post-COVID conditions (PCC) after severe infection data are limited on whether vaccination reduces the risk after cases of less-severe non-hospitalized COVID-19 disease with more recent SARS-CoV-2 variant viruses. This study assessed whether COVID-19 vaccination was protective against subsequent development of PCC in persons with predominantly mild initial infections during both Delta and Omicron variant predominance., Methods: This study utilized a case-control design, nested within the HEROES-RECOVER cohort. Participants aged ≥18 years with PCR-confirmed SARS-CoV-2 infection between 6/28/2021 and 9/14/2022 were surveyed for PCC, defined by symptoms lasting >1 month after initial infection Cases were participants self-reporting PCC and controls were participants that did not self-report PCC. The exposure was mRNA COVID-19 vaccination (2 or 3 monovalent doses) versus no COVID-19 vaccination. Logistic regression was used to compare the odds of PCC among vaccinated and unvaccinated persons; additional analyses evaluating PCC subtypes were also performed., Results: A total of 936 participants with documented SARS-CoV-2 infection were included; of these 23.6% (221) reported PCC and 83.3% (779) were vaccinated. Participants who received a 3rd COVID-19 monovalent mRNA dose prior to infection had lower odds of PCC-related gastrointestinal, neurological, and other symptoms compared to unvaccinated participants (aOR: 0.37; 95% CI: 0.16-0.85; aOR: 0.56; 95% CI: 0.32-0.97; aOR:0.48; 95% CI: 0.25-0.91)., Conclusions: COVID-19 vaccination protected against development of PCC among persons with mild infection during both Delta and Omicron variant predominance, supporting vaccination as an important tool for PCC prevention., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)

Objectives: The aims of the study are to evaluate how upper limb impairment ratings are affected by updates to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) Sixth Edition 2024 compared with the AMA Guides Sixth Edition 2008 and to investigate potential correlations with judicial, legislative, and economic factors., Methods: Two expert evaluators reviewed 31 upper limb clinical vignettes from the 2008 and 2024 versions. The impairment ratings for each version were compared., Results: After following the impairment ratings steps in each version, the results for 2024 showed no significant differences when compared with the impairment ratings generated using 2008 methods (Cohen's kappa = 1.00)., Conclusions: The updated AMA Guides Sixth Edition 2024 with improved, transparent processes and enhanced diagnosis-based impairment tables provides efficiency while retaining the accuracy, validity, and reliability of past versions of the AMA Guides ., Competing Interests: Conflict of interest: Melhorn and Martin are co-chairs of the AMA Guides Editorial Panel for which they receive an administrative fee. Gelinas is an unpaid member of the panel’s advisory committee. In the previous 36 months, Thiese’s institution received funding from Institute for Well Being in Law, CDC (NIOSH), Novavax, and the Federal Motor Carrier Safety Administration; these do not pose a conflict with this work. Hegmann has no conflicts to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Background: Immunogenicity studies suggest that recombinant influenza vaccine (RIV) may provide better protection against influenza than standard-dose inactivated influenza vaccines (SD IIV). This randomized trial evaluated the relative vaccine effectiveness (VE) and immunogenicity of RIV versus SD IIV in frontline workers and students aged 18-64 years., Methods: Participants were randomized to receive RIV or SD IIV and followed for reverse-transcription polymerase chain reaction (RT-PCR)-confirmed influenza during the 2022-2023 influenza season. Sera were collected from a subset of participants before and at 1 and 6 months postvaccination and tested by hemagglutination inhibition for A/H1N1, A/H3N2, B/Yamagata, and B/Victoria and against cell-grown vaccine reference viruses for A/H1N1 and A/H3N2., Results: Overall, 3988 participants were enrolled and vaccinated (25% of the trial sample size goal); RT-PCR-confirmed influenza occurred in 20 of 1963 RIV recipients and 28 of 1964 SD IIV recipients. Relative VE was 29% (95% confidence interval [CI], -26% to 60%). In the immunogenicity substudy (n = 118), the geometric mean titer ratio (GMTR) comparing RIV to SD IIV at 1 month was 2.3 (95% CI, 1.4-3.7) for cell-grown A/H1N1, 2.1 (95% CI, 1.3-3.4) for cell-grown A/H3N2, 1.1 (95% CI, .7-1.6) for B/Victoria, and 1.4 (95% CI, .9-2.0) for B/Yamagata. At 6 months, GMTRs were >1 against A/H1N1, A/H3N2, and B/Yamagata., Conclusions: Relative VE of RIV compared to SD IIV did not reach statistical significance, but RIV elicited more robust humoral immune responses to 2 of 4 vaccine viruses at 1 month and 3 of 4 viruses at 6 months after vaccination, suggesting possible improved and sustained immune protection from RIV. Clinical Trials Registration. NCT05514002., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts of interest., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)

Objective: Describe and evaluate methodological improvements in AMA Guides to the Evaluation of Permanent Impairment ( Guides ) Sixth Edition 2024, including an updated sequential method and enhanced diagnosis-based impairment tables, compared to the Guides Sixth 2008., Methods: Three physician experts and 3 premedical students, respectively, completed 2 rounds of impairment ratings using the AMA Guides Sixth 2008 versus 2024 methods. Impairment values and completion times using each method were compared for both groups., Results: Time to complete an impairment rating by experts averaged 3.5 minutes using Guides 2024 compared with 13.9 minutes using Guides 2008, with 100% accuracy and reliability for both. Students' time averaged 5.3 and 15.9 minutes, respectively, with increased accuracy and reliability with Guides 2024., Conclusions: The Guides Sixth 2024 allowed more efficient impairment ratings while retaining accuracy, consistency, reliability, and reproducibility., Competing Interests: Conflict of Interest: Melhorn and Martin are Co-Chairs of the AMA Guides® Editorial Panel for which they receive an administrative fee. Gelinas is an unpaid member of the Panel's advisory committee. Hegmann and Thiese have no conflicts to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Hybrid immunity, as a result of infection and vaccination to SARS-CoV-2, has been well studied in adults but limited evidence is available in children. We evaluated the antibody responses to primary SARS-CoV-2 infection among vaccinated and unvaccinated children aged ≥ 5 years., Methods: A longitudinal cohort study of children aged ≥ 5 was conducted during August 2021-August 2022, at sites in Arizona, Texas, Utah, and Florida. Children submitted weekly nasal swabs for PCR testing and provided sera 14-59 days after PCR-confirmed SARS-CoV-2 infection. Antibodies were measured by ELISA against the receptor-binding domain (RBD) and S2 domain of ancestral Spike (WA1), in addition to Omicron (BA.2) RBD, following infection in children, with and without prior monovalent ancestral mRNA COVID-19 vaccination., Results: Among the 257 participants aged 5 to 18 years, 166 (65%) had received at least two mRNA COVID-19 vaccine doses ≥ 14 days prior to infection. Of these, 53 occurred during Delta predominance, with 37 (70%) unvaccinated at the time of infection. The remaining 204 infections occurred during Omicron predominance, with 53 (26%) participants unvaccinated. After adjusting for weight, age, symptomatic infection, and gender, significantly higher mean RBD AUC values were observed among the vaccinated group compared to the unvaccinated group for both WA1 and Omicron ( p < 0.0001). A smaller percentage of vaccinated children reported fever during illness, with 55 (33%) reporting fever compared to 44 (48%) unvaccinated children reporting fever ( p = 0.021)., Conclusions: Children with vaccine-induced immunity at the time of SARS-CoV-2 infection had higher antibody levels during convalescence and experienced less fever compared to unvaccinated children during infection.

Excess health and safety risks of commercial drivers are largely determined by, embedded in, or operate as complex, dynamic, and randomly determined systems with interacting parts. Yet, prevailing epidemiology is entrenched in narrow, deterministic, and static exposure-response frameworks along with ensuing inadequate data and limiting methods, thereby perpetuating an incomplete understanding of commercial drivers' health and safety risks. This paper is grounded in our ongoing research that conceptualizes health and safety challenges of working people as multilayered "wholes" of interacting work and nonwork factors, exemplified by complex-systems epistemologies. Building upon and expanding these assumptions, herein we: (a) discuss how insights from integrative exposome and network-science-based frameworks can enhance our understanding of commercial drivers' chronic disease and injury burden; (b) introduce the "working life exposome of commercial driving" (WLE-CD)-an array of multifactorial and interdependent work and nonwork exposures and associated biological responses that concurrently or sequentially impact commercial drivers' health and safety during and beyond their work tenure; (c) conceptualize commercial drivers' health and safety risks as multilayered networks centered on the WLE-CD and network relational patterns and topological properties-that is, arrangement, connections, and relationships among network components-that largely govern risk dynamics; and (d) elucidate how integrative exposome and network-science-based innovations can contribute to a more comprehensive understanding of commercial drivers' chronic disease and injury risk dynamics. Development, validation, and proliferation of this emerging discourse can move commercial driving epidemiology to the frontier of science with implications for policy, action, other working populations, and population health at large., (© 2024 Wiley Periodicals LLC.)

Objectives: The thesis of this paper is that health and safety challenges of working people can only be fully understood by examining them as wholes with interacting parts. This paper unravels this indispensable whole by introducing the working life exposome and elucidating how associated epistemologies and methodologies can enhance empirical research., Methods: Network and population health scientists have initiated an ongoing discourse on the state of empirical work-health-safety-well-being research., Results: Empirical research has not fully captured the totality and complexity of multiple and interacting work and nonwork factors defining the health of working people over their life course. We challenge the prevailing paradigm by proposing to expand it from narrow work-related exposures and associated monocausal frameworks to the holistic study of work and population health grounded in complexity and exposome sciences. Health challenges of working people are determined by, embedded in, and/or operate as complex systems comprised of multilayered and interdependent components. One can identify many potentially causal factors as sufficient and component causes where removal of one or more of these can impact disease progression. We, therefore, cannot effectively study them by an a priori determination of a set of components and/or properties to be examined separately and then recombine partial approaches, attempting to form a picture of the whole. Instead, we must examine these challenges as wholes from the start, with an emphasis on interactions among their multifactorial components and their emergent properties. Despite various challenges, working-life-exposome-grounded frameworks and associated innovations have the potential to accomplish that., Conclusions: This emerging paradigm shift can move empirical work-health-safety-well-being research to cutting-edge science and enable more impactful policies and actions.

Per- and polyfluoroalkyl substances (PFAS) are ubiquitous throughout the United States. Previous studies have shown PFAS exposure to be associated with a reduced immune response. However, the relationship between serum PFAS and antibody levels following SARS-CoV-2 infection or COVID-19 vaccination has not been examined. We examined differences in peak immune response and the longitudinal decline of antibodies following SARS-CoV-2 infection and COVID-19 vaccination by serum PFAS levels in a cohort of essential workers in the United States. We measured serum antibodies using an in-house semi-quantitative enzyme-linked immunosorbent assay (ELISA). Two cohorts contributed blood samples following SARS-CoV-2 infection or COVID-19 vaccination. We used linear mixed regression models, adjusting for age, race/ethnicity, gender, presence of chronic conditions, location, and occupation, to estimate differences in immune response with respect to serum PFAS levels. Our study populations included 153 unvaccinated participants that contributed 316 blood draws over a 14-month period following infection, and 860 participants and 2451 blood draws over a 12-month period following vaccination. Higher perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) concentrations were associated with a lower peak antibody response after infection (p = 0.009, 0.031, 0.015). Higher PFOS, perfluorooctanoic acid (PFOA), PFHxS, and PFNA concentrations were associated with slower declines in antibodies over time after infection (p = 0.003, 0.014, 0.026, 0.025). PFOA, PFOS, PFHxS, and PFNA serum concentrations prior to vaccination were not associated with differences in peak antibody response after vaccination or with differences in decline of antibodies over time after vaccination. These results suggest that elevated PFAS may impede potential immune response to SARS-CoV-2 infection by blunting peak antibody levels following infection; the same finding was not observed for immune response to vaccination., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Allison L Naleway reports a relationship with Pfizer Inc that includes: funding grants. Allison L Naleway reports a relationship with Vir Biotechnology Inc that includes: funding grants. Kurt Hegmann reports a relationship with American College of Occupational and Environmental Medicine that includes: consulting or advisory. Kurt Hegmann reports a relationship with National Institute for Occupational Safety and Health that includes: funding grants. Manjusha Gaglani reports a relationship with Westat Inc that includes: funding grants. Manjusha Gaglani reports a relationship with Vanderbilt University Medical Center that includes: funding grants. Manjusha Gaglani reports a relationship with Abt Associates Inc that includes: funding grants. Manjusha Gaglani reports a relationship with Infectious Diseases and Immunization Committee, Texas Pediatric Society, Texas Chapter of the American Academy of Pediatrics that includes: board membership. Ryan Sprissler reports a relationship with American Council of Life Insurers that includes: speaking and lecture fees. Ryan Sprissler reports a relationship with California legal case Ebers v. Castle Park that includes: consulting or advisory. Ryan Sprissler reports a relationship with Geneticure, Inc. that includes: equity or stocks. Ryan Sprissler reports a relationship with Beckman Coulter that includes: speaking and lecture fees. Ryan Sprissler reports a relationship with Shay Emma Hammer Research Foundation that includes: board membership. Ryan Sprissler has patent issued to Arizona Board of Regents on Behalf of the University of Arizona., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of the study is to assess risk of common musculoskeletal disorders (MSDs) based on cardiovascular disease (CVD) risk scores., Methods: Data from a 9-year prospective cohort of 1224 workers in three states were analyzed. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy., Results: Adjusted RRs for one or more MSDs increased to 3.90 (95% confidence interval, 2.20-6.90) among those with 10-year cardiovascular disease risk scores greater than 15% and 17.4 (95% confidence interval, 3.85-78.62) among those with more than 4 disorders., Conclusions: Cardiovascular disease factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger., Competing Interests: Conflict of interest: K.T.H. is the Editor-in-Chief of the American College of Occupational and Environmental Medicine’s Evidence-Based Practice Guidelines. D.L.D. has received payments from the University of Wisconsin at Milwaukee (UW System). R.K. has received funding for committee work for the American Board of Anesthesia., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Background: This study investigated whether the time to amputation (TtoA) after a work-related injury had a significant effect on the medical costs accrued in the first year after injury., Data Source: Six thousand nine hundred fifty-three person-level workers' compensation claims data from the state of California, USA, from 2007 to 2018., Methods: Multiple quantile regression was used to assess the impact of TtoA on medical costs accrued during the first 12 months after injury. Three time intervals for TtoA were investigated: immediate (0, 1 days), short-delay (2-31 days), and long-delay (>31 days)., Results: The median (interquartile range) medical dollars paid per claim during the first 12 months for the study population was $12,414 ($6,324-$29,347). Amputations that occurred during the short-delay time interval resulted in significant ( p < 0.001) median (95% CI) savings of -$3,196 (-$3,968 to -$2,424) compared with the immediate amputation group. The long-delay time interval resulted in significantly ( p < 0.001) increased median (95% CI) spending of $5,613 ($4,675-$6,551) compared with the immediate amputation group. Covariates that significantly increased costs were medical intensity, medical complexity, use of a prosthesis, and if the injured worker pursued legal action in addition to a workers' compensation claim., Conclusions: This study presents the impact of TtoA on medical spending in the first year after a work-related injury that results in an amputation. Amputations that occurred within the first month after an injury resulted in reduced medical spending compared with immediate amputations, and amputations that occurred after the first month resulted in increased medical spending., (Copyright © 2023 International Society for Prosthetics and Orthotics.)

In a cohort of essential workers in the United States previously infected with SARS-CoV-2, risk factors for reinfection included being unvaccinated, infrequent mask use, time since first infection, and being non-Hispanic Black. Protecting workers from reinfection requires a multipronged approach including up-to-date vaccination, mask use as recommended, and reduction in underlying health disparities.

Background: Metabolic syndrome (MetS) is especially prevalent among US truck drivers. However, there has been limited research exploring associations between MetS conditions with roadway crashes among truck drivers. The objective of this paper is to assess relationships between specific combinations of individual MetS components and crashes and near-misses., Methods: Survey, biometric, and anthropometric data were collected from 817 truck drivers across 6 diverse US states. Survey data focused on demographics and roadway safety outcomes, and anthropometric/biometric data corresponded to five MetS conditions (waist circumference blood pressure, hemoglobin A1c, triglycerides, and high-density lipoprotein [HDL] cholesterol). Logistic regression was used to calculate odds ratios of lifetime crashes and near-miss 1-month period prevalence associated with: 1) specific MetS conditions regardless of presence or absence of other MetS conditions, and 2) specific MetS conditions and counts of other accompanying MetS conditions., Results: Hypertension was the MetS characteristic most strongly associated with lifetime crash and 1-month near-miss outcomes, while high triglycerides, low HDL cholesterol, and large waist circumference were most commonly present among groups of conditions associated with crashes and near-misses. Overall, an increasing number of specific co-occurring MetS conditions were associated with higher reporting of roadway crashes., Conclusions: Specific combinations and higher prevalence of MetS conditions were associated with increased frequency of reported crashes. Moreover, when the co-occurrence of MetS conditions is aggregated, a dose-response relationship with crashes appears. These results suggest that policy changes and interventions addressing MetS may increase driver health and reduce crash risk., (© 2022 Wiley Periodicals LLC.)

Objective: Ineffective meetings have been well-documented as presenting considerable direct (eg, salary) and indirect costs (eg, employee burnout). We explore the idea that people need meeting recovery, or time to transition from meetings to their next task. Doing so may reduce employee burnout., Methods: We used a quantitative survey of working adults' last meeting to determine the relationship between meeting outcomes (satisfaction and effectiveness) and meeting recovery., Results: We found that meeting outcomes are related to meeting recovery and that relationship is moderated by the degree to which the meeting was relevant to the individual. Implications for theory and practice are discussed to provide concrete recommendations for researchers, managers, and consultants., Conclusions: This study explores virtual meeting fatigue with a focus on meeting quality and explores the need for recovery after workplace meetings., Competing Interests: Conflict of interest: For M.S.T., a partnership between CDC and Abt Associates; a partnership between ACOEM and Reed Group; and working with FMCSA, Safelane Health, Utah State Bar for data access., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Importance: Data on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance., Objective: To evaluate associations between 2 or 3 doses of mRNA COVID-19 vaccine and attenuation of symptoms and viral RNA load across SARS-CoV-2 viral lineages., Design, Setting, and Participants: A prospective cohort study of essential and frontline workers in Arizona, Florida, Minnesota, Oregon, Texas, and Utah with COVID-19 infection confirmed by reverse transcriptase-polymerase chain reaction testing and lineage classified by whole genome sequencing of specimens self-collected weekly and at COVID-19 illness symptom onset. This analysis was conducted among 1199 participants with SARS-CoV-2 from December 14, 2020, to April 19, 2022, with follow-up until May 9, 2022, reported., Exposures: SARS-CoV-2 lineage (origin strain, Delta variant, Omicron variant) and COVID-19 vaccination status., Main Outcomes and Measures: Clinical outcomes included presence of symptoms, specific symptoms (including fever or chills), illness duration, and medical care seeking. Virologic outcomes included viral load by quantitative reverse transcriptase-polymerase chain reaction testing along with viral viability., Results: Among 1199 participants with COVID-19 infection (714 [59.5%] women; median age, 41 years), 14.0% were infected with the origin strain, 24.0% with the Delta variant, and 62.0% with the Omicron variant. Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; OR, 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, -6.1 [95% CI, -11.8 to -0.4] days). Among those with Omicron infection, the risk of symptomatic infection did not differ significantly for the 2-dose vaccination status vs unvaccinated status and was significantly higher for the 3-dose recipients vs those who were unvaccinated (327/370 [88.4%] vs 85/107 [79.4%]; OR, 2.0 [95% CI, 1.1-3.5]). Among symptomatic Omicron infections, those vaccinated with the third dose 7 to 149 days before infection compared with those who were unvaccinated were significantly less likely to report fever or chills (160/311 [51.5%] vs 64/81 [79.0%]; OR, 0.25 [95% CI, 0.1-0.5]) or seek medical care (45/308 [14.6%] vs 20/81 [24.7%]; OR, 0.45 [95% CI, 0.2-0.9]). Participants with Delta and Omicron infections who received the second dose 14 to 149 days before infection had a significantly lower mean viral load compared with unvaccinated participants (3 vs 4.1 log10 copies/μL; difference, -1.0 [95% CI, -1.7 to -0.2] for Delta and 2.8 vs 3.5 log10 copies/μL, difference, -1.0 [95% CI, -1.7 to -0.3] for Omicron)., Conclusions and Relevance: In a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, or viral load for some comparisons, although the precision and statistical significance of specific estimates varied.

Background: This study examined employer experience with SARS-CoV-2 (COVID-19) asymptomatic testing through a social marketing lens. Social marketing uses commercial marketing principles to achieve socially beneficial ends including improved health and safety behavior., Method: Twenty employers across 11 occupational sectors were interviewed about implementation of COVID-19 testing from January through April 2021. Recorded transcripts were coded and analyzed using marketing's "Four P's": "product," "price," "place," "promotion.", Results: COVID-19 tests (product) were uncomfortable, were easily confused, and didn't solve problems articulated by employers. Testing was not widely available or didn't line up with shifts or locations (place). The perceived price, which included direct and associated costs (e.g., laboratory fees, productivity loss, logistical challenges) was high. Most crucially, the time to receive (PCR) results negated the major benefit of less time spent in quarantine and challenged employer trust. A potential audience segmentation strategy based on perceptions of exposure risk also emerged., Conclusions: This social marketing analysis suggests ways to improve the value proposition for asymptomatic testing through changes in product, price, and placement features in line with employers' expressed needs. Study findings can also inform creation of employee communication materials that balance perceived rewards of testing against perceived risks of exposure.

During the first year of the COVID-19 pandemic, U.S. companies were seeking ways to support their employees to return to the workplace. Nonetheless, the development of strategies to support the access, use, and interpretation of SARS-CoV-2 testing was challenging. In the present study, we explore, from the perspective of owners and company leadership, the barriers to SARS-CoV-2 testing among U.S. companies. Key informant interviews with company representatives were conducted during January-April 2021 about SARS-CoV-2 testing. A pre-interview survey assessed respondent socio-demographic and organizational characteristics. Interview sessions were transcribed, coded, and analyzed using MaxQDA. A total of twenty interviews were completed with at least two interviews conducted in each major U.S. industry sector. Ninety percent of participants represented companies in business >10 years, comprising both small and large workforces. Using a grounded theory approach, six themes emerged: (1) access to and knowledge of SARS-CoV-2 tests; (2) strategies for symptomatic and asymptomatic testing of workers; (3) type/availability of personal protective equipment to mitigate coronavirus exposures; (4) return-to-work policies; (5) guidance and communication of SARS-CoV-2 Testing; and (6) use of contact tracing and SARS-CoV-2 vaccination. Various modifiable and non-modifiable challenges for SARS-CoV-2 testing among U.S. companies were identified and can inform work-related SARS-CoV-2 testing strategies.

Objective: To examine differences in demographic, psychosocial, and job physical exposure risk factors between multiple low back pain (LBP) outcomes in a prospective cohort of industrial workers., Background: LBP remains a leading cause of lost industrial productivity. Different case definitions involving pain (general LBP), medication use (M-LBP), seeking healthcare (H-LBP), and lost time (L-LBP) are often used to study LBP outcomes. However, the relationship between these outcomes remains unclear., Method: Demographic, health status, psychosocial, and job physical exposure risk factors were quantified for 635 incident-eligible industrial workers. Incident cases of LBP outcomes and pain symptoms were quantified and compared across the four outcomes., Results: Differences in age, gender, medical history, and LBP history were found between the four outcomes. Most incident-eligible workers (67%) suffered an LBP outcome during follow-up. Cases decreased from 420 for LBP (25.4 cases/100 person-years) to 303 for M-LBP (22.0 cases/100 person-years), to 151 for H-LBP (15.6 cases/100 person-years), and finally to 56 for L-LBP (8.7 cases/100 person-years). Conversely, pain intensity and duration increased from LBP to H-LBP. However, pain duration was relatively lower for L-LBP than for H-LBP., Conclusion: Patterns of cases, pain intensity, and pain duration suggest the influence of the four outcomes. However, few differences in apparent risk factors were observed between the outcomes. Further research is needed to establish consistent case definitions., Application: Knowledge of patterns between different LBP outcomes can improve interpretation of research and guide future research and intervention studies in industry.

Purpose: To determine the age-adjusted association between colorectal cancer (CRC) risk factors and CRC prevalence among long-haul truck drivers (aged 21-85), after adjustment for age., Design: Pooled cross-sectional analysis using Commercial Driver Medical Exam (CDME) data. Setting. National survey data from January 1, 2005, to October 31, 2012., Participants: 47,786 commercial motor vehicle drivers in 48 states., Measures: CRC prevalence was the primary outcome; independent variables included demographics, body mass index (BMI), and concomitant medical conditions., Analysis: Kruskal-Wallis tests to analyze continuous variables; Fischer's exact tests to analyze categorical variables; univariate and multivariable logistic regression for rare events (Firth method) to quantify the association between the independent variables of interest and CRC prevalence. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, gender, years with current employer, year of exam, and BMI in a multivariate logistic regression., Results: Many factors were statistically significant. Obesity (OR = 3.14; 95% CI = 1.03-9.61) and increasing age (OR = 1.10 per year; 95% CI = 1.07-1.13) were significantly associated with CRC prevalence. Truckers with 4 or more concomitant medical conditions were significantly more likely to have CRC (OR = 7.03; 95% CI = 1.83-27.03)., Conclusions: Our findings highlight mutable risk factors and represent an opportunity for intervention that may decrease CRC morbidity and mortality among truck drivers, a unique population in the United States estimated to live up to 16 years less than the general population.

Objective: The aim of the study is to determine relationships between lockdowns and excess mortality, unemployment, and employment growth., Methods: Each US states' mortality data for 2020 were compared with the prior 3 years to determine excess mortality. Data were compared using measures of lockdowns, or state openness scores and adjusted for age, sex, race/ethnicity, and cardiovascular disease. Comparisons were made with unemployment rates and employment growth rates., Results: The 2020 excess mortality ranged from -9% to 46%. The average openness score was not significant ( P = 0.20). However, openness was strongly associated with both unemployment ( P = 0.01) and employment growth ( P = 0.0008)., Conclusions: There was no statistical relationship between excess mortality and openness scores, while there were strong relationships with employment measures. These results suggest that lockdowns are not sufficiently beneficial for future use in this pandemic and raise concerns for use in future pandemics., Competing Interests: Conflicts of Interest: Dr Hegmann is an editor of the American College of Occupational and Environmental Medicine practice guidelines., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Background: Data on the development of neutralizing antibodies (nAbs) against SARS-CoV-2 after SARS-CoV-2 infection and after vaccination with mRNA COVID-19 vaccines are limited., Methods: From a prospective cohort of 3975 adult essential and frontline workers tested weekly from August 2020 to March 2021 for SARS-CoV-2 infection by reverse transcription-polymerase chain reaction assay irrespective of symptoms, 497 participants had sera drawn after infection (170), vaccination (327), and after both infection and vaccination (50 from the infection population). Serum was collected after infection and each vaccine dose. Serum-neutralizing antibody titers against USA-WA1/2020-spike pseudotype virus were determined by the 50% inhibitory dilution. Geometric mean titers (GMTs) and corresponding fold increases were calculated using t tests and linear mixed-effects models., Results: Among 170 unvaccinated participants with SARS-CoV-2 infection, 158 (93%) developed nAbs with a GMT of 1003 (95% confidence interval, 766-1315). Among 139 previously uninfected participants, 138 (99%) developed nAbs after mRNA vaccine dose 2 with a GMT of 3257 (2596-4052). GMT was higher among those receiving mRNA-1273 vaccine (GMT, 4698; 3186-6926) compared with BNT162b2 vaccine (GMT, 2309; 1825-2919). Among 32 participants with prior SARS-CoV-2 infection, GMT was 21 655 (14 766-31 756) after mRNA vaccine dose 1, without further increase after dose 2., Conclusions: A single dose of mRNA vaccine after SARS-CoV-2 infection resulted in the highest observed nAb response. Two doses of mRNA vaccine in previously uninfected participants resulted in higher nAbs to SARS-CoV-2 than after 1 dose of vaccine or SARS-CoV-2 infection alone. nAb response also differed by mRNA vaccine product., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Background: Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children are essential to inform policy and guide health care professionals in advising parents and caregivers of children who test positive for SARS-CoV-2., Objective: This report describes the objectives and methods for conducting the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) study. PROTECT is a longitudinal prospective pediatric cohort study designed to estimate SARS-CoV-2 incidence and COVID-19 vaccine effectiveness (VE) against infection among children aged 6 months to 17 years, as well as differences in SARS-CoV-2 infection and vaccine response between children and adolescents., Methods: The PROTECT multisite network was initiated in July 2021, which aims to enroll approximately 2305 children across four US locations and collect data over a 2-year surveillance period. The enrollment target was based on prospective power calculations and accounts for expected attrition and nonresponse. Study sites recruit parents and legal guardians of age-eligible children participating in the existing Arizona Healthcare, Emergency Response, and Other Essential Workers Surveillance (HEROES)-Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) network as well as from surrounding communities. Child demographics, medical history, COVID-19 exposure, vaccination history, and parents/legal guardians' knowledge and attitudes about COVID-19 are collected at baseline and throughout the study. Mid-turbinate nasal specimens are self-collected or collected by parents/legal guardians weekly, regardless of symptoms, for SARS-CoV-2 and influenza testing via reverse transcription-polymerase chain reaction (RT-PCR) assay, and the presence of COVID-like illness (CLI) is reported. Children who test positive for SARS-CoV-2 or influenza, or report CLI are monitored weekly by online surveys to report exposure and medical utilization until no longer ill. Children, with permission of their parents/legal guardians, may elect to contribute blood at enrollment, following SARS-CoV-2 infection, following COVID-19 vaccination, and at the end of the study period. PROTECT uses electronic medical record (EMR) linkages where available, and verifies COVID-19 and influenza vaccinations through EMR or state vaccine registries., Results: Data collection began in July 2021 and is expected to continue through the spring of 2023. As of April 13, 2022, 2371 children are enrolled in PROTECT. Enrollment is ongoing at all study sites., Conclusions: As COVID-19 vaccine products are authorized for use in pediatric populations, PROTECT study data will provide real-world estimates of VE in preventing infection. In addition, this prospective cohort provides a unique opportunity to further understand SARS-CoV-2 incidence, clinical course, and key knowledge gaps that may inform public health., International Registered Report Identifier (irrid): RR1-10.2196/37929., (©Joy Burns, Patrick Rivers, Lindsay B LeClair, Krystal S Jovel, Ramona P Rai, Ashley A Lowe, Laura J Edwards, Sana M Khan, Clare Mathenge, Maria Ferraris, Jennifer L Kuntz, Julie Mayo Lamberte, Kurt T Hegmann, Marilyn J Odean, Hilary McLeland-Wieser, Shawn Beitel, Leah Odame-Bamfo, Natasha Schaefer Solle, Josephine Mak, Andrew L Phillips, Brian E Sokol, James Hollister, Jezahel S Ochoa, Lauren Grant, Matthew S Thiese, Keya B Jacoby, Karen Lutrick, Felipe A Pubillones, Young M Yoo, Danielle Rentz Hunt, Katherine Ellingson, Mark C Berry, Joe K Gerald, Joanna Lopez, Lynn B Gerald, Meredith G Wesley, Karl Krupp, Meghan K Herring, Purnima Madhivanan, Alberto J Caban-Martinez, Harmony L Tyner, Jennifer K Meece, Sarang K Yoon, Ashley L Fowlkes, Allison L Naleway, Lisa Gwynn, Jefferey L Burgess, Mark G Thompson, Lauren EW Olsho, Manjusha Gaglani. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 28.07.2022.)

Objective: Investigate the associations between drug abuse and the prevalence of the engagement and burnout dichotomy in law professionals., Methods: Eligible participants completed a questionnaire where odds ratios of drug abuse and other confounding variables and their association to engagement or burnout were calculated using multiple logistic regression., Results: When looking at all law professionals, burnout is a statistically significant predictor for drug abuse ( P = 0.04, not shown). Law professionals whose burnout scores fell in the highest bin have 4.71 (95% CI [1.38-16.08]) times higher odds of having a problem with drug abuse than those whose burnout scores fell in the second bin., Conclusion: Study findings showed a possible way to affect the prevalence of drug abuse in law professionals by affecting the engagement and burnout dichotomy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Background: Although recent studies have identified important risk factors associated with incident carpal tunnel syndrome (CTS), risk factors associated with its severity have not been well explored., Objective: To examine the associations between personal, workplace psychosocial and biomechanical factors and incident work disability among workers with CTS., Methods: Between 2001 and 2010 five research groups conducted coordinated prospective studies of CTS and related work disability among US workers from various industries. Workers with prevalent or incident CTS (N=372) were followed for up to 6.4 years. Incident work disability was measured as: (1) change in work pace or work quality, (2) lost time or (3) job change following the development of CTS. Psychosocial factors were assessed by questionnaire. Biomechanical exposures were assessed by observation and measurements and included force, repetition, duty cycle and posture. HRs were estimated using Cox models., Results: Disability incidence rates per 100 person-years were 33.2 for changes in work pace or quality, 16.3 for lost time and 20.0 for job change. There was a near doubling of risk for job change among those in the upper tertile of the Hand Activity Level Scale (HR 2.17; 95% CI 1.17 to 4.01), total repetition rate (HR 1.75; 95% CI 1.02 to 3.02), % time spent in all hand exertions (HR 2.20; 95% CI 1.21 to 4.01) and a sixfold increase for high job strain. Sensitivity analyses indicated attenuation due to inclusion of the prevalent CTS cases., Conclusion: Personal, biomechanical and psychosocial job factors predicted CTS-related disability. Results suggest that prevention of severe disability requires a reduction of both biomechanical and organisational work stressors., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: We sought to evaluate the impact of changes in estimates of COVID-19 vaccine effectiveness on the incidence of laboratory-confirmed infection among frontline workers at high risk for SARS-CoV-2., Methods: We analyzed data from a prospective frontline worker cohort to estimate the incidence of COVID-19 by month as well as the association of COVID-19 vaccination, occupation, demographics, physical distancing, and mask use with infection risk. Participants completed baseline and quarterly surveys, and each week self-collected mid-turbinate nasal swabs and reported symptoms., Results: Among 1018 unvaccinated and 3531 fully vaccinated workers, the monthly incidence of laboratory-confirmed SARS-CoV-2 infection in January 2021 was 13.9 (95% confidence interval [CI]: 10.4-17.4), declining to 0.5 (95% CI -0.4-1.4) per 1000 person-weeks in June. By September 2021, when the Delta variant predominated, incidence had once again risen to 13.6 (95% CI 7.8-19.4) per 1000 person-weeks. In contrast, there was no reportable incidence among fully vaccinated participants at the end of January 2021, and incidence remained low until September 2021 when it rose modestly to 4.1 (95% CI 1.9-3.8) per 1000. Below average facemask use was associated with a higher risk of infection for unvaccinated participants during exposure to persons who may have COVID-19 and vaccinated participants during hours in the community., Conclusions: COVID-19 vaccination was significantly associated with a lower risk of SARS-CoV-2 infection despite Delta variant predominance. Our data demonstrate the added protective benefit of facemask use among both unvaccinated and vaccinated frontline workers., (© 2022 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

Objective: This study examines the relationship between opioid use prevalence and subsequent filing of workers' compensation claims., Methods: A retrospective cohort study design was utilized to examine data from drivers' initial commercial driver medical exam, employment data, and workers' compensation claims data., Results: Data from 57,733 over 7 years were analyzed. Drivers who reported opioid use at their initial medical exam visit filed subsequent workers' compensation claims 1.81 times sooner (P = 0.0001; 95% CI 1.34, 2.44) than drivers who did not report opioid use at their CDME when controlling for age, gender, BMI, and diastolic blood pressure., Conclusions: These findings provide information that may aid in improving regulations to control for incidents, training programs to inform professional drivers of factors that increase accident risk and educating prescribers about increased risks of injury among opioid-using drivers., Competing Interests: Dr Thiese has been a consultant for the American College of Occupational and Environmental Medicine and Reed Group for development of the Best Practice Guidelines, Union Pacific Railroad, Association of American Railroads and is a part owner in SafeLane Health. The other authors have no declared potential conflicts of interest., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Competing Interests: Conflict of Interest/ Sources of Funding: Payments for ACOEM Guidelines Editor, Reed/MDA Guidelines, Orthofix, SpineCare & Forensic Medicine, PLLC, AMA, IAIME, spinehealth.com, Skoll Foundation, NMIC Foundation, McGraw-Hill, CMCC, Workers Compensation Research Institute, Medrisk Scientific Advisory, Opisafe, Colorado Division of Workers Compensation, PCORI Washington State Advisory, American Board of Independent Medical Examiners, State Farm, Norwegian Chiropractic Association, Amazon, Spine Care Partners, LLC, Primary Spine Provider Network, Reed Group, University of Utah, NIOSH, St Luke's Occupational Health Services.

Introduction: In a multi-center prospective cohort of essential workers, we assessed knowledge, attitudes, and practices (KAP) by vaccine intention, prior SARS-CoV-2 positivity, and occupation, and their impact on vaccine uptake over time., Methods: Initiated in July 2020, the HEROES-RECOVER cohort provided socio-demographics and COVID-19 vaccination data. Using two follow-up surveys approximately three months apart, COVID-19 vaccine KAP, intention, and receipt was collected; the first survey categorized participants as reluctant, reachable, or endorser., Results: A total of 4,803 participants were included in the analysis. Most (70%) were vaccine endorsers, 16% were reachable, and 14% were reluctant. By May 2021, 77% had received at least one vaccine dose. KAP responses strongly predicted vaccine uptake, particularly positive attitudes about safety (aOR = 5.46, 95% CI: 1.4-20.8) and effectiveness (aOR = 5.0, 95% CI: 1.3-19.1). Participants' with prior SARS-CoV-2 infection were 22% less likely to believe the COVID-19 vaccine was effective compared with uninfected participants (aOR 0.78, 95% CI: 0.64-0.96). This was even more pronounced in first responders compared with other occupations, with first responders 42% less likely to believe in COVID-19 vaccine effectiveness (aOR = 0.58, 95% CI 0.40-0.84). Between administrations of the two surveys, 25% of reluctant, 56% reachable, and 83% of endorser groups received the COVID-19 vaccine. The reachable group had large increases in positive responses for questions about vaccine safety (10% of vaccinated, 34% of unvaccinated), and vaccine effectiveness (12% of vaccinated, 27% of unvaccinated)., Discussion: Our study demonstrates attitudes associated with COVID-19 vaccine uptake and a positive shift in attitudes over time. First responders, despite potential high exposure to SARS-CoV-2, and participants with a history of SARS-CoV-2 infection were more vaccine reluctant., Conclusions: Perceptions of the COVID-19 vaccine can shift over time. Targeting messages about the vaccine's safety and effectiveness in reducing SARS-CoV-2 virus infection and illness severity may increase vaccine uptake for reluctant and reachable participants., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Allison L. Naleway reported funding from Pfizer for a meningococcal B vaccine study unrelated to the submitted work., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Workers critical to emergency response and continuity of essential services during the COVID-19 pandemic are at a disproportionally high risk of SARS-CoV-2 infection. Prospective cohort studies are needed for enhancing the understanding of the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, identifying risk factors, assessing clinical outcomes, and determining the effectiveness of vaccination., Objective: The Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) prospective cohort study was designed to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, examine the risk factors for infection and clinical spectrum of illness, and assess the effectiveness of vaccination among essential workers., Methods: The RECOVER multisite network was initiated in August 2020 and aims to enroll 3000 health care personnel (HCP), first responders, and other essential and frontline workers (EFWs) at 6 US locations. Data on participant demographics, medical history, and vaccination history are collected at baseline and throughout the study. Active surveillance for the symptoms of COVID-19-like illness (CLI), access of medical care, and symptom duration is performed by text messages, emails, and direct participant or medical record reports. Participants self-collect a mid-turbinate nasal swab weekly, regardless of symptoms, and 2 additional respiratory specimens at the onset of CLI. Blood is collected upon enrollment, every 3 months, approximately 28 days after a reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection, and 14 to 28 days after a dose of any COVID-19 vaccine. From February 2021, household members of RT-PCR-confirmed participants are self-collecting mid-turbinate nasal swabs daily for 10 days., Results: The study observation period began in August 2020 and is expected to continue through spring 2022. There are 2623 actively enrolled RECOVER participants, including 280 participants who have been found to be positive for SARS-CoV-2 by RT-PCR. Enrollment is ongoing at 3 of the 6 study sites., Conclusions: Data collected through the cohort are expected to provide important public health information for essential workers at high risk for occupational exposure to SARS-CoV-2 and allow early evaluation of COVID-19 vaccine effectiveness., International Registered Report Identifier (irrid): DERR1-10.2196/31574., (©Laura J Edwards, Ashley L Fowlkes, Meredith G Wesley, Jennifer L Kuntz, Marilyn J Odean, Alberto J Caban-Martinez, Kayan Dunnigan, Andrew L Phillips, Lauren Grant, Meghan K Herring, Holly C Groom, Karley Respet, Shawn Beitel, Tnelda Zunie, Kurt T Hegmann, Archana Kumar, Gregory Joseph, Brandon Poe, Paola Louzado-Feliciano, Michael E Smith, Matthew S Thiese, Natasha Schaefer-Solle, Young M Yoo, Carlos A Silvera, Julie Mayo Lamberte, Josephine Mak, L Clifford McDonald, Matthew J Stuckey, Preeta Kutty, Melissa L Arvay, Sarang K Yoon, Harmony L Tyner, Jefferey L Burgess, Danielle Rentz Hunt, Jennifer Meece, Manjusha Gaglani, Allison L Naleway, Mark G Thompson. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 03.12.2021.)

The Revised Strain Index (RSI), a model that quantifies physical exposure from individual hand/wrist exertions, tasks, and multi-task jobs, was used to quantify exposure for 1372 incident-eligible manufacturing, service and healthcare workers. Workers were followed for an average of 2.5 years (maximum 6 years) and had an average carpal tunnel syndrome (CTS) incidence rate of 4.6 per 100 person-years. Exceeding the a-priori RSI limit of 10.0 showed increased risk of CTS (Hazard Ratio (HR) = 1.45, 95% CI: 1.11-1.91, p  = 0.01). There also was a dose-response relationship using proposed low (RSI ≤ 8.5, HR = 1.00), medium (HR = 1.42 (95% CI: 0.96-2.09 , p  = 0.08)), and high limits (RSI > 15, HR = 1.79 (95% CI: 1.19-2.69, p  = 0.01), respectively. RSI as a continuous variable showed CTS risk increased steadily by between 1.9% and 3.3% per unit increase in RSI ( p  ≤ 0.03). These results suggest that the RSI is a useful tool for surveillance as well as for job intervention/design and continuous improvement processes. Practitioner Summary The Revised Strain Index (RSI) quantifies physical exposure from individual hand/wrist exertions, tasks, and multi-task jobs. Increased cumulative RSI scores (i.e. daily exposure score) are associated with increased risk of carpal tunnel syndrome (CTS). The RSI is potentially useful as a risk surveillance and intervention design tool.

Background: The objective of this study was to investigate the prevalence of carpal tunnel syndrome (CTS) in workers with trigger digit. There are few cross-sectional studies that assess this relationship. Methods: A baseline examination of 1216 workers from 17 diverse manufacturing facilities was conducted. Worker demographics, medical history, and symptoms of trigger digit were assessed. Age, sex, and body mass index were obtained. Biomechanical factors were individually measured using the Strain Index (SI). Prevalence was assessed with univariate and multivariate logistic regression. Results: Unadjusted prevalence of trigger digit was 12.0%, and among those workers, there was an unadjusted CTS prevalence of 26.7%. The adjusted multivariate model found an odds ratio (OR) of CTS of 1.56 (95% confidence interval [CI], 1.03-2.36) among the workers with trigger digit. The ORs of CTS for SI (OR = 1.53 [95% CI, 1.04-2.23]), age (OR = 1.03 [95% CI, 1.01-1.04]), and current smoking (OR = 1.76 [95% CI, 1.12-2.75]) were also significant. Sex and diabetes were not statistically significant covariates. Conclusion: The prevalence of CTS is higher among workers with trigger digit.

Competing Interests: The authors report no conflicts of interest.

Background: Transit workers have jobs requiring close public contact for extended periods of time, placing them at increased risk for severe acute respiratory syndrome coronavirus 2 infection and more likely to have risk factors for coronavirus disease 2019 (COVID-19)-related complications. Collecting timely occupational data can help inform public health guidance for transit workers; however, it is difficult to collect during a public health emergency. We used nontraditional epidemiological surveillance methods to report demographics and job characteristics of transit workers reported to have died from COVID-19., Methods: We abstracted demographic and job characteristics from media scans on COVID-19 related deaths and reviewed COVID-19 memorial pages for the Amalgamated Transit Union (ATU) and Transport Workers Union (TWU). ATU and TWU provided a list of union members who died from COVID-19 between March 1-July 7, 2020 and a total count of NYC metro area union members. Peer-reviewed publications identified through a scientific literature search were used to compile comparison demographic statistics of NYC metro area transit workers. We analyzed and reported characteristics of ATU and TWU NYC metro area decedents., Results: We identified 118 ATU and TWU NYC metro area transit worker COVID-19 decedents with an incidence proportion of 0.3%. Most decedents were male (83%); median age was 58 years (range: 39-71). Median professional tenure was 20 years (range: 2-41 years). Operator (46%) was the most reported job classification. More than half of the decedents (57%) worked in positions associated with close public contact., Conclusion: Data gathered through nontraditional epidemiological surveillance methods provided insight into risk factors among this workforce, demonstrating the need for mitigation plans for this workforce and informing transit worker COVID-19 guidance as the pandemic progressed., (© 2021 Wiley Periodicals LLC.)

During December 14, 2020-April 10, 2021, data from the HEROES-RECOVER Cohorts,* a network of prospective cohorts among frontline workers, showed that the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines were approximately 90% effective in preventing symptomatic and asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19, in real-world conditions (1,2). This report updates vaccine effectiveness (VE) estimates including all COVID-19 vaccines available through August 14, 2021, and examines whether VE differs for adults with increasing time since completion of all recommended vaccine doses. VE before and during SARS-CoV-2 B.1.617.2 (Delta) variant predominance, which coincided with an increase in reported COVID-19 vaccine breakthrough infections, were compared (3,4)., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Matthew S. Thiese reports grants and personal fees from Reed Group and the American College of Occupational and Environmental Medicine, outside the submitted work. No other potential conflicts of interest were disclosed.

Background: Information is limited regarding the effectiveness of the two-dose messenger RNA (mRNA) vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) in preventing infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in attenuating coronavirus disease 2019 (Covid-19) when administered in real-world conditions., Methods: We conducted a prospective cohort study involving 3975 health care personnel, first responders, and other essential and frontline workers. From December 14, 2020, to April 10, 2021, the participants completed weekly SARS-CoV-2 testing by providing mid-turbinate nasal swabs for qualitative and quantitative reverse-transcriptase-polymerase-chain-reaction (RT-PCR) analysis. The formula for calculating vaccine effectiveness was 100% × (1 - hazard ratio for SARS-CoV-2 infection in vaccinated vs. unvaccinated participants), with adjustments for the propensity to be vaccinated, study site, occupation, and local viral circulation., Results: SARS-CoV-2 was detected in 204 participants (5%), of whom 5 were fully vaccinated (≥14 days after dose 2), 11 partially vaccinated (≥14 days after dose 1 and <14 days after dose 2), and 156 unvaccinated; the 32 participants with indeterminate vaccination status (<14 days after dose 1) were excluded. Adjusted vaccine effectiveness was 91% (95% confidence interval [CI], 76 to 97) with full vaccination and 81% (95% CI, 64 to 90) with partial vaccination. Among participants with SARS-CoV-2 infection, the mean viral RNA load was 40% lower (95% CI, 16 to 57) in partially or fully vaccinated participants than in unvaccinated participants. In addition, the risk of febrile symptoms was 58% lower (relative risk, 0.42; 95% CI, 0.18 to 0.98) and the duration of illness was shorter, with 2.3 fewer days spent sick in bed (95% CI, 0.8 to 3.7)., Conclusions: Authorized mRNA vaccines were highly effective among working-age adults in preventing SARS-CoV-2 infection when administered in real-world conditions, and the vaccines attenuated the viral RNA load, risk of febrile symptoms, and duration of illness among those who had breakthrough infection despite vaccination. (Funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention.)., (Copyright © 2021 Massachusetts Medical Society.)

Background: Detailed information regarding workers who experience an amputation in the workplace over the last decade is limited. To better understand the financial and functional impact of a work-related amputation, this study quantifies the incidence of work-related amputations in the California workforce from 2007 to 2018 as well as the relationship between medical costs and lost workdays as a function of amputation level., Methods: Workers' compensation claims data from California spanning the years 2007 to 2018 were evaluated to describe trends in amputation incidence (N = 16 931). Quartile values for medical costs, indemnity costs, and lost workdays were reported as a function of amputation level. Correlations were performed between medical costs and lost workdays to examine their relationship., Results: The average incidence from 2007 to 2018 was 8.9 (95% CI 8.5, 9.4) amputations per 100 000 workers. There was a significant spike in amputations in 2008. Partial-hand amputations were the most common with 73.3 (95% CI 69.2, 77.7) cases per 1 000 000 workers, and the industry with the highest incidence was construction with 26.0 (95% CI 22.4, 30.0) cases per 100 000 workers. Overall, medical costs were moderately correlated with lost workdays (Spearman's rho = 0.51), and that level of correlation remained relatively consistent across all levels of amputation (Spearman's rho = 0.48-0.62)., Conclusions: Amputations represent high medical costs and number of lost workdays. Considering the type of amputation and the industry the injury occurred in is important in order to work toward returning this population to work. Our results present the status of amputations in the California workplace and establish a basis for using medical costs to infer lost work productivity for this population., Competing Interests: The authors declare that they have no conflict of interest., (© 2021 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Context: The use of clinical-practice guidelines is a suggested method for improving health outcomes by the earlier provision of necessary and effective medical interventions., Objective: To quantify the influence of adherence to guideline-recommended interventions in the first week of treatment for an initial low back pain (LBP) injury on lost workdays., Methods: In a retrospective cohort of California's workers' compensation claims data from May 2009 to May 2018, 41 diagnostic and treatment interventions were abstracted from the medical claims for workers with acute LBP injuries and compared with guideline recommendations. Lost workdays within 1-year post-injury were compared by guideline adherence using quantile regressions., Results: Of the 59,656 workers who met the study inclusion criteria, 66.1% were male and the average (SD) age was 41 (12) years. The median number (IQR) of lost workdays was 27 (6-146) days. In the first week of treatment, 14.2% of workers received only recommended interventions, 14.6% received only non-recommended interventions, and 51.1% received both recommended and non-recommended interventions. Opioid prescriptions fell 86% from 2009 to 2018. Workers who received only guideline-recommended interventions experienced significantly fewer lost workdays (11.5 days; 95% CI: -13.9, -9.1), a 29.3% reduction, than workers who received only non-recommended interventions. The percentage of workers receiving only recommended interventions increased from 10.3% to 18.2% over the 9 years., Conclusion and Relevance: When workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers., Competing Interests: FG and KW were employees of ReedGroup Ltd during the study, which provided salaries for authors FG and KW. KH is the Editor and MT the lead researcher for the American College of Occupational and Environmental Medicine’s (ACOEM) Practice Guidelines used in this study. Drs. Hegmann and Thiese are compensated to develop the ACOEM Guidelines. ReedGroup, Ltd. are the sole proprietors of the guidelines. ReedGroup, Ltd did not have any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Law professionals are an understudied population that is integral to society. Limited research indicates lawyers experience poor mental health, decreased wellbeing, and suicidality. This cross-sectional study recruited 654 law professionals and responses to a depression scale, the patient health questionnaire 9 (PHQ-9) were compared with the general working population. Lawyers were significantly more likely to report suicidal ideation "several days" and "more than half the days" as compared with the general working population, with odds ratios (OR) of 6.54 (95% confidence interval [CI] 4.16 to 10.29) and 5.50 (95% CI 2.23 to 13.53) respectively. Lawyers were more likely reported mild (OR = 3.89, 95% CI 3.04 to 4.96), moderate (OR = 5.29, 95% CI 3.61 to 7.76), moderately severe (OR = 9.71, 95% CI 5.50 to 17.14), and severe (OR = 18.34, 95% CI 6.00 to 56.11) depressive symptoms. 17.5% of lawyers in this study were experiencing symptoms equivalent to a diagnosis of a major depressive disorder., Competing Interests: Thiese, Allen, Knudson, Free, and Petersen have no relationships/conditions/circumstances that present potential conflict of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine. † Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days. § In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Allison L. Naleway reported funding from Pfizer for a meningococcal B vaccine study unrelated to the submitted work. Kurt T. Hegmann serves at the Editor of the American College of Occupational and Environmental Medicine’s evidence-based practice guidelines. Matthew S. Thiese reported grants and personal fees from Reed Group and the American College of Occupational and Environmental Medicine, outside the submitted work. No other potential conflicts of interest were disclosed.

Objective: This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders., Methods: Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders., Results: Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations., Conclusion: Quality evidence should guide invasive treatment for all phases of managing low back disorders., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Commercial Motor Vehicle drivers must be medically certified to obtain/maintain a commercial driver license. 88,246 exams from 2005 to 2012 were analyzed for relationships between health and certification length. Relationships were quantified using adjusted odds ratios (ORs). Most conditions and/or examination findings had statically significantly limited medical certification. Obesity > 35 kg/m2, hypertension and diabetes mellitus requiring medication were most common. Significant and meaningful relationships were found for opioid or benzodiazepine use (OR = 7.30), heart disease (OR = 5.19), musculoskeletal conditions (OR = 5.13), seizures (10.18), stroke (OR = 6.73), neurological (OR = 18.51) and vascular (OR = 11.83). Drivers with 2 or more of 13 medical conditions were statistically significantly more likely to have limited medical certification (OR = 122.35) or disqualification (OR = 4.91). Drivers with any condition are more likely to have limited medical certification. There is variability in medical certification lengths related to medical conditions and differences between examiners., Competing Interests: Natalie Hartenbaum is President of Occumedix, Review Officer/Medical Advisor for Occupational Health of FirstLab, Medical Director for Sunoco, Inc and Medical Director of the Federal Reserve Bank of Philadelphia. Matthew S. Thiese is CEO and Kurt Hegmann is President of SafeLane Health. Drs Hartenbaum, Hegmann and Kales has served as a medicolegal consultant and expert witness on cases involving commercial drivers. Dr Hanowski serves as a truck driver distraction/fatigue expert on legal cases. The other authors have no declared potential conflicts of interest., (Copyright © 2020 American College of Occupational and Environmental Medicine.)