Knut Ringen, John M Dement, Marianne Cloeren, Sammy Almashat, William Grier, Stella Hines, Laura S Welch, Kim Cranford, Scott Haas, Patricia Quinn, Anna Chen, Miles Fisher
Background: Since 1997 the Building Trades National Medical Screening Program (BTMed) has offered medical exams to construction workers employed in US nuclear weapons facilities. The process consists of two steps: (1) a detailed work history interview; and (2) a medical exam. Some participants only completed the work history interview, and we compared their mortality experience to those who also completed medical exams.
Methods: We compared the mortality of 3470 work-history-only participants to 23,452 participants who completed both the work history interview and medical exams and, of these, 1720 who additionally participated in lung cancer screening. We used Cox proportional hazard and Poisson regression models to estimate hazard ratios and risk ratios while controlling for potential confounders.
Results: Medical exam participants experienced a reduction in mortality risk of 28% for all causes combined; 27% for all respiratory diseases combined; 37% for chronic obstructive pulmonary disease; 30% for cardiovascular diseases combined; 32% for all cancers combined; 36% for lung cancer; and 53% for colorectal cancer. The more medical exams they undertook the greater the mortality risk reduction (25%, 29%, and 43% for one, two, and three medical exams, respectively), demonstrating a clear trend. BTMed has prevented approximately 2911 premature deaths among our participants through 2021 and added 35,178 years of life, an average of 1.5 years per participant, at a cost of $2757 per year of life saved.
Conclusions: Secondary prevention in occupational high-risk groups is very effective. Continued surveillance beyond retirement age is important to reduce mortality.
{"title":"Impact of Secondary Prevention on Mortality in the Building Trades National Medical Screening Program: Effectiveness of Occupational High-Risk Management.","authors":"Knut Ringen, John M Dement, Marianne Cloeren, Sammy Almashat, William Grier, Stella Hines, Laura S Welch, Kim Cranford, Scott Haas, Patricia Quinn, Anna Chen, Miles Fisher","doi":"10.1002/ajim.70052","DOIUrl":"https://doi.org/10.1002/ajim.70052","url":null,"abstract":"<p><strong>Background: </strong>Since 1997 the Building Trades National Medical Screening Program (BTMed) has offered medical exams to construction workers employed in US nuclear weapons facilities. The process consists of two steps: (1) a detailed work history interview; and (2) a medical exam. Some participants only completed the work history interview, and we compared their mortality experience to those who also completed medical exams.</p><p><strong>Methods: </strong>We compared the mortality of 3470 work-history-only participants to 23,452 participants who completed both the work history interview and medical exams and, of these, 1720 who additionally participated in lung cancer screening. We used Cox proportional hazard and Poisson regression models to estimate hazard ratios and risk ratios while controlling for potential confounders.</p><p><strong>Results: </strong>Medical exam participants experienced a reduction in mortality risk of 28% for all causes combined; 27% for all respiratory diseases combined; 37% for chronic obstructive pulmonary disease; 30% for cardiovascular diseases combined; 32% for all cancers combined; 36% for lung cancer; and 53% for colorectal cancer. The more medical exams they undertook the greater the mortality risk reduction (25%, 29%, and 43% for one, two, and three medical exams, respectively), demonstrating a clear trend. BTMed has prevented approximately 2911 premature deaths among our participants through 2021 and added 35,178 years of life, an average of 1.5 years per participant, at a cost of $2757 per year of life saved.</p><p><strong>Conclusions: </strong>Secondary prevention in occupational high-risk groups is very effective. Continued surveillance beyond retirement age is important to reduce mortality.</p>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145909880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yating Jiang, Xueqi Zhu, Leilei Zhu, Jian Zhang, Kai Xun, Xukai Zhou, Liwen Du
This study retrospectively analyzed seven cases of acute chemical pneumonitis caused by inhalation of fluoride-based waterproofing agents, that were admitted to Ningbo Second Hospital in September 2025. We summarize their clinical features, treatment strategies and outcomes. All patients had a clear history of occupational exposure to fluoride-containing gases. Early manifestations primarily consisted of respiratory irritation symptoms, with one critically-ill patient progressing to acute respiratory distress syndrome (ARDS) complicated by multiple organ failure within 24 h of exposure. Chest CT scans revealed characteristic acute lung injury changes. Case 7 exhibited elevated white blood cell counts, inflammatory markers, and significantly increased blood and urinary fluoride levels. All received comprehensive treatment, with respiratory support and corticosteroids as the core therapy. This case series indicates that this type of poisoning progresses rapidly. Early recognition, stepwise respiratory support based on oxygenation index, and early administration of high-dose corticosteroids are crucial for improving prognosis. These findings provide a reference for the clinical management of this rare but critical form of toxic lung injury.
{"title":"Chemical Pneumonitis Following Inhalation of Fluoride-Based Waterproofing Agent: A Case Series","authors":"Yating Jiang, Xueqi Zhu, Leilei Zhu, Jian Zhang, Kai Xun, Xukai Zhou, Liwen Du","doi":"10.1002/ajim.70048","DOIUrl":"10.1002/ajim.70048","url":null,"abstract":"<div>\u0000 \u0000 <p>This study retrospectively analyzed seven cases of acute chemical pneumonitis caused by inhalation of fluoride-based waterproofing agents, that were admitted to Ningbo Second Hospital in September 2025. We summarize their clinical features, treatment strategies and outcomes. All patients had a clear history of occupational exposure to fluoride-containing gases. Early manifestations primarily consisted of respiratory irritation symptoms, with one critically-ill patient progressing to acute respiratory distress syndrome (ARDS) complicated by multiple organ failure within 24 h of exposure. Chest CT scans revealed characteristic acute lung injury changes. Case 7 exhibited elevated white blood cell counts, inflammatory markers, and significantly increased blood and urinary fluoride levels. All received comprehensive treatment, with respiratory support and corticosteroids as the core therapy. This case series indicates that this type of poisoning progresses rapidly. Early recognition, stepwise respiratory support based on oxygenation index, and early administration of high-dose corticosteroids are crucial for improving prognosis. These findings provide a reference for the clinical management of this rare but critical form of toxic lung injury.</p>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"69 2","pages":"144-150"},"PeriodicalIF":3.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dwayne Van Eerd, Lynda Robson, Basak Yanar, Emma Irvin, Morgane Le Pouésard, Hadia Rafiqzad
Background
Small businesses (SB) constitute a significant proportion of businesses in all major industrial sectors and pose challenges to occupational health and safety (OHS) authorities. They contribute disproportionately to the total burden of work-related injuries, illnesses, and fatalities. Reaching SB early in their life cycle to support OHS could decrease injuries and related burden. Our objective was to describe the nature of early OHS interventions for SB.
Methods
We conducted an environmental scan (ES) of OHS interventions that could be implemented early in SB. We searched for documents from peer-reviewed literature, non-peer-reviewed literature, and websites. Findings from the documents were synthesized using a framework of intervention types from Michie et al. We also conducted interviews with 11 key informants who had experience with OHS in SB and, using a qualitative thematic analysis, produced a narrative summary. We synthesized the document review and interview findings.
Results
We found 20 relevant documents from all sources describing 24 OHS interventions for SB that could be applied early. The most prevalent SB interventions were education (increasing knowledge), enablement (through consulting and tools), training (imparting skills), and persuasion (through assessment, feedback, and planning). The interview data revealed similar types of interventions, but informants often noted an explicit focus on reaching businesses early.
Conclusions
Our findings reveal that there are few published OHS interventions explicitly focused on application early in the life cycle of SB. However, there were 24 interventions identified that could be applied early, most often focusing on education, enablement, training, and persuasion.
{"title":"Early Occupational Health and Safety Interventions for Small Businesses: An Environmental Scan","authors":"Dwayne Van Eerd, Lynda Robson, Basak Yanar, Emma Irvin, Morgane Le Pouésard, Hadia Rafiqzad","doi":"10.1002/ajim.70046","DOIUrl":"10.1002/ajim.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Small businesses (SB) constitute a significant proportion of businesses in all major industrial sectors and pose challenges to occupational health and safety (OHS) authorities. They contribute disproportionately to the total burden of work-related injuries, illnesses, and fatalities. Reaching SB early in their life cycle to support OHS could decrease injuries and related burden. Our objective was to describe the nature of early OHS interventions for SB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an environmental scan (ES) of OHS interventions that could be implemented early in SB. We searched for documents from peer-reviewed literature, non-peer-reviewed literature, and websites. Findings from the documents were synthesized using a framework of intervention types from Michie et al. We also conducted interviews with 11 key informants who had experience with OHS in SB and, using a qualitative thematic analysis, produced a narrative summary. We synthesized the document review and interview findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found 20 relevant documents from all sources describing 24 OHS interventions for SB that could be applied early. The most prevalent SB interventions were education (increasing knowledge), enablement (through consulting and tools), training (imparting skills), and persuasion (through assessment, feedback, and planning). The interview data revealed similar types of interventions, but informants often noted an explicit focus on reaching businesses early.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings reveal that there are few published OHS interventions explicitly focused on application early in the life cycle of SB. However, there were 24 interventions identified that could be applied early, most often focusing on education, enablement, training, and persuasion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"69 2","pages":"115-131"},"PeriodicalIF":3.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ricardo Diego Suárez Rojas, Dean Hashimoto, Erika L. Sabbath
Background
Workplace violence (WPV) in hospitals worldwide has been on the rise for the last decade, marked by increased verbal and physical aggression. From a biopsychosocial perspective, we conceptualize aggressors' mental states as their control (or lack of) of an impulse across their life course. To contribute to violence prevention, our study synthesizes theoretical assumptions and organizational analysis.
Methods
An exploratory sequential mixed-methods design analyzed 2634 WPV narratives from two hospitals in a large city in the Northeastern United States of America (2019–2023). Narratives were coded for “involuntary mental states” (e.g., dementia, delirium, lack of inhibition) and “unremorseful attitudes” (denial, minimization, justification without medical causation). Quantitative analysis identified patterns within these categories, types of violence, and safety responses.
Results
WPV incidents increased by 212.4% from 2020 to 2021 and did not decrease in incidence in subsequent years. Patient/visitor workplace violence (Type 2) accounted for 93%. Physical violence was most prevalent (76%), followed by verbal (48%) and sexual (6%). “Involuntary mental states” comprised 28% of narratives, while “unremorseful attitudes” represented 29%. Workers often showed compassion, omitting emotional details for involuntary aggression, but reported significant distress from unremorseful acts.
Conclusion
Our novel middle-range theory and mixed-methods approach reveal the complexity of WPV beyond simple dichotomies. Differentiating between involuntary and unremorseful aggression provides actionable insights for tailoring prevention strategies, de-escalation training, and aftermath support. Integrating mental health professionals and addressing the profound impact of remorseless acts is crucial for worker morale and retention.
{"title":"The Mental States of Aggressors: A Biopsychosocial Analysis of Workplace Violence Reports in Hospitals","authors":"Ricardo Diego Suárez Rojas, Dean Hashimoto, Erika L. Sabbath","doi":"10.1002/ajim.70047","DOIUrl":"10.1002/ajim.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Workplace violence (WPV) in hospitals worldwide has been on the rise for the last decade, marked by increased verbal and physical aggression. From a biopsychosocial perspective, we conceptualize aggressors' mental states as their control (or lack of) of an impulse across their life course. To contribute to violence prevention, our study synthesizes theoretical assumptions and organizational analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An exploratory sequential mixed-methods design analyzed 2634 WPV narratives from two hospitals in a large city in the Northeastern United States of America (2019–2023). Narratives were coded for “involuntary mental states” (e.g., dementia, delirium, lack of inhibition) and “unremorseful attitudes” (denial, minimization, justification without medical causation). Quantitative analysis identified patterns within these categories, types of violence, and safety responses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>WPV incidents increased by 212.4% from 2020 to 2021 and did not decrease in incidence in subsequent years. Patient/visitor workplace violence (Type 2) accounted for 93%. Physical violence was most prevalent (76%), followed by verbal (48%) and sexual (6%). “Involuntary mental states” comprised 28% of narratives, while “unremorseful attitudes” represented 29%. Workers often showed compassion, omitting emotional details for involuntary aggression, but reported significant distress from unremorseful acts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our novel middle-range theory and mixed-methods approach reveal the complexity of WPV beyond simple dichotomies. Differentiating between involuntary and unremorseful aggression provides actionable insights for tailoring prevention strategies, de-escalation training, and aftermath support. Integrating mental health professionals and addressing the profound impact of remorseless acts is crucial for worker morale and retention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"69 2","pages":"132-143"},"PeriodicalIF":3.1,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145832924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sheldon Samuels, a founding contributing editor of this Journal, where in 2022 he published his last paper with us as coauthors [1], died on November 25, 2025. Before he entered occupational safety and health he was a national leader in air pollution control. He forged a very effective partnership with Professor Irving J. Selikoff which significantly shaped the field of occupational safety and health during following the adoption of the OSHAct in 1970.
《华尔街日报》的创始特约编辑谢尔登·塞缪尔斯于2025年11月25日去世，他于2022年与我们共同发表了最后一篇论文b[1]。在进入职业安全与健康领域之前，他是全国空气污染控制领域的领导者。他与Irving J. Selikoff教授建立了非常有效的伙伴关系，在1970年通过《职业安全与健康法案》之后，极大地塑造了职业安全与健康领域。
{"title":"Sheldon W. Samuels, A Champion of Air Pollution Control and Worker Health","authors":"Knut Ringen, Arthur Frank, William Rom","doi":"10.1002/ajim.70044","DOIUrl":"10.1002/ajim.70044","url":null,"abstract":"<div>\u0000 \u0000 <p>Sheldon Samuels, a founding contributing editor of this Journal, where in 2022 he published his last paper with us as coauthors [1], died on November 25, 2025. Before he entered occupational safety and health he was a national leader in air pollution control. He forged a very effective partnership with Professor Irving J. Selikoff which significantly shaped the field of occupational safety and health during following the adoption of the OSHAct in 1970.</p>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"69 2","pages":"79-81"},"PeriodicalIF":3.1,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew Horch, Matthew O. Gribble, Jordan McAdam, Dana L. Thomas, Lawrence S. Engel, Jennifer A. Rusiecki
Background
Oil spill response workers encounter a unique mixture of hazardous exposures. Few studies have attempted to model these mixtures and evaluate the impact on worker health. The purpose of this investigation was to understand the association between clustered patterns of hazardous exposure and acute symptoms reported by United States Coast Guard (USCG) responders during the Deepwater Horizon oil spill (DWHOS).
Methods
We conducted a cross-sectional study of USCG members who responded to the DWHOS and completed a post-deployment survey (n = 4855). The survey asked responders about a variety of hazardous exposures and acute symptoms experienced during their deployment. A previously-conducted latent class analysis identified four unique latent classes (LC) which represent reported exposure patterns within this study population. We utilized the three higher LC levels to represent increasing probabilities of exposures to crude oil, exhaust, general outdoor environment, and experience of anxiety, with a “low overall exposure” group acting as the reference. For the present analysis, participants were assigned their most probable LC. Using multivariable log-binomial regression analyses, adjusted prevalence ratios (aPR) of acute symptoms in each most probable LC compared to the reference LC were estimated.
Results
There were significant positive associations between most probable LCs and acute symptoms in all major organ systems with evidence of exposure−response relationships. Some of the strongest associations for individual acute symptoms representative of each organ system included chest pain, skin rash/itching, difficulty hearing, diarrhea, muscle pain, lightheadedness/dizziness, and shortness of breath.
Conclusions
This study broadens the current understanding of oil spill response work hazards by focusing on a more holistic exposure assessment, modeled by most probable LC-derived exposure patterns.
{"title":"Associations Between Oil Spill Exposure Patterns and Acute Symptoms in United States Coast Guard Responders During the Deepwater Horizon Response","authors":"Matthew Horch, Matthew O. Gribble, Jordan McAdam, Dana L. Thomas, Lawrence S. Engel, Jennifer A. Rusiecki","doi":"10.1002/ajim.70039","DOIUrl":"10.1002/ajim.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oil spill response workers encounter a unique mixture of hazardous exposures. Few studies have attempted to model these mixtures and evaluate the impact on worker health. The purpose of this investigation was to understand the association between clustered patterns of hazardous exposure and acute symptoms reported by United States Coast Guard (USCG) responders during the Deepwater Horizon oil spill (DWHOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study of USCG members who responded to the DWHOS and completed a post-deployment survey (<i>n</i> = 4855). The survey asked responders about a variety of hazardous exposures and acute symptoms experienced during their deployment. A previously-conducted latent class analysis identified four unique latent classes (LC) which represent reported exposure patterns within this study population. We utilized the three higher LC levels to represent increasing probabilities of exposures to crude oil, exhaust, general outdoor environment, and experience of anxiety, with a “low overall exposure” group acting as the reference. For the present analysis, participants were assigned their most probable LC. Using multivariable log-binomial regression analyses, adjusted prevalence ratios (aPR) of acute symptoms in each most probable LC compared to the reference LC were estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were significant positive associations between most probable LCs and acute symptoms in all major organ systems with evidence of exposure−response relationships. Some of the strongest associations for individual acute symptoms representative of each organ system included chest pain, skin rash/itching, difficulty hearing, diarrhea, muscle pain, lightheadedness/dizziness, and shortness of breath.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study broadens the current understanding of oil spill response work hazards by focusing on a more holistic exposure assessment, modeled by most probable LC-derived exposure patterns.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"69 2","pages":"89-101"},"PeriodicalIF":3.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Knut Ringen, John M. Dement, Sammy Almashat, Marianne Cloeren, William Grier, Stella Hines, Laura S. Welch, Kim Cranford, Janet Shorter, Patricia Quinn, Anna Chen
Background
We assessed the effectiveness of early lung cancer detection (ELCD) in reducing lung cancer mortality in a high-risk occupational cohort using low-dose CT (LDCT) with eligibility criteria that included age, smoking, and occupational risk factors without regard to time since having stopped smoking.
Methods
We investigated lung cancers diagnosed and mortality outcomes since the ELCD program's inception in 2011. Lung cancer mortality analyses included ELCD participants who completed at least a baseline scan and a control group of ELCD-eligible nonparticipants. Cox models estimated the relationship between ELCD program participation and lung cancer mortality, with deaths identified using the National Death Index.
Results
Lung cancer was detected in 57 (2.94%, 95% CI = 2.19–3.69) of 1941 ELCD participants. Forty-nine cases of nonsmall cell lung cancer (NSCLC) were detected, with 40 (81.6%) being Stage I or Stage II. A 49% reduction in lung cancer mortality was observed among ELCD participants (hazard ratio = 0.51, 95% CI = 0.32–0.81) with median follow-up 6.1 years. Applying the USPSTF 2021 eligibility criteria would have excluded nearly 40% of lung cancer deaths from screening.
Conclusions
Lung cancer screening in this high-risk population, with screening eligibility adjusted for occupational risk factors and no time limit since last having smoked, is effective in reducing lung cancer mortality. Continued annual screening is important. Revisions to ELCD eligibility criteria are needed to include risk factors beyond age and smoking when supported by population-specific evidence.
背景：我们使用低剂量CT （LDCT）评估了早期肺癌检测（ELCD）在降低高风险职业队列肺癌死亡率方面的有效性，其资格标准包括年龄、吸烟和职业危险因素，而不考虑戒烟后的时间。方法：自2011年ELCD项目启动以来，我们调查了肺癌诊断和死亡率结果。肺癌死亡率分析包括至少完成基线扫描的ELCD参与者和符合ELCD条件的非参与者的对照组。Cox模型估计了ELCD项目参与与肺癌死亡率之间的关系，使用国家死亡指数确定死亡人数。结果：1941名ELCD参与者中有57人（2.94%,95% CI = 2.19-3.69）被检测出肺癌。非小细胞肺癌（NSCLC） 49例，I期或II期40例（81.6%）。ELCD参与者肺癌死亡率降低49%（风险比= 0.51,95% CI = 0.32-0.81），中位随访6.1年。应用USPSTF 2021资格标准将会将近40%的肺癌死亡排除在筛查之外。结论：在高危人群中进行肺癌筛查，根据职业危险因素调整筛查资格，并且自上次吸烟以来没有时间限制，可有效降低肺癌死亡率。持续的年度筛查很重要。当有特定人群证据支持时，需要修订ELCD的资格标准，以包括年龄和吸烟以外的危险因素。
{"title":"Evaluation of Early Lung Cancer Detection in a Population at High Risk due to Occupation","authors":"Knut Ringen, John M. Dement, Sammy Almashat, Marianne Cloeren, William Grier, Stella Hines, Laura S. Welch, Kim Cranford, Janet Shorter, Patricia Quinn, Anna Chen","doi":"10.1002/ajim.70041","DOIUrl":"10.1002/ajim.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We assessed the effectiveness of early lung cancer detection (ELCD) in reducing lung cancer mortality in a high-risk occupational cohort using low-dose CT (LDCT) with eligibility criteria that included age, smoking, and occupational risk factors without regard to time since having stopped smoking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated lung cancers diagnosed and mortality outcomes since the ELCD program's inception in 2011. Lung cancer mortality analyses included ELCD participants who completed at least a baseline scan and a control group of ELCD-eligible nonparticipants. Cox models estimated the relationship between ELCD program participation and lung cancer mortality, with deaths identified using the National Death Index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Lung cancer was detected in 57 (2.94%, 95% CI = 2.19–3.69) of 1941 ELCD participants. Forty-nine cases of nonsmall cell lung cancer (NSCLC) were detected, with 40 (81.6%) being Stage I or Stage II. A 49% reduction in lung cancer mortality was observed among ELCD participants (hazard ratio = 0.51, 95% CI = 0.32–0.81) with median follow-up 6.1 years. Applying the USPSTF 2021 eligibility criteria would have excluded nearly 40% of lung cancer deaths from screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lung cancer screening in this high-risk population, with screening eligibility adjusted for occupational risk factors and no time limit since last having smoked, is effective in reducing lung cancer mortality. Continued annual screening is important. Revisions to ELCD eligibility criteria are needed to include risk factors beyond age and smoking when supported by population-specific evidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"69 2","pages":"102-114"},"PeriodicalIF":3.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Occupational health hazards can exacerbate pre-existing chronic diseases and can also lead to the onset of new job-related chronic diseases. A comprehensive strategy to eliminate the root causes of chronic diseases in America should include not only those causes arising from lifestyle influences beginning in childhood but also those diseases that are caused by workplace hazards or are made worse by workplace conditions. Interactions between pre-existing chronic diseases that adolescents and young adults carry with them into the work environment, and those that are caused by work itself, are complex and require a framework that enables an integrated approach to workplace health promotion and health protection. An important feature of the Total Worker Health (TWH) approach to worker safety, health, and well-being is its programmatic adaptability. As new national health strategies emerge, such as the Make America Healthy Again initiative aimed at chronic disease elimination, the TWH approach can support such initiatives by contributing to preventing and managing chronic disease in the work environment. This Commentary describes those aspects of the TWH approach that can be adapted to support the new national health initiative to eliminate chronic diseases.
{"title":"Preventing and Managing Chronic Disease in the Work Environment: Using the Total Worker Health Approach","authors":"John Howard, Paul A. Schulte","doi":"10.1002/ajim.70042","DOIUrl":"10.1002/ajim.70042","url":null,"abstract":"<div>\u0000 \u0000 <p>Occupational health hazards can exacerbate pre-existing chronic diseases and can also lead to the onset of new job-related chronic diseases. A comprehensive strategy to eliminate the root causes of chronic diseases in America should include not only those causes arising from lifestyle influences beginning in childhood but also those diseases that are caused by workplace hazards or are made worse by workplace conditions. Interactions between pre-existing chronic diseases that adolescents and young adults carry with them into the work environment, and those that are caused by work itself, are complex and require a framework that enables an integrated approach to workplace health promotion and health protection. An important feature of the <i>Total Worker Health</i> (TWH) approach to worker safety, health, and well-being is its programmatic adaptability. As new national health strategies emerge, such as the <i>Make America Healthy Again</i> initiative aimed at chronic disease elimination, the TWH approach can support such initiatives by contributing to preventing and managing chronic disease in the work environment. This Commentary describes those aspects of the TWH approach that can be adapted to support the new national health initiative to eliminate chronic diseases.</p>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"69 2","pages":"82-88"},"PeriodicalIF":3.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Toni Alterman, Jeffrey M. Timberlake, Madeline Flores-Redd, Daniel J. Carroll
Background
Hired crop workers face harsh working conditions, including physical, economic, and social challenges. We present a population-based assessment of anxiety symptoms among a large national sample of hired crop workers in the United States.
Methods
In-person interviews were conducted with 6108 crop workers during 2018–2022. Generalized anxiety disorder (GAD-2) questions were included in the National Agricultural Workers Survey to provide weighted prevalences of anxiety symptoms and prevalence ratios for the association between anxiety symptoms and crop worker demographics and employment characteristics.
Results
The prevalence of anxiety symptoms was 20.6% for scoring ≥ 1 on the GAD-2, and 7.7% for scoring ≥ 3 on the GAD-2. Women had a 73% excess risk of any anxiety (GAD-2 ≥ 1) and an 84% higher risk of severe anxiety (GAD-2 ≥ 3) than men. Men with a medium level of English language ability had a 28%−31% increased risk of anxiety symptoms compared to those with a lower English language ability. Not having workers' compensation insurance was associated with a 56% reduced risk of having severe anxiety symptoms among men. However, total family income, working directly for an agricultural employer or farm labor contractor, method of payment, unemployment insurance, and health insurance were not significantly associated with anxiety symptoms. Compared to working in California, men working in the Northeast showed a 57% reduced risk of more severe anxiety symptoms.
Conclusions
Based on a large national sample of hired crop workers, nearly one in four crop workers suffered from anxiety, with women having a much higher prevalence than men, suggesting the need for mental health services for this population.
{"title":"Prevalence of Anxiety Symptoms by Sociodemographic and Employment Characteristics in a National Sample of Hired Crop Workers: Evidence From the National Agricultural Workers Survey (2018–2022)","authors":"Toni Alterman, Jeffrey M. Timberlake, Madeline Flores-Redd, Daniel J. Carroll","doi":"10.1002/ajim.70040","DOIUrl":"10.1002/ajim.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hired crop workers face harsh working conditions, including physical, economic, and social challenges. We present a population-based assessment of anxiety symptoms among a large national sample of hired crop workers in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In-person interviews were conducted with 6108 crop workers during 2018–2022. Generalized anxiety disorder (GAD-2) questions were included in the National Agricultural Workers Survey to provide weighted prevalences of anxiety symptoms and prevalence ratios for the association between anxiety symptoms and crop worker demographics and employment characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of anxiety symptoms was 20.6% for scoring ≥ 1 on the GAD-2, and 7.7% for scoring ≥ 3 on the GAD-2. Women had a 73% excess risk of any anxiety (GAD-2 ≥ 1) and an 84% higher risk of severe anxiety (GAD-2 ≥ 3) than men. Men with a medium level of English language ability had a 28%−31% increased risk of anxiety symptoms compared to those with a lower English language ability. Not having workers' compensation insurance was associated with a 56% reduced risk of having severe anxiety symptoms among men. However, total family income, working directly for an agricultural employer or farm labor contractor, method of payment, unemployment insurance, and health insurance were not significantly associated with anxiety symptoms. Compared to working in California, men working in the Northeast showed a 57% reduced risk of more severe anxiety symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Based on a large national sample of hired crop workers, nearly one in four crop workers suffered from anxiety, with women having a much higher prevalence than men, suggesting the need for mental health services for this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"69 1","pages":"61-76"},"PeriodicalIF":3.1,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul K. Henneberger, Steven M. Rollins, Michael J. Humann, Xiaoming Liang, Feng-Chiao Su, Caroline P. Groth, M. Abbas Virji
Background
Results from a 2014 survey of 2030 healthcare workers (76% female, mean age 48.6 years) in New York City included the association of current asthma and asthma exacerbation with the general activities of cleaning fixed surfaces and administering aerosolized medications. We extended that analysis to determine if specific products and tasks for these and other activities were associated with the same outcomes.
Methods
The survey instrument inquired about asthma-related outcomes, products used, and tasks performed. Polytomous logistic regression was used to model a three-category outcome for current asthma without and with exacerbation and no current asthma (referent). Inverse probability weights were applied in all regression models to adjust for selection and participation bias that may have resulted from a low response of 11.1% of invitees. A separate model was fit for each exposure variable and yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
Results
For cleaning fixed surfaces, two products and eight tasks had increased odds of at least one adverse outcome. Enzymes had an OR = 3.01 (95% CI 1.50, 6.04) for current asthma with exacerbation, and bleach had an OR = 1.92 (95% CI 1.22, 3.01) for current asthma without exacerbation. The eight general cleaning tasks included three (cleanup blood/spills, wipe furniture, wipe equipment) associated with both adverse outcomes, and five tasks associated only with current asthma without exacerbation. For aerosolized medication tasks, the small-volume nebulizer was associated with current asthma with (OR = 1.89, 95% CI 1.06, 3.34) and without (OR = 1.66, 95% CI 1.01, 2.72) exacerbation, and two other tasks (continuous delivery system, metered dose inhaler) were associated only with current asthma without exacerbation.
Conclusions
Products and tasks in healthcare were associated with current asthma and asthma exacerbation. Future analyses will explore quantitative exposure-assessment strategies for specific chemicals and mixtures.
背景：2014年对纽约市2030名卫生保健工作者（76%为女性，平均年龄48.6岁）的调查结果包括当前哮喘和哮喘加重与清洁固定表面和使用雾化药物的一般活动的关联。我们扩展了这一分析，以确定这些活动和其他活动的特定产品和任务是否与相同的结果相关联。方法：使用问卷调查工具询问哮喘相关结果、使用的产品和执行的任务。采用多元逻辑回归对当前哮喘（无哮喘、有哮喘加重和无哮喘）的三类结果进行建模。在所有回归模型中应用逆概率权重来调整选择和参与偏差，这可能是由于11.1%的受邀者的低反应造成的。为每个暴露变量拟合一个单独的模型，并得出调整后的优势比（ORs）和95%置信区间（ci）。结果：对于清洁固定表面，两种产品和八项任务增加了至少一种不良后果的几率。对于当前哮喘有加重，enzyme的OR = 3.01 (95% CI 1.50, 6.04)，而对于当前哮喘无加重，bleach的OR = 1.92 （95% CI 1.22, 3.01）。8项一般清洁任务包括3项（清理血液/溢出物、擦拭家具、擦拭设备）与两种不良结果相关，5项任务仅与当前哮喘无恶化相关。对于雾化用药任务，小容量雾化器与当前有（OR = 1.89, 95% CI 1.06, 3.34）和无（OR = 1.66, 95% CI 1.01, 2.72）加重的哮喘相关，另外两个任务（持续给药系统，计量吸入器）仅与当前无加重的哮喘相关。结论：医疗保健产品和任务与当前哮喘和哮喘加重相关。未来的分析将探索特定化学品和混合物的定量暴露评估策略。
{"title":"The Association of Current Asthma With and Without Exacerbation With Products Used and Tasks Performed by Healthcare Workers","authors":"Paul K. Henneberger, Steven M. Rollins, Michael J. Humann, Xiaoming Liang, Feng-Chiao Su, Caroline P. Groth, M. Abbas Virji","doi":"10.1002/ajim.70038","DOIUrl":"10.1002/ajim.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Results from a 2014 survey of 2030 healthcare workers (76% female, mean age 48.6 years) in New York City included the association of current asthma and asthma exacerbation with the general activities of cleaning fixed surfaces and administering aerosolized medications. We extended that analysis to determine if specific products and tasks for these and other activities were associated with the same outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The survey instrument inquired about asthma-related outcomes, products used, and tasks performed. Polytomous logistic regression was used to model a three-category outcome for current asthma without and with exacerbation and no current asthma (referent). Inverse probability weights were applied in all regression models to adjust for selection and participation bias that may have resulted from a low response of 11.1% of invitees. A separate model was fit for each exposure variable and yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For cleaning fixed surfaces, two products and eight tasks had increased odds of at least one adverse outcome. Enzymes had an OR = 3.01 (95% CI 1.50, 6.04) for current asthma with exacerbation, and bleach had an OR = 1.92 (95% CI 1.22, 3.01) for current asthma without exacerbation. The eight general cleaning tasks included three (cleanup blood/spills, wipe furniture, wipe equipment) associated with both adverse outcomes, and five tasks associated only with current asthma without exacerbation. For aerosolized medication tasks, the small-volume nebulizer was associated with current asthma with (OR = 1.89, 95% CI 1.06, 3.34) and without (OR = 1.66, 95% CI 1.01, 2.72) exacerbation, and two other tasks (continuous delivery system, metered dose inhaler) were associated only with current asthma without exacerbation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Products and tasks in healthcare were associated with current asthma and asthma exacerbation. Future analyses will explore quantitative exposure-assessment strategies for specific chemicals and mixtures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"69 1","pages":"49-60"},"PeriodicalIF":3.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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