Juliana G. E. Bartels, Jennifer R. Head, Simon K. Camponuri, Ellen A. Eisen
Valley fever is a fungal disease acquired through inhalation of spores of the fungus Coccidioides. Spores become airborne when soil is disturbed, making outdoor workers, such as agricultural or construction workers, at higher risk of exposure and disease. Valley fever is endemic and increasing in the American Southwest, with numerous documented outbreaks among construction crews, archeologists, prison employees, wildland firefighters, and military personnel. Valley fever is recognized as a work-related disease in California, but not Arizona or other states with endemic disease. Epidemiologists require surveillance data with patient industry and occupation to make the case to clinicians, legislators, and employers that Valley fever is an occupational disease that can be prevented through tailored interventions. Valley fever is a reportable disease in 28 states, including California and Arizona, and Washington, D.C.; however, most case reports are sent through automated lab reports or manual case reporting, which seldom include information about industry or occupation. Electronic case reporting (eCR), in which automated disease reports are sent to public health agencies from health care facilities via electronic medical records, provides a new pathway to streamline case reporting and is more conducive to inclusion of industry and occupation data in case reports. Occupational reporting through eCR would help build the epidemiological base to identify worker populations with excess cases of Valley fever, to identify occupational clusters, facilitate early outbreak detection, provide evidence for worker compensation claims of work-related infections, and support the development of more protective legislation to train and educate workers on prevention methods.
{"title":"Valley Fever Is an Occupational Illness: Let's Get the Data to Prevent It","authors":"Juliana G. E. Bartels, Jennifer R. Head, Simon K. Camponuri, Ellen A. Eisen","doi":"10.1002/ajim.70017","DOIUrl":"10.1002/ajim.70017","url":null,"abstract":"<p>Valley fever is a fungal disease acquired through inhalation of spores of the fungus <i>Coccidioides</i>. Spores become airborne when soil is disturbed, making outdoor workers, such as agricultural or construction workers, at higher risk of exposure and disease. Valley fever is endemic and increasing in the American Southwest, with numerous documented outbreaks among construction crews, archeologists, prison employees, wildland firefighters, and military personnel. Valley fever is recognized as a work-related disease in California, but not Arizona or other states with endemic disease. Epidemiologists require surveillance data with patient industry and occupation to make the case to clinicians, legislators, and employers that Valley fever is an occupational disease that can be prevented through tailored interventions. Valley fever is a reportable disease in 28 states, including California and Arizona, and Washington, D.C.; however, most case reports are sent through automated lab reports or manual case reporting, which seldom include information about industry or occupation. Electronic case reporting (eCR), in which automated disease reports are sent to public health agencies from health care facilities via electronic medical records, provides a new pathway to streamline case reporting and is more conducive to inclusion of industry and occupation data in case reports. Occupational reporting through eCR would help build the epidemiological base to identify worker populations with excess cases of Valley fever, to identify occupational clusters, facilitate early outbreak detection, provide evidence for worker compensation claims of work-related infections, and support the development of more protective legislation to train and educate workers on prevention methods.</p>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 11","pages":"929-932"},"PeriodicalIF":3.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068821","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}
Caitlin M. McGowan, Linda F. Cantley, Robert Klein, Carrie A. Redlich
Background
Reports of silicosis among US workers who fabricate and install stone countertops are increasing. Our aim was to better characterize work processes, stone type, occupational health practices, and exposures to respirable crystalline silica (RCS) in this industry.
Methods
A survey was administered to stone countertop fabrication shops to assess shop characteristics, controls, and operations. Shops were asked to share past RCS air monitoring reports. We examined associations between RCS concentrations and stone type, similar exposure groups (SEG), and engineering controls in multivariate models, and RCS exposures by shop.
Results
Of 257 shops surveyed, 98% reported processing both natural and engineered stone (ES), utilizing semi-automated equipment and small hand tools, and a variety of control methods. Only 42% of shops that required the use of a respirator reported conducting respirator fit testing, and only 19.5% performed medical surveillance. A total of 47% of shops reported RCS air sampling, with 38% submitting 292 RCS air samples used for this analysis. Overall, the RCS geometric mean (GM) was 14.1 μg/m3, with 75.7% of RCS samples below the US Occupational Safety and Health Administration (OSHA) action limit (AL). However, RCS levels were highly variable (range 2.8–5100.0 μg/m3), with 9.2% of RCS samples exceeding the OSHA permissible exposure limit (PEL), and 43.5% shops 1 or more samples above the OSHA AL. Use of small hand tools with no controls produced the highest RCS exposures, and dry work had significantly higher RCS exposures than any control method.
Conclusions
The findings underscore the extensive use of ES and the opportunity for overexposure to RCS in this industry. They highlight the need to eliminate dry processing methods, enhance respiratory protection, and perform repeated RCS sampling to monitor the effectiveness of controls. Additionally, more widespread medical surveillance is urgently needed to assess the extent of silicosis in this industry.
{"title":"Work Practices and Respirable Crystalline Silica Exposures in Stone Countertop Fabrication Shops","authors":"Caitlin M. McGowan, Linda F. Cantley, Robert Klein, Carrie A. Redlich","doi":"10.1002/ajim.70020","DOIUrl":"10.1002/ajim.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reports of silicosis among US workers who fabricate and install stone countertops are increasing. Our aim was to better characterize work processes, stone type, occupational health practices, and exposures to respirable crystalline silica (RCS) in this industry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A survey was administered to stone countertop fabrication shops to assess shop characteristics, controls, and operations. Shops were asked to share past RCS air monitoring reports. We examined associations between RCS concentrations and stone type, similar exposure groups (SEG), and engineering controls in multivariate models, and RCS exposures by shop.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 257 shops surveyed, 98% reported processing both natural and engineered stone (ES), utilizing semi-automated equipment and small hand tools, and a variety of control methods. Only 42% of shops that required the use of a respirator reported conducting respirator fit testing, and only 19.5% performed medical surveillance. A total of 47% of shops reported RCS air sampling, with 38% submitting 292 RCS air samples used for this analysis. Overall, the RCS geometric mean (GM) was 14.1 μg/m<sup>3</sup>, with 75.7% of RCS samples below the US Occupational Safety and Health Administration (OSHA) action limit (AL). However, RCS levels were highly variable (range 2.8–5100.0 μg/m<sup>3</sup>), with 9.2% of RCS samples exceeding the OSHA permissible exposure limit (PEL), and 43.5% shops 1 or more samples above the OSHA AL. Use of small hand tools with no controls produced the highest RCS exposures, and dry work had significantly higher RCS exposures than any control method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings underscore the extensive use of ES and the opportunity for overexposure to RCS in this industry. They highlight the need to eliminate dry processing methods, enhance respiratory protection, and perform repeated RCS sampling to monitor the effectiveness of controls. Additionally, more widespread medical surveillance is urgently needed to assess the extent of silicosis in this industry.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 11","pages":"973-987"},"PeriodicalIF":3.1,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058272","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}
Hayden W. Hess, M. Jo Hite, Molly E. Heikkinen, Macie L. Tarr, Erica Tourula, Blair D. Johnson, David Hostler, Zachary J. Schlader
Background
Occupational heat stress recommendations aim to achieve thermal equilibrium and keep core temperature (Tc) below 38.0°C. We assessed the recommended alert limit curves when: (1) work–rest ratios are adjusted based on wet-bulb globe temperature (WBGT) at a fixed rate of metabolic heat production (Hprod) and (2) Hprod is adjusted based on WBGT at a fixed work–rest ratio. We tested the hypothesis that adhering to occupational heat stress recommendations results in thermal equilibrium and prevents TC from exceeding 38.0°C.
Methods
Unacclimated adults completed 4-hour exposures at a fixed WBGT, Hprod, and work–rest ratio. There were six iterations of compliant trials (n = 70 observations; A: 24.1°C, 431 W, 60:0 min; B: 26.6°C, 461 W, 45:15 min; C: 28.4°C, 462 W, 30:30 min; D: 29.7, 453 W, 15:45 min; E: 27.3°C, 412 W, 30:30 min; F: 31.6°C, 290 W, 30:30 min) and two iterations of noncompliant trials (n = 24 observations; G: 31.6°C, 413 W, 30:30 min; H: 36.1°C, 453 W, 15:45 min).
Results
Mean and peak TC across the compliant trials were 37.6°C ± 0.3°C and 37.9°C ± 0.3°C. Thus, 65/70 (93%) and 44/70 (63%) trials did not exceed a mean or peak core TC of 38.0°C. Mean and peak TC across the noncompliant trials exceeded 38.0°C in all trials. The rate of heat gain differed between compliant and noncompliant trials (0.08°C ± 0.07°C/h vs. 0.41°C ± 0.34°C/h; p < 0.0001) but on average thermal equilibrium was < 0.1°C/h in the compliant trials.
Conclusion
Compliance with the occupational heat stress recommendations resulted in thermal equilibrium and mitigated the development of excessive heat strain.
{"title":"Critical Assessment of the Recommended Alert Limit Curves for Occupational Heat Exposure","authors":"Hayden W. Hess, M. Jo Hite, Molly E. Heikkinen, Macie L. Tarr, Erica Tourula, Blair D. Johnson, David Hostler, Zachary J. Schlader","doi":"10.1002/ajim.70022","DOIUrl":"10.1002/ajim.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Occupational heat stress recommendations aim to achieve thermal equilibrium and keep core temperature (<i>T</i><sub>c</sub>) below 38.0°C. We assessed the recommended alert limit curves when: (1) work–rest ratios are adjusted based on wet-bulb globe temperature (WBGT) at a fixed rate of metabolic heat production (<i>H</i><sub>prod</sub>) and (2) <i>H</i><sub>prod</sub> is adjusted based on WBGT at a fixed work–rest ratio. We tested the hypothesis that adhering to occupational heat stress recommendations results in thermal equilibrium and prevents <i>T</i><sub>C</sub> from exceeding 38.0°C.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Unacclimated adults completed 4-hour exposures at a fixed WBGT, <i>H</i><sub>prod</sub>, and work–rest ratio. There were six iterations of compliant trials (<i>n</i> = 70 observations; A: 24.1°C, 431 W, 60:0 min; B: 26.6°C, 461 W, 45:15 min; C: 28.4°C, 462 W, 30:30 min; D: 29.7, 453 W, 15:45 min; E: 27.3°C, 412 W, 30:30 min; F: 31.6°C, 290 W, 30:30 min) and two iterations of noncompliant trials (<i>n</i> = 24 observations; G: 31.6°C, 413 W, 30:30 min; H: 36.1°C, 453 W, 15:45 min).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean and peak <i>T</i><sub>C</sub> across the compliant trials were 37.6°C ± 0.3°C and 37.9°C ± 0.3°C. Thus, 65/70 (93%) and 44/70 (63%) trials did not exceed a mean or peak core <i>T</i><sub>C</sub> of 38.0°C. Mean and peak <i>T</i><sub>C</sub> across the noncompliant trials exceeded 38.0°C in all trials. The rate of heat gain differed between compliant and noncompliant trials (0.08°C ± 0.07°C/h vs. 0.41°C ± 0.34°C/h; <i>p</i> < 0.0001) but on average thermal equilibrium was < 0.1°C/h in the compliant trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compliance with the occupational heat stress recommendations resulted in thermal equilibrium and mitigated the development of excessive heat strain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov: NCT04767347.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 11","pages":"1004-1012"},"PeriodicalIF":3.1,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008019","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}
Wei Gong, David C. Byrne, Christa L. Themann, H. Amy Feng
Background
Workers in industry settings are often exposed to complex noise, which poses a greater risk to hearing loss than continuous noise at equivalent energy levels. Previous studies have identified kurtosis as an essential metric for evaluating complex noise-induced hearing loss (NIHL). This study aimed to characterize the distribution of workers exposed to complex noise, examine the associations between kurtosis and changes in hearing thresholds at various frequencies, and explore kurtosis's role in estimating NIHL and its integration into occupational hearing loss prevention programs.
Methods
The study quantitatively analyzed data from 2400 workers exposed to industrial complex noise and 1520 non-noise-exposed workers in China. Both arithmetic and geometric average kurtosis were used to characterize the work-shift noise records. Linear regression models assessed noise-induced permanent threshold shift (NIPTS) across different frequency ranges.
Results
For workers exposed to average noise levels between 80 and 92 dBA, increased kurtosis levels correlated with worsening NIPTS across frequencies from 0.5 to 8 kHz. However, the impact of kurtosis at lower noise exposure levels (70–79 dBA) remains uncertain.
Conclusions
Kurtosis is crucial for predicting hearing loss among workers exposed to complex noise at average levels of 85 and 90 dBA. The findings have potential implications for occupational safety and health, particularly for the recruitment of workers into hearing loss prevention programs. Further risk assessment analysis could use the noise kurtosis metric to examine the excess risk of NIHL associated with complex noise exposure.
{"title":"A Quantitative Analysis of Kurtosis Impact on Occupational Complex Noise-Induced Hearing Loss","authors":"Wei Gong, David C. Byrne, Christa L. Themann, H. Amy Feng","doi":"10.1002/ajim.70021","DOIUrl":"10.1002/ajim.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Workers in industry settings are often exposed to complex noise, which poses a greater risk to hearing loss than continuous noise at equivalent energy levels. Previous studies have identified kurtosis as an essential metric for evaluating complex noise-induced hearing loss (NIHL). This study aimed to characterize the distribution of workers exposed to complex noise, examine the associations between kurtosis and changes in hearing thresholds at various frequencies, and explore kurtosis's role in estimating NIHL and its integration into occupational hearing loss prevention programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study quantitatively analyzed data from 2400 workers exposed to industrial complex noise and 1520 non-noise-exposed workers in China. Both arithmetic and geometric average kurtosis were used to characterize the work-shift noise records. Linear regression models assessed noise-induced permanent threshold shift (NIPTS) across different frequency ranges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For workers exposed to average noise levels between 80 and 92 dBA, increased kurtosis levels correlated with worsening NIPTS across frequencies from 0.5 to 8 kHz. However, the impact of kurtosis at lower noise exposure levels (70–79 dBA) remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Kurtosis is crucial for predicting hearing loss among workers exposed to complex noise at average levels of 85 and 90 dBA. The findings have potential implications for occupational safety and health, particularly for the recruitment of workers into hearing loss prevention programs. Further risk assessment analysis could use the noise kurtosis metric to examine the excess risk of NIHL associated with complex noise exposure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 11","pages":"988-1003"},"PeriodicalIF":3.1,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008064","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}
Arif Jetha, Hyunmi Lee, Maxwell J. Smith, Victoria H. Arrandale, Aviroop Biswas, Cameron Mustard, Peter M. Smith
Background
Artificial intelligence (AI) can modernize occupational health and safety (OHS) practice and provide solutions to the most complex health and safety challenges. Empirical data on firm-level AI utilization in OHS practice remain limited. The objective of this study was to examine AI use for OHS and firm-level descriptive and OHS characteristics associated with AI use.
Methods
A total of 810 OHS professionals in British Columbia and Ontario, Canada were surveyed in the summer of 2024. Surveys asked about firm-level AI use for OHS and items asked about descriptive and OHS characteristics. Participants were also asked about perceived AI concerns and OHS impact. A multivariate logistic regression model was fitted to examine factors associated with firm-level AI use for OHS.
Results
In total, 29% reported firm-level AI use for OHS. Larger-sized firms and those with hybrid work arrangements had a greater odds of AI use for OHS. Also, firms with high workplace hazard exposure had a greater odds of AI OHS use. More positive perceptions of AI's impact on OHS were associated with firm-level AI use for OHS.
Conclusions
AI use for OHS may be concentrated among hazardous firms and those with the conditions to support technological adoption. Research examining AI's effectiveness in OHS settings is needed to guide evidence-based implementation in occupational health practice.
{"title":"Landscape of Artificial Intelligence Use for Occupational Health and Safety Practice in Two Canadian Provinces","authors":"Arif Jetha, Hyunmi Lee, Maxwell J. Smith, Victoria H. Arrandale, Aviroop Biswas, Cameron Mustard, Peter M. Smith","doi":"10.1002/ajim.70018","DOIUrl":"10.1002/ajim.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Artificial intelligence (AI) can modernize occupational health and safety (OHS) practice and provide solutions to the most complex health and safety challenges. Empirical data on firm-level AI utilization in OHS practice remain limited. The objective of this study was to examine AI use for OHS and firm-level descriptive and OHS characteristics associated with AI use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 810 OHS professionals in British Columbia and Ontario, Canada were surveyed in the summer of 2024. Surveys asked about firm-level AI use for OHS and items asked about descriptive and OHS characteristics. Participants were also asked about perceived AI concerns and OHS impact. A multivariate logistic regression model was fitted to examine factors associated with firm-level AI use for OHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 29% reported firm-level AI use for OHS. Larger-sized firms and those with hybrid work arrangements had a greater odds of AI use for OHS. Also, firms with high workplace hazard exposure had a greater odds of AI OHS use. More positive perceptions of AI's impact on OHS were associated with firm-level AI use for OHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI use for OHS may be concentrated among hazardous firms and those with the conditions to support technological adoption. Research examining AI's effectiveness in OHS settings is needed to guide evidence-based implementation in occupational health practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 11","pages":"965-972"},"PeriodicalIF":3.1,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008049","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}
Fergus K. O'Connor, Kristina-Marie T. Janetos, Brodie J. Richards, Roberto C. Harris-Mostert, Katie E. Wagar, Leonidas G. Ioannou, James J. McCormick, Robert D. Meade, Emily J. Tetzlaff, Ronald J. Sigal, W. Shane Journeay, Glen P. Kenny
Rationale
Industry guidelines recommend work-rest schedules to prevent unsafe core temperature elevations (> 38.0°C or > Δ1.0°C above baseline resting) in an “average” worker exposed to occupational heat stress. While permissible initial work durations (initial stay times [IST]) before implementing rest schedules have been suggested, existing data are limited to moderate-intensity efforts.
Objectives
The objective of this study was to assess whether factors of sex and age influence IST during heavy-intensity work.
Methods
We assessed work durations before reaching unsafe core temperature thresholds (i.e., > 38.0°C or > Δ1.0°C above baseline resting) among young (18–30 years) and older (50–69 years) males and females during simulated heavy-intensity work at 26°C, 29°C, and 32°C wet-bulb globe temperatures (WBGT).
Findings
The likelihood of surpassing a core temperature of 38.0°C significantly increased at 32°C WBGT (hazard ratio [95% confidence interval]: 2.0 [1.5, 2.7], p = 0.001), but not at 29°C WBGT (1.1 [0.9, 1.4], p = 0.342), compared to 26°C WBGT. Median (interquartile range) durations to reach 38.0°C across groups were 32 (23–52), 29 (23–47), and 26 (18–35) minutes at 26°C, 29°C, and 32°C WBGT, respectively. The likelihood of reaching Δ1.0°C above baseline resting significantly increased at both 32°C (3.8 [2.6, 5.4], p < 0.001) and 29°C WBGT (1.5 [1.1, 2.0], p < 0.001), with median durations being 55 (40–82), 42 (35–56), and 33 (29–42) min, respectively. Older females were more likely to reach 38.0°C (2.4 [1.3, 4.3], p = 0.004) and Δ1.0°C above baseline resting (2.5 [1.4, 4.7], p = 0.003) compared to young males. No other sex- or age-related differences were detected (p > 0.145).
Impact
These findings highlight the heightened vulnerability of older females during heavy-intensity occupational heat stress, emphasizing the need for tailored guidelines to ensure equitable workforce protection.
{"title":"Defining Sex- and Age-Specific Initial Stay Times for Continuous Heavy-Intensity Work in Hot Environments Before Heat-Mitigation Controls Are Implemented—Part B","authors":"Fergus K. O'Connor, Kristina-Marie T. Janetos, Brodie J. Richards, Roberto C. Harris-Mostert, Katie E. Wagar, Leonidas G. Ioannou, James J. McCormick, Robert D. Meade, Emily J. Tetzlaff, Ronald J. Sigal, W. Shane Journeay, Glen P. Kenny","doi":"10.1002/ajim.70015","DOIUrl":"10.1002/ajim.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Industry guidelines recommend work-rest schedules to prevent unsafe core temperature elevations (> 38.0°C or > Δ1.0°C above baseline resting) in an “average” worker exposed to occupational heat stress. While permissible initial work durations (initial stay times [IST]) before implementing rest schedules have been suggested, existing data are limited to moderate-intensity efforts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study was to assess whether factors of sex and age influence IST during heavy-intensity work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We assessed work durations before reaching unsafe core temperature thresholds (i.e., > 38.0°C or > Δ1.0°C above baseline resting) among young (18–30 years) and older (50–69 years) males and females during simulated heavy-intensity work at 26°C, 29°C, and 32°C wet-bulb globe temperatures (WBGT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The likelihood of surpassing a core temperature of 38.0°C significantly increased at 32°C WBGT (hazard ratio [95% confidence interval]: 2.0 [1.5, 2.7], <i>p</i> = 0.001), but not at 29°C WBGT (1.1 [0.9, 1.4], <i>p</i> = 0.342), compared to 26°C WBGT. Median (interquartile range) durations to reach 38.0°C across groups were 32 (23–52), 29 (23–47), and 26 (18–35) minutes at 26°C, 29°C, and 32°C WBGT, respectively. The likelihood of reaching Δ1.0°C above baseline resting significantly increased at both 32°C (3.8 [2.6, 5.4], <i>p</i> < 0.001) and 29°C WBGT (1.5 [1.1, 2.0], <i>p</i> < 0.001), with median durations being 55 (40–82), 42 (35–56), and 33 (29–42) min, respectively. Older females were more likely to reach 38.0°C (2.4 [1.3, 4.3], <i>p</i> = 0.004) and Δ1.0°C above baseline resting (2.5 [1.4, 4.7], <i>p</i> = 0.003) compared to young males. No other sex- or age-related differences were detected (<i>p</i> > 0.145).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Impact</h3>\u0000 \u0000 <p>These findings highlight the heightened vulnerability of older females during heavy-intensity occupational heat stress, emphasizing the need for tailored guidelines to ensure equitable workforce protection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 11","pages":"949-964"},"PeriodicalIF":3.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991191","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}
Fergus K. O'Connor, Kristina-Marie T. Janetos, Brodie J. Richards, Roberto C. Harris-Mostert, Katie E. Wagar, Leonidas G. Ioannou, James J. McCormick, Robert D. Meade, Emily J. Tetzlaff, Ronald J. Sigal, W. Shane Journeay, Glen P. Kenny
Rationale
Industry guidelines recommend work-rest allocations to limit increases in core temperature (Tcore; > 38.0°C or > Δ1.0°C above resting) during work in the heat. However, the initial duration of permissible work before implementing these allocations is not specified (initial stay time [IST]) and individual factors such as sex and age affecting thermoregulation are not considered.
Objectives
The objective of this study was to assess whether factors of sex and age influence IST.
Methods
We examined the permissible work duration before reaching Tcore of 38.0°C or Δ1.0°C above resting in young (18–30 years) and older (50–69 years) males and females performing moderate-intensity (200 W/m2) simulated work at ambient conditions of 26, 29, and 32°C wet-bulb globe temperature (WBGT).
Findings
IST significantly decreased as ambient conditions intensified (p < 0.0001). Median (95% CI) durations to 38°C across groups were 59 (43–87) minutes at 26°C, 40 (34–65) minutes at 29°C, and 35 (31–46) minutes at 32°C WBGT. Likewise, median times to achieve Δ1.0°C above resting temperature significantly differed by environmental conditions (p < 0.0001): 66 (56–128) minutes at 26°C, 68 (54–80) minutes at 29°C, and 44 (41–53) minutes at 32°C WBGT. Older females were significantly more likely to experience Tcore elevations of 38.0°C (hazard ratio [95% CI]: (3.1 [1.6, 5.8], p < 0.001) and Δ1.0°C above resting (1.9 [1.1, 3.0], p = 0.007) compared to young males. In contrast, IST for young females and older males were similar to young males.
Impact
Our findings underscore the impact of hotter ambient conditions on IST and identify older females as particularly susceptible during moderate-intensity work in heat emphasizing the need for tailored occupational heat exposure guidelines.
{"title":"Defining Sex- and Age-Specific Initial Stay Times for Continuous Moderate-Intensity Work in Hot Environments Before Heat-Mitigation Controls Are Implemented – Part A","authors":"Fergus K. O'Connor, Kristina-Marie T. Janetos, Brodie J. Richards, Roberto C. Harris-Mostert, Katie E. Wagar, Leonidas G. Ioannou, James J. McCormick, Robert D. Meade, Emily J. Tetzlaff, Ronald J. Sigal, W. Shane Journeay, Glen P. Kenny","doi":"10.1002/ajim.70013","DOIUrl":"10.1002/ajim.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Industry guidelines recommend work-rest allocations to limit increases in core temperature (Tcore; > 38.0°C or > Δ1.0°C above resting) during work in the heat. However, the initial duration of permissible work before implementing these allocations is not specified (initial stay time [IST]) and individual factors such as sex and age affecting thermoregulation are not considered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study was to assess whether factors of sex and age influence IST.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined the permissible work duration before reaching Tcore of 38.0°C or Δ1.0°C above resting in young (18–30 years) and older (50–69 years) males and females performing moderate-intensity (200 W/m<sup>2</sup>) simulated work at ambient conditions of 26, 29, and 32°C wet-bulb globe temperature (WBGT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>IST significantly decreased as ambient conditions intensified (<i>p</i> < 0.0001). Median (95% CI) durations to 38°C across groups were 59 (43–87) minutes at 26°C, 40 (34–65) minutes at 29°C, and 35 (31–46) minutes at 32°C WBGT. Likewise, median times to achieve Δ1.0°C above resting temperature significantly differed by environmental conditions (<i>p</i> < 0.0001): 66 (56–128) minutes at 26°C, 68 (54–80) minutes at 29°C, and 44 (41–53) minutes at 32°C WBGT. Older females were significantly more likely to experience Tcore elevations of 38.0°C (hazard ratio [95% CI]: (3.1 [1.6, 5.8], <i>p</i> < 0.001) and Δ1.0°C above resting (1.9 [1.1, 3.0], <i>p</i> = 0.007) compared to young males. In contrast, IST for young females and older males were similar to young males.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Impact</h3>\u0000 \u0000 <p>Our findings underscore the impact of hotter ambient conditions on IST and identify older females as particularly susceptible during moderate-intensity work in heat emphasizing the need for tailored occupational heat exposure guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 11","pages":"933-948"},"PeriodicalIF":3.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991193","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}
Laura Kurth, Noemi B. Hall, Brian Ansell, A. Scott Laney, David J. Blackley
Background
Small airways disease is a risk factor for the development of obstructive lung disease and may be present among coal miners without obstructive ventilatory impairment. Our study estimated the prevalence of reduced spirometric mid-expiratory flow among coal miners without obstructive ventilatory impairment.
Methods
Data were from coal miners participating in the Coal Workers' Health Surveillance Program (CWHSP) during 2014–2022 with forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) meeting quality criteria and no missing spirometry parameter values. We defined low forced expiratory flow at 25%–75% (FEF25%–75%) as < 65% predicted.
Results
The prevalence of FEF25%–75% < 65% predicted among miners without obstructive ventilatory impairment was 7.1% overall, 10.7% among retired miners, and 16.8% among miners with radiographic evidence of coal workers' pneumoconiosis (CWP).
Conclusions
Among miners without obstructive ventilatory impairment, reduced mid-expiratory flow was more prevalent in older miners with longer tenure, specifically retired miners. From a surveillance perspective, reduced spirometric mid-expiratory flow can be an early indicator of more serious health problems in coal miners, including obstructive lung disease.
{"title":"Prevalence of Reduced Mid-Expiratory Flow Among Coal Workers' Health Surveillance Program Participants","authors":"Laura Kurth, Noemi B. Hall, Brian Ansell, A. Scott Laney, David J. Blackley","doi":"10.1002/ajim.70019","DOIUrl":"10.1002/ajim.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Small airways disease is a risk factor for the development of obstructive lung disease and may be present among coal miners without obstructive ventilatory impairment. Our study estimated the prevalence of reduced spirometric mid-expiratory flow among coal miners without obstructive ventilatory impairment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were from coal miners participating in the Coal Workers' Health Surveillance Program (CWHSP) during 2014–2022 with forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) meeting quality criteria and no missing spirometry parameter values. We defined low forced expiratory flow at 25%–75% (FEF<sub>25%–75%</sub>) as < 65% predicted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of FEF<sub>25%–75%</sub> < 65% predicted among miners without obstructive ventilatory impairment was 7.1% overall, 10.7% among retired miners, and 16.8% among miners with radiographic evidence of coal workers' pneumoconiosis (CWP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among miners without obstructive ventilatory impairment, reduced mid-expiratory flow was more prevalent in older miners with longer tenure, specifically retired miners. From a surveillance perspective, reduced spirometric mid-expiratory flow can be an early indicator of more serious health problems in coal miners, including obstructive lung disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 11","pages":"1028-1033"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939487","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}
A safe workplace goes beyond simply following regulations, it is a basic right that shields employees from physical, emotional, and psychological harm. This position paper looks at the various aspects of workplace safety, especially for women physicians, highlighting the need for an environment built on trust, inclusivity, and respect. Even with advancements in gender representation, women in medicine often face problems like harassment, discrimination, and systemic inequalities that affect their well-being and career development. The connection between workplace safety and quality patient care is examined, showing evidence that harassment and systemic neglect can cause clinician burnout and medical errors, ultimately harming patient outcomes. This position paper addresses systemic obstacles, such as power imbalances, restrictive contracts, and socioeconomic challenges that prevent women physicians from advocating for their safety. The paper highlights the need for strong reporting systems, independent oversight, and supportive practices for victims as essential parts of a broad strategy to improve workplace safety. Additionally, it argues that supportive measures like better parental leave, hiring focused on diversity, and steps to reduce workplace violence are vital for building a strong medical workforce. By committing to inclusivity and fair policies, the medical community can empower women physicians and provide high-quality care for diverse patient groups. In the end, a safe and fair workplace is crucial for the long-term success of the healthcare profession, leading to a healthier future for everyone.
{"title":"AMWA's Commitment to Workplace Safety for Women Physicians: A Path Toward Equity and Protection","authors":"Devki Patel, Meghan Etsey, Vaishnavi Patel, Brianna Clark, Ariela Marshall, Rosy Thachil, Kellie Lease Stecher, Roberta Gebhard","doi":"10.1002/ajim.70016","DOIUrl":"10.1002/ajim.70016","url":null,"abstract":"<div>\u0000 \u0000 <p>A safe workplace goes beyond simply following regulations, it is a basic right that shields employees from physical, emotional, and psychological harm. This position paper looks at the various aspects of workplace safety, especially for women physicians, highlighting the need for an environment built on trust, inclusivity, and respect. Even with advancements in gender representation, women in medicine often face problems like harassment, discrimination, and systemic inequalities that affect their well-being and career development. The connection between workplace safety and quality patient care is examined, showing evidence that harassment and systemic neglect can cause clinician burnout and medical errors, ultimately harming patient outcomes. This position paper addresses systemic obstacles, such as power imbalances, restrictive contracts, and socioeconomic challenges that prevent women physicians from advocating for their safety. The paper highlights the need for strong reporting systems, independent oversight, and supportive practices for victims as essential parts of a broad strategy to improve workplace safety. Additionally, it argues that supportive measures like better parental leave, hiring focused on diversity, and steps to reduce workplace violence are vital for building a strong medical workforce. By committing to inclusivity and fair policies, the medical community can empower women physicians and provide high-quality care for diverse patient groups. In the end, a safe and fair workplace is crucial for the long-term success of the healthcare profession, leading to a healthier future for everyone.</p></div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 10","pages":"920-925"},"PeriodicalIF":3.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870983","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}
Nicole D. Ford, Alexandra F. Dalton, Deja Edwards, Hope King, Sara E. Luckhaupt, Kevin C. Ma, Douglas Slaughter, Sharon R. Silver, Sharon Saydah
Introduction
Long COVID may limit people's ability to carry out daily activities, including work. Little is known about the potential effect of long COVID on work limitations and absenteeism. We describe employment status and characteristics, work limitations, cognitive dysfunction, and sickness absenteeism among adults with and without long COVID.
Methods
Using data from the cross-sectional 2022 National Health Interview Survey, we estimated the prevalence (95% confidence intervals [CI]) of work-related outcomes by long COVID status among US adults ≥ 18 years (n = 26,270). Among employed adults with prior COVID-19 illness, we estimated crude and adjusted odds ratios for work limitations (compared to no limitations), cognitive dysfunction (some or a lot of difficulty with memory or concentration compared to no difficulty), and sickness absenteeism ( ≥ 11 sick days compared to 0–10 days) in the prior year. All estimates account for survey design and are weighted to the US noninstitutionalized population. Analyses were conducted in 2024.
Results
3.4% of adults reported long COVID. Adults with long COVID more often reported being unable to work due to health or disability compared to adults without long COVID (p = 0.0006). Among employed adults with prior COVID-19 illness, long COVID was associated with higher odds of work limitations (aOR 1.3, 95% CI 1.1–1.5), cognitive dysfunction (aOR 1.3, 95% CI 1.1–1.5), and sickness absenteeism (aOR 1.4, 95% CI 1.2–1.5) compared to those who did not develop long COVID.
Conclusions
Long COVID was associated with work limitations, cognitive dysfunction, and sickness absenteeism among employed US adults. Workplace accommodations may be important considerations for people with long COVID.
导语：长冠状病毒可能会限制人们进行日常活动的能力，包括工作。人们对长期COVID对工作限制和缺勤的潜在影响知之甚少。我们描述了患有和不患有长期COVID的成年人的就业状况和特征、工作限制、认知功能障碍和病假缺勤情况。方法：使用来自2022年全国健康访谈调查（National Health Interview Survey）的横断面数据，我们估计了≥18岁的美国成年人（n = 26,270）因长时间感染COVID而导致工作相关结果的患病率（95%置信区间[CI]）。在先前患有COVID-19疾病的在职成年人中，我们估计了前一年工作限制（与无限制相比）、认知功能障碍（与无困难相比，在记忆或注意力方面有一些或很多困难）和病假缺勤（与0-10天相比，病假天数≥11天）的粗比值比和调整后的比值比。所有的估计都考虑了调查设计，并对美国非机构人口进行了加权。分析于2024年进行。结果：3.4%的成年人报告长COVID。与没有长COVID的成年人相比，长COVID的成年人更常报告因健康或残疾而无法工作（p = 0.0006）。在先前患有COVID-19疾病的在职成年人中，与未患长期COVID的人相比，长期COVID与更高的工作限制（aOR 1.3, 95% CI 1.1-1.5），认知功能障碍（aOR 1.3, 95% CI 1.1-1.5）和病假缺勤（aOR 1.4, 95% CI 1.2-1.5）相关。结论：在美国成年雇员中，长COVID与工作限制、认知功能障碍和病假缺勤有关。对于长期感染COVID的人来说，工作场所的住宿可能是重要的考虑因素。
{"title":"Employment Status, Work Limitations, Cognitive Dysfunction, and Sickness Absenteeism Among US Adults With and Without Long COVID","authors":"Nicole D. Ford, Alexandra F. Dalton, Deja Edwards, Hope King, Sara E. Luckhaupt, Kevin C. Ma, Douglas Slaughter, Sharon R. Silver, Sharon Saydah","doi":"10.1002/ajim.70014","DOIUrl":"10.1002/ajim.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long COVID may limit people's ability to carry out daily activities, including work. Little is known about the potential effect of long COVID on work limitations and absenteeism. We describe employment status and characteristics, work limitations, cognitive dysfunction, and sickness absenteeism among adults with and without long COVID.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the cross-sectional 2022 National Health Interview Survey, we estimated the prevalence (95% confidence intervals [CI]) of work-related outcomes by long COVID status among US adults ≥ 18 years (<i>n</i> = 26,270). Among employed adults with prior COVID-19 illness, we estimated crude and adjusted odds ratios for work limitations (compared to no limitations), cognitive dysfunction (some or a lot of difficulty with memory or concentration compared to no difficulty), and sickness absenteeism ( ≥ 11 sick days compared to 0–10 days) in the prior year. All estimates account for survey design and are weighted to the US noninstitutionalized population. Analyses were conducted in 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>3.4% of adults reported long COVID. Adults with long COVID more often reported being unable to work due to health or disability compared to adults without long COVID (<i>p</i> = 0.0006). Among employed adults with prior COVID-19 illness, long COVID was associated with higher odds of work limitations (aOR 1.3, 95% CI 1.1–1.5), cognitive dysfunction (aOR 1.3, 95% CI 1.1–1.5), and sickness absenteeism (aOR 1.4, 95% CI 1.2–1.5) compared to those who did not develop long COVID.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Long COVID was associated with work limitations, cognitive dysfunction, and sickness absenteeism among employed US adults. Workplace accommodations may be important considerations for people with long COVID.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 10","pages":"909-919"},"PeriodicalIF":3.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870984","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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