Marianne Cloeren, John Dement, Jane Quackenbush, Patricia Quinn, Knut Ringen
Background
Age-related hearing loss is associated with increased dementia risk. We examined the association between hearing loss and dementia in a population at high risk for hearing loss from occupational noise exposures.
Methods
We conducted cross-sectional and longitudinal analyses using logistic regression and interval-censored Cox models using data from the Building Trades National Medical Screening Program (BTMed), from inception in 1996 through March 2024. Hearing loss was defined as a speech-frequency pure-tone average ≥ 20 decibels (dB) in the better ear and categorized as mild (20–34 dB), moderate (35–49 dB), moderately severe (50–64 dB), or severe to complete (≥ 65 dB). Dementia was defined using criteria from medical history, physical exams, and medication data across all medical screening examinations.
Results
The study included 44,000 exams in 24,958 BTMed participants; 54.6% had hearing loss. Hearing loss was strongly associated with dementia prevalence (211 cases, p < 0.001), with prevalence increasing by severity. Cross-sectional analysis found a significant association between hearing loss ≥ 20 dB and dementia (adjusted odds ratio = 1.88, 95% confidence interval (CI) = 1.15–3.07). In longitudinal analysis, a Cox model adjusted for confounders estimated a hazard ratio of 1.60 (95% CI = 0.99–2.59, p-trend = 0.0928) for incident dementia.
Discussion
Cross-sectional results support an association between occupational hearing loss and dementia, consistent in direction with findings for age-related hearing loss; longitudinal estimates were not significant but were directionally similar. If confirmed in other high-risk cohorts with repeated audiometry, these findings underscore the potential for hearing conservation and hearing loss rehabilitation in dementia prevention.
{"title":"Is Work-Related Hearing Loss Associated With Dementia? Evidence From a High-Risk Population","authors":"Marianne Cloeren, John Dement, Jane Quackenbush, Patricia Quinn, Knut Ringen","doi":"10.1002/ajim.70026","DOIUrl":"10.1002/ajim.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Age-related hearing loss is associated with increased dementia risk. We examined the association between hearing loss and dementia in a population at high risk for hearing loss from occupational noise exposures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted cross-sectional and longitudinal analyses using logistic regression and interval-censored Cox models using data from the Building Trades National Medical Screening Program (BTMed), from inception in 1996 through March 2024. Hearing loss was defined as a speech-frequency pure-tone average ≥ 20 decibels (dB) in the better ear and categorized as mild (20–34 dB), moderate (35–49 dB), moderately severe (50–64 dB), or severe to complete (≥ 65 dB). Dementia was defined using criteria from medical history, physical exams, and medication data across all medical screening examinations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 44,000 exams in 24,958 BTMed participants; 54.6% had hearing loss. Hearing loss was strongly associated with dementia prevalence (211 cases, <i>p</i> < 0.001), with prevalence increasing by severity. Cross-sectional analysis found a significant association between hearing loss ≥ 20 dB and dementia (adjusted odds ratio = 1.88, 95% confidence interval (CI) = 1.15–3.07). In longitudinal analysis, a Cox model adjusted for confounders estimated a hazard ratio of 1.60 (95% CI = 0.99–2.59, <i>p</i>-trend = 0.0928) for incident dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Cross-sectional results support an association between occupational hearing loss and dementia, consistent in direction with findings for age-related hearing loss; longitudinal estimates were not significant but were directionally similar. If confirmed in other high-risk cohorts with repeated audiometry, these findings underscore the potential for hearing conservation and hearing loss rehabilitation in dementia prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 11","pages":"1013-1027"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211396","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}
Emily J. Tetzlaff, Bruce E. Oddson, Kristina-Marie T. Janetos, Robert D. Meade, Glen P. Kenny
Introduction
With the frequency and intensity of extreme heat events rising, occupational health and safety (OHS) personnel must be well-informed about heat management solutions. Consequently, assessing the knowledge level and technical expertise of OHS personnel is essential for equipping workplaces to operate safely in hotter conditions.
Methods
The Human and Environmental Physiology Research Unit-Occupational Heat Stress Knowledge Assessment Test (HEPRU-OHSKAT) was distributed among OHS personnel and the general working population (GWP) (> 18 years) throughout Ontario, Canada, to assess their current knowledge regarding managing occupational heat stress. The instrument included 31 items grouped into four core competency areas including: (A) General Heat Stress Knowledge (items (q): 8, max score (ms): 13), (B) Knowing the Signs and Symptoms of Heat Stress and First Aid (q: 7, ms: 32), (C) Exposure Limits and Heat Monitoring Practices (q: 13, ms: 40), and (D) Workplace Controls for Heat (q: 3, ms: 15). The number of respondents and the percentage of the total sample were calculated based on individual response rates to each question.
Results
A total of 317 respondents (female: 110, median age: 42 years, range: 18–74) from 17 industries (OHS: 68% vs. GWP: 32%) completed the HEPRU-OHSKAT. The average total knowledge score for all respondents was 54 ± 22% (56 ± 22% vs. 48 ± 21%), with no respondents exceeding 90% overall and scores on individual knowledge categories varying substantially.
Conclusions
The HEPRU-OHSKAT identified knowledge gaps among OHS personnel in Ontario's workplaces, particularly for knowledge of control measures for reducing or preventing exposure to heat stress.
Practical Applications
Training and education are necessary across all HEPRU-OHSKAT knowledge categories to enhance heat stress management and minimize the OHS hazards associated with working in the heat.
{"title":"An Evaluation of Health and Safety Personnel and Workers' Occupational Heat Stress Knowledge in Ontario: Paper B","authors":"Emily J. Tetzlaff, Bruce E. Oddson, Kristina-Marie T. Janetos, Robert D. Meade, Glen P. Kenny","doi":"10.1002/ajim.70025","DOIUrl":"10.1002/ajim.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>With the frequency and intensity of extreme heat events rising, occupational health and safety (OHS) personnel must be well-informed about heat management solutions. Consequently, assessing the knowledge level and technical expertise of OHS personnel is essential for equipping workplaces to operate safely in hotter conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Human and Environmental Physiology Research Unit-Occupational Heat Stress Knowledge Assessment Test (HEPRU-OHSKAT) was distributed among OHS personnel and the general working population (GWP) (> 18 years) throughout Ontario, Canada, to assess their current knowledge regarding managing occupational heat stress. The instrument included 31 items grouped into four core competency areas including: (A) General Heat Stress Knowledge (items (q): 8, max score (ms): 13), (B) Knowing the Signs and Symptoms of Heat Stress and First Aid (q: 7, ms: 32), (C) Exposure Limits and Heat Monitoring Practices (q: 13, ms: 40), and (D) Workplace Controls for Heat (q: 3, ms: 15). The number of respondents and the percentage of the total sample were calculated based on individual response rates to each question.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 317 respondents (female: 110, median age: 42 years, range: 18–74) from 17 industries (OHS: 68% vs. GWP: 32%) completed the HEPRU-OHSKAT. The average total knowledge score for all respondents was 54 ± 22% (56 ± 22% vs. 48 ± 21%), with no respondents exceeding 90% overall and scores on individual knowledge categories varying substantially.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The HEPRU-OHSKAT identified knowledge gaps among OHS personnel in Ontario's workplaces, particularly for knowledge of control measures for reducing or preventing exposure to heat stress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practical Applications</h3>\u0000 \u0000 <p>Training and education are necessary across all HEPRU-OHSKAT knowledge categories to enhance heat stress management and minimize the OHS hazards associated with working in the heat.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 12","pages":"1077-1087"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224841","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}
Edite Macaringue Raja, Sujatha Hariparsad, Rajen N. Naidoo
Background
Work exposure-related declines in lung function among aluminum smelter workers are well documented, yet task-varying exposures are likely to contribute differently to respiratory outcomes. This study aimed to assess the association between potroom exposure and lung function changes over time among aluminum smelter workers.
Methods
A retrospective review of spirometric assessments of 265 potroom workers and their exposure to sulfur dioxide (SO2) and fluoride was conducted. Cumulative exposure was described through job exposure matrices by job titles and exposure across the lifetime of employment. Associations between exposure and lung function were determined using mixed-effect models and a 1-year lag exposure.
Results
Exposures were within the prescribed occupational exposure limits. SO2 was highest in the maintenance section (mean: 0.4 ppm [range 0.3–0.5 ppm]), while the process control section (mean: 1.1 mg/m3 [range 0.04–2.6 mg/m3]) had the highest level of fluoride. Among those workers who contributed lung function measures at each of the 10 years (n = 98), there was a decline in the percentpredicted forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC) of 0.21% (95% CI: 0.35–0.07). Within the entire sample, there was an estimated decline of 2.9% (95% CI: −3.9 to −1.9) and 0.15% (95% CI: −0.23 to −0.07) in percentage-predicted FEV1/FVC, associated with cumulative SO2 and cumulative fluoride exposure, respectively. A 1-year lagged decline was also seen for the FEV1/FVC ratio for both pollutants.
Conclusion
SO2 and fluoride exposure in aluminum smelting is associated with statistically significant lung function declines over the years of exposure.
{"title":"Sulfur Dioxide- and Fluoride-Associated Declines in Lung Function Over an 11-Year Observation Among Aluminum Smelter Workers","authors":"Edite Macaringue Raja, Sujatha Hariparsad, Rajen N. Naidoo","doi":"10.1002/ajim.70023","DOIUrl":"10.1002/ajim.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Work exposure-related declines in lung function among aluminum smelter workers are well documented, yet task-varying exposures are likely to contribute differently to respiratory outcomes. This study aimed to assess the association between potroom exposure and lung function changes over time among aluminum smelter workers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review of spirometric assessments of 265 potroom workers and their exposure to sulfur dioxide (SO<sub>2</sub>) and fluoride was conducted. Cumulative exposure was described through job exposure matrices by job titles and exposure across the lifetime of employment. Associations between exposure and lung function were determined using mixed-effect models and a 1-year lag exposure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Exposures were within the prescribed occupational exposure limits. SO<sub>2</sub> was highest in the maintenance section (mean: 0.4 ppm [range 0.3–0.5 ppm]), while the process control section (mean: 1.1 mg/m<sup>3</sup> [range 0.04–2.6 mg/m<sup>3</sup>]) had the highest level of fluoride. Among those workers who contributed lung function measures at each of the 10 years (<i>n</i> = 98), there was a decline in the percentpredicted forced expiratory volume in 1 second/forced vital capacity ratio (FEV<sub>1</sub>/FVC) of 0.21% (95% CI: 0.35–0.07). Within the entire sample, there was an estimated decline of 2.9% (95% CI: −3.9 to −1.9) and 0.15% (95% CI: −0.23 to −0.07) in percentage-predicted FEV<sub>1</sub>/FVC, associated with cumulative SO<sub>2</sub> and cumulative fluoride exposure, respectively. A 1-year lagged decline was also seen for the FEV<sub>1</sub>/FVC ratio for both pollutants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SO<sub>2</sub> and fluoride exposure in aluminum smelting is associated with statistically significant lung function declines over the years of exposure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 12","pages":"1053-1061"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224811","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}
Emily J. Tetzlaff, Bruce E. Oddson, Kristina-Marie T. Janetos, Robert D. Meade, Glen P. Kenny
Introduction
Occupational heat stress poses a critical threat to workers' health, safety, and productivity. To effectively manage this hazard, occupational health and safety (OHS) representatives must comprehensively understand heat stress, heat-associated injury and disease outcomes, and heat mitigation measures to protect workers. We developed the Human and Environmental Physiology Research Unit-Occupational Heat Stress Knowledge Assessment Test (HEPRU-OHSKAT) as an initial step toward facilitating research in this area.
Method
The HEPRU-OHSKAT was developed using a mixed-methods approach. Preliminary items were developed after reviewing the academic and gray literature. A standardized content validity assessment was conducted with heat stress and OHS experts (n = 9); a trial distribution to refine and test feasibility was performed with an internal pilot group (n = 18). The instrument was then distributed to individuals involved with OHS (n = 216) and members of the general working population (n = 101) in Ontario, Canada (n = 317). Item analysis and item response theory modelling were used to refine the scale and scope of the instrument.
Results
Thirty-two items were developed for the preliminary instrument. Following expert consultation, a review of content validity, and the internal pilot, 31 items were retained in four subscales: General Heat Stress Knowledge (n = 8), Recognizing the Signs and Symptoms of Heat Stress and First Aid (n = 7), Exposure Limits and Heat Monitoring Practices (n= 13), and Workplace Controls for Heat (n = 3). Following item selection, the broader instrument was reduced to 20 items grouped into one scale.
Conclusions
The HEPRU-OHSKAT is the first instrument to assess knowledge of heat stress among those responsible for OHS. The instrument showed good reliability and internal consistency across knowledge categories.
Practical Applications
The instrument can help OHS representatives better evaluate knowledge of, and manage training about, heat stress.
{"title":"Developing and Refining a Knowledge Assessment Instrument for Individuals Involved in Managing Occupational Heat Stress: Paper A","authors":"Emily J. Tetzlaff, Bruce E. Oddson, Kristina-Marie T. Janetos, Robert D. Meade, Glen P. Kenny","doi":"10.1002/ajim.70024","DOIUrl":"10.1002/ajim.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Occupational heat stress poses a critical threat to workers' health, safety, and productivity. To effectively manage this hazard, occupational health and safety (OHS) representatives must comprehensively understand heat stress, heat-associated injury and disease outcomes, and heat mitigation measures to protect workers. We developed the Human and Environmental Physiology Research Unit-Occupational Heat Stress Knowledge Assessment Test (HEPRU-OHSKAT) as an initial step toward facilitating research in this area.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The HEPRU-OHSKAT was developed using a mixed-methods approach. Preliminary items were developed after reviewing the academic and gray literature. A standardized content validity assessment was conducted with heat stress and OHS experts (<i>n</i> = 9); a trial distribution to refine and test feasibility was performed with an internal pilot group (<i>n</i> = 18). The instrument was then distributed to individuals involved with OHS (<i>n</i> = 216) and members of the general working population (<i>n</i> = 101) in Ontario, Canada (<i>n</i> = 317). Item analysis and item response theory modelling were used to refine the scale and scope of the instrument.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-two items were developed for the preliminary instrument. Following expert consultation, a review of content validity, and the internal pilot, 31 items were retained in four subscales: <i>General Heat Stress Knowledge</i> (<i>n</i> = 8), <i>Recognizing the Signs and Symptoms of Heat Stress and First Aid</i> (<i>n</i> = 7), <i>Exposure Limits and Heat Monitoring Practices</i> (<i>n</i>= 13), and <i>Workplace Controls for Heat</i> (<i>n</i> = 3). Following item selection, the broader instrument was reduced to 20 items grouped into one scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The HEPRU-OHSKAT is the first instrument to assess knowledge of heat stress among those responsible for OHS. The instrument showed good reliability and internal consistency across knowledge categories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practical Applications</h3>\u0000 \u0000 <p>The instrument can help OHS representatives better evaluate knowledge of, and manage training about, heat stress.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 12","pages":"1062-1076"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224808","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}
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}
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