Louis Everest MPH, Shirui Tan MSc, Tanya Navaneelan MSc, Paul A. Demers PhD, Nathan DeBono PhD, Colin Berriault MSc, Jeavana Sritharan PhD
Objectives
Prior analyses of the Occupational Disease Surveillance System (ODSS) have compared cancer rates using internal referent groups. As an exploratory analysis, we sought to estimate cancer risk using general population reference rates to evaluate the impact that the comparison population has on findings from our surveillance program.
Methods
A cohort of approximately 2.3 million workers in Ontario, Canada with an accepted lost-time workers' compensation claim were followed for all cancer diagnoses between 1983 and 2018. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated for workers in specific occupational groups using (1) all other workers in the ODSS cohort, and (2) the general population of Ontario.
Results
SIRs using the general population reference group were generally equal to or modestly lower compared to SIRs using the internal reference group. Within occupation groups, SIRs had a discordant direction of association (increased rate in the internal comparison and decreased in the external comparison) for some cancer sites including urinary, prostate, and colorectal.
Conclusions
Findings emphasize the importance of the choice of reference group when evaluating cancer risks in large occupational surveillance cohorts. Importantly, the magnitude of confounding and the healthy worker hire bias may depend on the occupation group and cancer site of interest.
{"title":"Comparison of internal and external reference populations for occupational cancer surveillance in a cohort drawn from a diverse workforce","authors":"Louis Everest MPH, Shirui Tan MSc, Tanya Navaneelan MSc, Paul A. Demers PhD, Nathan DeBono PhD, Colin Berriault MSc, Jeavana Sritharan PhD","doi":"10.1002/ajim.23637","DOIUrl":"10.1002/ajim.23637","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Prior analyses of the Occupational Disease Surveillance System (ODSS) have compared cancer rates using internal referent groups. As an exploratory analysis, we sought to estimate cancer risk using general population reference rates to evaluate the impact that the comparison population has on findings from our surveillance program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort of approximately 2.3 million workers in Ontario, Canada with an accepted lost-time workers' compensation claim were followed for all cancer diagnoses between 1983 and 2018. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated for workers in specific occupational groups using (1) all other workers in the ODSS cohort, and (2) the general population of Ontario.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SIRs using the general population reference group were generally equal to or modestly lower compared to SIRs using the internal reference group. Within occupation groups, SIRs had a discordant direction of association (increased rate in the internal comparison and decreased in the external comparison) for some cancer sites including urinary, prostate, and colorectal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings emphasize the importance of the choice of reference group when evaluating cancer risks in large occupational surveillance cohorts. Importantly, the magnitude of confounding and the healthy worker hire bias may depend on the occupation group and cancer site of interest.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"67 9","pages":"865-873"},"PeriodicalIF":2.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23637","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141557790","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}
Julie E. Pedersen PhD, Kajsa U. Petersen PhD, Maria-Helena G. Andersen PhD, Anne T. Saber PhD, Ulla Vogel PhD, Niels E. Ebbehøj PhD, Tina K. Jensen PhD, Regitze S. Wils PhD, Jens P. Bonde PhD, Johnni Hansen PhD
Objectives
To update and extend the examination of cancer incidence in a cohort of Danish firefighters, now adding 7 years of follow-up and 2766 additional firefighters. The primary focus was directed toward cancer sites that recently contributed to the hazard evaluation conducted by the International Agency for Research on Cancer (IARC).
Methods
The updated cohort consisted of 11,827 male Danish firefighters who were followed up for cancer from 1968 to 2021. Cohort cancer morbidity was compared with a working population reference group, and standardized incidence ratios (SIR) were used for estimation of relative risks, along with 95% confidence intervals (95% CI).
Results
Among full-time firefighters, SIR of skin melanoma was 1.30 (95% CI: 1.02–1.66), and SIR = 1.37 (95% CI: 1.02–1.85) for over 5 years of employment. Slightly positive associations were also observed for cancer of the urinary bladder (SIR = 1.16; 95% CI: 0.93–1.45), prostate (SIR = 1.11; 95% CI: 0.97–1.28), and testis (SIR = 1.11; 95% CI: 0.75–1.63).
Conclusions
This updated study provides evidence indicating an elevated risk of skin melanoma in firefighters. Consistent with IARC's evaluation, we also identified positive associations for urinary bladder, prostate, and testis cancer. In contrast, our findings did not suggest an increased risk of colon cancer, non-Hodgkin lymphoma, and mesothelioma. The latter may be due to small numbers in our still relatively young cohort. Continuous follow-up for cancer in firefighters is warranted, including assessment of influence from surveillance bias.
{"title":"Cancer incidence in a cohort of Danish firefighters: An extended long-term follow-up 1968–2021","authors":"Julie E. Pedersen PhD, Kajsa U. Petersen PhD, Maria-Helena G. Andersen PhD, Anne T. Saber PhD, Ulla Vogel PhD, Niels E. Ebbehøj PhD, Tina K. Jensen PhD, Regitze S. Wils PhD, Jens P. Bonde PhD, Johnni Hansen PhD","doi":"10.1002/ajim.23635","DOIUrl":"10.1002/ajim.23635","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To update and extend the examination of cancer incidence in a cohort of Danish firefighters, now adding 7 years of follow-up and 2766 additional firefighters. The primary focus was directed toward cancer sites that recently contributed to the hazard evaluation conducted by the International Agency for Research on Cancer (IARC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The updated cohort consisted of 11,827 male Danish firefighters who were followed up for cancer from 1968 to 2021. Cohort cancer morbidity was compared with a working population reference group, and standardized incidence ratios (SIR) were used for estimation of relative risks, along with 95% confidence intervals (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among full-time firefighters, SIR of skin melanoma was 1.30 (95% CI: 1.02–1.66), and SIR = 1.37 (95% CI: 1.02–1.85) for over 5 years of employment. Slightly positive associations were also observed for cancer of the urinary bladder (SIR = 1.16; 95% CI: 0.93–1.45), prostate (SIR = 1.11; 95% CI: 0.97–1.28), and testis (SIR = 1.11; 95% CI: 0.75–1.63).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This updated study provides evidence indicating an elevated risk of skin melanoma in firefighters. Consistent with IARC's evaluation, we also identified positive associations for urinary bladder, prostate, and testis cancer. In contrast, our findings did not suggest an increased risk of colon cancer, non-Hodgkin lymphoma, and mesothelioma. The latter may be due to small numbers in our still relatively young cohort. Continuous follow-up for cancer in firefighters is warranted, including assessment of influence from surveillance bias.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"67 9","pages":"857-864"},"PeriodicalIF":2.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533418","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}
Asthma, a chronic respiratory disease, is associated with high economic burden. This study estimates per-worker medical and incremental medical costs associated with treated asthma by socioeconomic and demographic characteristics, industries, medical events, and sources of payments for workers aged ≥18 years.
Methods
We analyzed Medical Expenditure Panel Survey data from 2018 to 2020 to assess medical costs for treated asthma among workers using the International Classification of Diseases, Tenth Revision, Clinical Modification code for asthma (J45). We used two-part regression models to estimate medical and incremental medical costs controlling for covariates. All results are adjusted for inflation and presented in 2022 US dollar values.
Results
An estimated annual average of 8.2 million workers out of 176 million had at least one medical event associated with treated asthma. The annualized estimated per-worker incremental medical costs for those with treated asthma was $457 and was highest among: those in the age group of 35–44 years ($534), in the western region ($768), of Hispanic ethnicity ($693), employed in the utility and transportation industries ($898), males ($650), and for inpatient admissions ($754). The total annualized medical costs of treated asthma was $21 billion and total of incremental medical costs was $3.8 billion.
Conclusion
Findings of higher incremental medical costs for treated asthma among workers in certain socioeconomic, demographic, and industry groups highlight the economic benefit of prevention and early intervention to reduce morbidity of asthma in working adults. Our results suggest that the per-person incremental medical costs of treated asthma among workers are lower than that for all US adults.
{"title":"Medical costs and incremental medical costs of asthma among workers in the United States","authors":"Anasua Bhattacharya PhD, Girija Syamlal MBBS, MPH, Katelynn E. Dodd MPH","doi":"10.1002/ajim.23633","DOIUrl":"10.1002/ajim.23633","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Asthma, a chronic respiratory disease, is associated with high economic burden. This study estimates per-worker medical and incremental medical costs associated with treated asthma by socioeconomic and demographic characteristics, industries, medical events, and sources of payments for workers aged ≥18 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed Medical Expenditure Panel Survey data from 2018 to 2020 to assess medical costs for treated asthma among workers using the International Classification of Diseases, Tenth Revision, Clinical Modification code for asthma (J45). We used two-part regression models to estimate medical and incremental medical costs controlling for covariates. All results are adjusted for inflation and presented in 2022 US dollar values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>An estimated annual average of 8.2 million workers out of 176 million had at least one medical event associated with treated asthma. The annualized estimated per-worker incremental medical costs for those with treated asthma was $457 and was highest among: those in the age group of 35–44 years ($534), in the western region ($768), of Hispanic ethnicity ($693), employed in the utility and transportation industries ($898), males ($650), and for inpatient admissions ($754). The total annualized medical costs of treated asthma was $21 billion and total of incremental medical costs was $3.8 billion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings of higher incremental medical costs for treated asthma among workers in certain socioeconomic, demographic, and industry groups highlight the economic benefit of prevention and early intervention to reduce morbidity of asthma in working adults. Our results suggest that the per-person incremental medical costs of treated asthma among workers are lower than that for all US adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"67 9","pages":"834-843"},"PeriodicalIF":2.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141496894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew M. Coates MPH, Onyebuchi A. Arah PhD, Timothy A. Matthews PhD, Dale P. Sandler PhD, Chandra L. Jackson PhD, Jian Li PhD
Background
Hypertension has been linked to socially patterned stressors, including discrimination. Few studies have quantified the risk of hypertension associated with exposure to perceived job discrimination.
Methods
We used prospective cohort data from the Sister Study (enrollment from 2003–2009) to estimate self-reported incident hypertension associated with perceived job discrimination based on race, gender, age, sexual orientation, or health status. Job discrimination in the prior 5 years was assessed in 2008–2012, and incident doctor-diagnosed hypertension was ascertained in previously hypertension-free participants.
Results
Among the 16,770 eligible participants aged 37–78 years at the start of follow-up, 10.5% reported job discrimination in the past 5 years, and 19.2% (n = 3226) reported incident hypertension during a median follow-up of 9.7 years (interquartile range 8.2–11.0 years). Self-reported poor health or inclusion in minoritized groups based on race/ethnicity or sexual orientation were more frequent among those reporting job discrimination. In a Cox proportional hazards model adjusting for covariates, report of at least one type of job discrimination (compared to none) was associated with a 14% (hazard ratio = 1.14 [95% confidence: 1.02–1.27]) higher hypertension risk. Results from sensitivity analyses reinforced the findings.
Conclusions
Results suggest that interventions addressing job discrimination could have workplace equity and health benefits.
{"title":"Multiple forms of perceived job discrimination and hypertension risk among employed women: Findings from the Sister Study","authors":"Matthew M. Coates MPH, Onyebuchi A. Arah PhD, Timothy A. Matthews PhD, Dale P. Sandler PhD, Chandra L. Jackson PhD, Jian Li PhD","doi":"10.1002/ajim.23634","DOIUrl":"10.1002/ajim.23634","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertension has been linked to socially patterned stressors, including discrimination. Few studies have quantified the risk of hypertension associated with exposure to perceived job discrimination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used prospective cohort data from the Sister Study (enrollment from 2003–2009) to estimate self-reported incident hypertension associated with perceived job discrimination based on race, gender, age, sexual orientation, or health status. Job discrimination in the prior 5 years was assessed in 2008–2012, and incident doctor-diagnosed hypertension was ascertained in previously hypertension-free participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 16,770 eligible participants aged 37–78 years at the start of follow-up, 10.5% reported job discrimination in the past 5 years, and 19.2% (<i>n</i> = 3226) reported incident hypertension during a median follow-up of 9.7 years (interquartile range 8.2–11.0 years). Self-reported poor health or inclusion in minoritized groups based on race/ethnicity or sexual orientation were more frequent among those reporting job discrimination. In a Cox proportional hazards model adjusting for covariates, report of at least one type of job discrimination (compared to none) was associated with a 14% (hazard ratio = 1.14 [95% confidence: 1.02–1.27]) higher hypertension risk. Results from sensitivity analyses reinforced the findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Results suggest that interventions addressing job discrimination could have workplace equity and health benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"67 9","pages":"844-856"},"PeriodicalIF":2.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141475707","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}
Paolo Girardi PhD, Sara Rigoni BSc, Daniela Ferrante PhD, Stefano Silvestri MD, Alessia Angelini PhD, Francesco Cuccaro MD, Enrico Oddone PhD, Massimo Vicentini MD, Francesco Barone-Adesi MD, Sara Tunesi MSc, Enrica Migliore MSc, Francesca Roncaglia PhD, Orietta Sala MSc, Roberta Pirastu MSc, Elisabetta Chellini MD, Lucia Miligi MSc, Patrizia Perticaroli MD, Vittoria Bressan BSc, Enzo Merler MD, Danila Azzolina PhD, Alessandro Marinaccio MSc, Stefania Massari PhD, Corrado Magnani MD
Objectives
In Italy, asbestos was used intensively until its ban in 1992, which was extended for asbestos cement factories until 1994. The aim of this study was to evaluate the dose–response between asbestos exposure and asbestosis mortality across a pool of Italian occupational cohorts, taking into account the presence of competing risks.
Methods
Cohorts were followed for vital status and the cause of death was ascertained by a linkage with mortality registers. Cause-specific (CS) Cox-regression models were used to evaluate the dose-exposure relationship between asbestosis mortality and the time-dependent cumulative exposure index (CEI) to asbestos. Fine and Gray regression models were computed to assess the effect of competing risks of death.
Results
The cohort included 12,963 asbestos cement workers. During the follow-up period (1960−2012), of a total of 6961 deaths, we observed 416 deaths attributed to asbestosis, 879 to lung cancer, 400 to primary pleural cancer, 135 to peritoneal cancer, and 1825 to diseases of the circulatory system. The CS model showed a strong association between CEI and asbestosis mortality. Dose–response models estimated an increasing trend in mortality even below a CEI of 25 ff/mL-years. Lung cancer and circulatory diseases were the main competing causes of death.
Conclusions
Asbestos exposure among Italian asbestos-cement workers has led to a very high number of deaths from asbestosis and asbestos-related diseases. The increasing risk trend associated with excess deaths, even at low exposure levels, suggests that the proposed limit values would not have been adequate to prevent disability and mortality from asbestosis.
{"title":"Asbestos exposure and asbestosis mortality in Italian cement-asbestos cohorts: Dose-response relationship and the role of competing death causes","authors":"Paolo Girardi PhD, Sara Rigoni BSc, Daniela Ferrante PhD, Stefano Silvestri MD, Alessia Angelini PhD, Francesco Cuccaro MD, Enrico Oddone PhD, Massimo Vicentini MD, Francesco Barone-Adesi MD, Sara Tunesi MSc, Enrica Migliore MSc, Francesca Roncaglia PhD, Orietta Sala MSc, Roberta Pirastu MSc, Elisabetta Chellini MD, Lucia Miligi MSc, Patrizia Perticaroli MD, Vittoria Bressan BSc, Enzo Merler MD, Danila Azzolina PhD, Alessandro Marinaccio MSc, Stefania Massari PhD, Corrado Magnani MD","doi":"10.1002/ajim.23629","DOIUrl":"10.1002/ajim.23629","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In Italy, asbestos was used intensively until its ban in 1992, which was extended for asbestos cement factories until 1994. The aim of this study was to evaluate the dose–response between asbestos exposure and asbestosis mortality across a pool of Italian occupational cohorts, taking into account the presence of competing risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cohorts were followed for vital status and the cause of death was ascertained by a linkage with mortality registers. Cause-specific (CS) Cox-regression models were used to evaluate the dose-exposure relationship between asbestosis mortality and the time-dependent cumulative exposure index (CEI) to asbestos. Fine and Gray regression models were computed to assess the effect of competing risks of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included 12,963 asbestos cement workers. During the follow-up period (1960−2012), of a total of 6961 deaths, we observed 416 deaths attributed to asbestosis, 879 to lung cancer, 400 to primary pleural cancer, 135 to peritoneal cancer, and 1825 to diseases of the circulatory system. The CS model showed a strong association between CEI and asbestosis mortality. Dose–response models estimated an increasing trend in mortality even below a CEI of 25 ff/mL-years. Lung cancer and circulatory diseases were the main competing causes of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Asbestos exposure among Italian asbestos-cement workers has led to a very high number of deaths from asbestosis and asbestos-related diseases. The increasing risk trend associated with excess deaths, even at low exposure levels, suggests that the proposed limit values would not have been adequate to prevent disability and mortality from asbestosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"67 9","pages":"813-822"},"PeriodicalIF":2.7,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465637","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}
Jaeun Choi PhD, Charles B. Hall PhD, Sean A. P. Clouston PhD, Krystal L. Cleven MD, Frank D. Mann PhD, Benjamin J. Luft MD, Andrea R. Zammit PhD
Background
Posttraumatic stress disorder (PTSD) symptomatology and poorer pulmonary function are highly prevalent psychiatric and medical conditions. In the present study, we tested for the individual, additive, and modifying associations of PTSD symptomatology and pulmonary function with cognitive performance.
Methods
In this cross-sectional study, a total of 1,401 World Trade Center (WTC) responders (mean age = 53, SD = 8 years, 92% males) participated in the study. Cogstate assessment measured cognitive performance. PTSD symptomatology was measured using the trauma-specific version of the posttraumatic stress disorder checklist (PCL-17) adapted for the WTC attacks. The 1-second forced expiratory volume and forced vital capacity (FEV1/FVC) ratio was used to measure pulmonary function. Linear regressions with cognitive performance as the outcome were conducted to assess individual, additive, and moderating associations of PTSD symptomatology and pulmonary function.
Results
Higher PTSD symptomatology and poorer pulmonary function were negatively associated with cognitive performance. A 10% increase on the FEV1/FVC ratio moderated the association between PTSD symptomatology and cognition, whereby its association with cognition was stronger when PTSD symptomatology was higher (est. = 0.01, 95%CI = 0.004, 0.01, p < 0.001). When stratified by responder type, these associations persisted in trained (est. = 0.01, 95%CI = 0.01, 0.02, p < 0.001), but not in non-trained (est. = 0.004, 95% C.I. = −0.01, 0.02, p = 0.39) responders.
Conclusions
In the presence of higher PTSD, better pulmonary functioning is associated with better cognitive performance. Early intervention efforts to mitigate preventable cognitive decline in high-risk populations should be studied, especially since intervention in one modality may have an impact on others.
{"title":"Cross-sectional association between posttraumatic stress and cognition is moderated by pulmonary functioning in world trade center responders","authors":"Jaeun Choi PhD, Charles B. Hall PhD, Sean A. P. Clouston PhD, Krystal L. Cleven MD, Frank D. Mann PhD, Benjamin J. Luft MD, Andrea R. Zammit PhD","doi":"10.1002/ajim.23631","DOIUrl":"10.1002/ajim.23631","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Posttraumatic stress disorder (PTSD) symptomatology and poorer pulmonary function are highly prevalent psychiatric and medical conditions. In the present study, we tested for the individual, additive, and modifying associations of PTSD symptomatology and pulmonary function with cognitive performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, a total of 1,401 World Trade Center (WTC) responders (mean age = 53, SD = 8 years, 92% males) participated in the study. Cogstate assessment measured cognitive performance. PTSD symptomatology was measured using the trauma-specific version of the posttraumatic stress disorder checklist (PCL-17) adapted for the WTC attacks. The 1-second forced expiratory volume and forced vital capacity (FEV1/FVC) ratio was used to measure pulmonary function. Linear regressions with cognitive performance as the outcome were conducted to assess individual, additive, and moderating associations of PTSD symptomatology and pulmonary function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher PTSD symptomatology and poorer pulmonary function were negatively associated with cognitive performance. A 10% increase on the FEV1/FVC ratio moderated the association between PTSD symptomatology and cognition, whereby its association with cognition was stronger when PTSD symptomatology was higher (est. = 0.01, 95%CI = 0.004, 0.01, <i>p</i> < 0.001). When stratified by responder type, these associations persisted in trained (est. = 0.01, 95%CI = 0.01, 0.02, <i>p</i> < 0.001), but not in non-trained (est. = 0.004, 95% C.I. = −0.01, 0.02, <i>p</i> = 0.39) responders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the presence of higher PTSD, better pulmonary functioning is associated with better cognitive performance. Early intervention efforts to mitigate preventable cognitive decline in high-risk populations should be studied, especially since intervention in one modality may have an impact on others.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"67 9","pages":"823-833"},"PeriodicalIF":2.7,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23631","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465708","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}
Suraj Adhikari MS, Fernando Wilson PhD, Risto Rautiainen PhD
Background
Agriculture is a hazardous industry but the frequency and severity of agricultural injuries are not well documented as nonfatal injuries to self-employed farmers are excluded from national surveillance. The aim of this study was to provide new injury rate and cost estimates in US agriculture.
Methods
Injury data were obtained from 2018 to 2020 Farm and Ranch Health and Safety Surveys. Responses from 7,195 farm/ranch operators included injury frequency, medical expense, and lost work time data. These injury rate and cost data were used to estimate national injury costs for self-employed farmers using Census of Agriculture operator count, injury costs for hired agricultural workers using Bureau of Labor Statistics (BLS) nonfatal injury count, and fatal injury costs using BLS count of fatal injuries.
Results
The injury rate for self-employed farmers and ranchers was 15.25 injuries per 100 operators or 11.9 “recordable” injuries per 100 full time equivalent operators (FTE). Average costs for nonfatal injuries were: $10,878 for medical care, $4735 for lost work time, and $15,613 in total per injury case. The total national agricultural injury cost estimate was $11.31 billion per year; 11.3% higher than the earlier benchmark using 1992 data; both in March 2024 dollars. The cost burden was 2.1% of the US national gross farm income and 13.4% of the net farm income in 2019.
Conclusions
Injuries result in significant economic losses to farm and ranch operators, their family members, workers, and society. Preventive efforts should be scaled up to reduce the frequency and costs of agricultural injuries.
{"title":"Cost of agricultural injuries in the United States: Estimates based on surveillance, insurance, and government statistics","authors":"Suraj Adhikari MS, Fernando Wilson PhD, Risto Rautiainen PhD","doi":"10.1002/ajim.23628","DOIUrl":"10.1002/ajim.23628","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Agriculture is a hazardous industry but the frequency and severity of agricultural injuries are not well documented as nonfatal injuries to self-employed farmers are excluded from national surveillance. The aim of this study was to provide new injury rate and cost estimates in US agriculture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Injury data were obtained from 2018 to 2020 Farm and Ranch Health and Safety Surveys. Responses from 7,195 farm/ranch operators included injury frequency, medical expense, and lost work time data. These injury rate and cost data were used to estimate national injury costs for self-employed farmers using Census of Agriculture operator count, injury costs for hired agricultural workers using Bureau of Labor Statistics (BLS) nonfatal injury count, and fatal injury costs using BLS count of fatal injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The injury rate for self-employed farmers and ranchers was 15.25 injuries per 100 operators or 11.9 “recordable” injuries per 100 full time equivalent operators (FTE). Average costs for nonfatal injuries were: $10,878 for medical care, $4735 for lost work time, and $15,613 in total per injury case. The total national agricultural injury cost estimate was $11.31 billion per year; 11.3% higher than the earlier benchmark using 1992 data; both in March 2024 dollars. The cost burden was 2.1% of the US national gross farm income and 13.4% of the net farm income in 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Injuries result in significant economic losses to farm and ranch operators, their family members, workers, and society. Preventive efforts should be scaled up to reduce the frequency and costs of agricultural injuries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"67 9","pages":"801-812"},"PeriodicalIF":2.7,"publicationDate":"2024-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23628","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454695","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}
Aurora B Le, Abas Shkembi, G Scott Earnest, Elizabeth Garza, Douglas Trout, Sang D Choi
Background: U.S. construction workers experience high rates of injury that can lead to chronic pain. This pilot study examined nonpharmacological (without medication prescribed by healthcare provider) and pharmacological (e.g., prescription opioids) pain management approaches used by construction workers.
Methods: A convenience sample of U.S. construction workers was surveyed, in partnership with the U.S. National Institute for Occupational Safety and Health (NIOSH) Construction Sector Program. Differences in familiarity and use of nonpharmacological and pharmacological pain management approaches, by demographics, were assessed using logistic regression models. A boosted regression tree model examined the most influential factors related to pharmacological pain management use, and potential reductions in use were counterfactually modeled.
Results: Of 166 (85%) of 195 participants reporting pain/discomfort in the last year, 72% reported using pharmacological pain management approaches, including 19% using opioids. There were significant differences in familiarity with nonpharmacological approaches by gender, education, work experience, and job title. Among 37 factors that predicted using pharmacological and non-pharmacological pain management approaches, training on the risks of opioids, job benefits for unpaid leave and paid disability, and familiarity with music therapy, meditation or mindful breathing, and body scans were among the most important predictors of potentially reducing use of pharmacological approaches. Providing these nonpharmacological approaches to workers could result in an estimated 23% (95% CI: 16%-30%) reduction in pharmacological pain management approaches.
Conclusion: This pilot study suggests specific factors related to training, job benefits, and worker familiarity with nonpharmacological pain management approaches influence use of these approaches.
{"title":"Nonpharmacological pain management approaches among U.S. construction workers: A cross-sectional pilot study.","authors":"Aurora B Le, Abas Shkembi, G Scott Earnest, Elizabeth Garza, Douglas Trout, Sang D Choi","doi":"10.1002/ajim.23630","DOIUrl":"10.1002/ajim.23630","url":null,"abstract":"<p><strong>Background: </strong>U.S. construction workers experience high rates of injury that can lead to chronic pain. This pilot study examined nonpharmacological (without medication prescribed by healthcare provider) and pharmacological (e.g., prescription opioids) pain management approaches used by construction workers.</p><p><strong>Methods: </strong>A convenience sample of U.S. construction workers was surveyed, in partnership with the U.S. National Institute for Occupational Safety and Health (NIOSH) Construction Sector Program. Differences in familiarity and use of nonpharmacological and pharmacological pain management approaches, by demographics, were assessed using logistic regression models. A boosted regression tree model examined the most influential factors related to pharmacological pain management use, and potential reductions in use were counterfactually modeled.</p><p><strong>Results: </strong>Of 166 (85%) of 195 participants reporting pain/discomfort in the last year, 72% reported using pharmacological pain management approaches, including 19% using opioids. There were significant differences in familiarity with nonpharmacological approaches by gender, education, work experience, and job title. Among 37 factors that predicted using pharmacological and non-pharmacological pain management approaches, training on the risks of opioids, job benefits for unpaid leave and paid disability, and familiarity with music therapy, meditation or mindful breathing, and body scans were among the most important predictors of potentially reducing use of pharmacological approaches. Providing these nonpharmacological approaches to workers could result in an estimated 23% (95% CI: 16%-30%) reduction in pharmacological pain management approaches.</p><p><strong>Conclusion: </strong>This pilot study suggests specific factors related to training, job benefits, and worker familiarity with nonpharmacological pain management approaches influence use of these approaches.</p>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426160","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}
Workplaces are suitable areas for smoking cessation programs and incentives. This study was carried out to determine the effectiveness of interventions in the workplace for smoking cessation in working individuals.
Methods
All studies published in English between 2013 and 2022 were searched in Pub Med, Science Direct, Scopus, Web of Science, and CINAHL databases. Meta-analysis was based on PRISMA 2020. The study protocol was registered with PROSPERO. A random effects model was applied to the meta-analysis processes, and Hedges' g was used to calculate the effect size.
Results
Of the included studies, 11 were randomized controlled trials, and 8 were cluster randomized controlled trials. In different working sectors, various interventions such as motivational/individual interviews, group counseling, telephone coaching, web-based training, mindfulness meditation, and financial interventions were implemented. These interventions were carried out alone or in combination with one or more other interventions. The interventions generally have short-term effects, and financial incentives or supports were the factors that positively motivate the interventions. The joint effect size of attempts to quit smoking in the workplace (Hedges' g) was 1.171. Heterogeneity between studies was significant (Q = 199.762, p = 0.015, I2 = 80.477%). No publication bias was detected.
Conclusions
We determined that smoking cessation interventions applied in the workplace have a large effect. We recommend that the long-term effects of increasing effectiveness of these interventions be considered and planned in line with the needs of working groups.
{"title":"Effectiveness of smoking cessation interventions in the workplace: A systematic review and meta-analysis","authors":"Dilek Ayaz MSc, Ercan Asi MSc, Ayse Meydanlioglu PhD, Selma Oncel PhD","doi":"10.1002/ajim.23627","DOIUrl":"10.1002/ajim.23627","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Workplaces are suitable areas for smoking cessation programs and incentives. This study was carried out to determine the effectiveness of interventions in the workplace for smoking cessation in working individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All studies published in English between 2013 and 2022 were searched in Pub Med, Science Direct, Scopus, Web of Science, and CINAHL databases. Meta-analysis was based on PRISMA 2020. The study protocol was registered with PROSPERO. A random effects model was applied to the meta-analysis processes, and Hedges' <i>g</i> was used to calculate the effect size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the included studies, 11 were randomized controlled trials, and 8 were cluster randomized controlled trials. In different working sectors, various interventions such as motivational/individual interviews, group counseling, telephone coaching, web-based training, mindfulness meditation, and financial interventions were implemented. These interventions were carried out alone or in combination with one or more other interventions. The interventions generally have short-term effects, and financial incentives or supports were the factors that positively motivate the interventions. The joint effect size of attempts to quit smoking in the workplace (Hedges' <i>g</i>) was 1.171. Heterogeneity between studies was significant (<i>Q</i> = 199.762, <i>p</i> = 0.015, <i>I</i><sup>2</sup> = 80.477%). No publication bias was detected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We determined that smoking cessation interventions applied in the workplace have a large effect. We recommend that the long-term effects of increasing effectiveness of these interventions be considered and planned in line with the needs of working groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"67 8","pages":"712-722"},"PeriodicalIF":2.7,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330315","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}
Edward Yelin PhD, Laura Trupin MPH, Trisha Iley AB, Nari Rhee PhD, Alicia Lafrance MPH, MSW, Ima Varghese Mac AB
Background
There is recognition of the growing prevalence of alternative work arrangements, contingent jobs, and work secured through an app. However, there have been few systematic efforts to understand the impact of these forms of work on individuals and households.
Methods
The data derive from the California Work and Health Survey administered to a sample of the working age population of the state solicited through random-digit dialing of cell phone numbers. 4014 individuals completed the survey, 26% of those with an in-service cell phone number. We present odds ratios and 95% confidence intervals from logistic regression estimating the impact of being an independent contractor, in other forms of alternative work arrangements, in contingent jobs, and in work secured through an app, on economic and health status and working conditions in main jobs, with and without adjustment for covariates.
Results
Several of the forms of work analyzed are associated with lower earnings and higher rates of wage theft, household poverty, benefit recipiency, and expectation of hardships in food, housing, and medical care in the immediate future. Association between the forms of work and current health status is less consistent. However, several forms of work are associated with working conditions known to be risk factors for subsequent health problems.
Conclusions
Public policy to mitigate the adverse impacts of work, largely developed in the 20th Century when there was an identified workplace, may be insufficient to protect workers' well-being for alternative work arrangements, contingent jobs, and work secured through an app.
{"title":"The impact of alternative arrangements, contingent jobs, and work secured through an app on the well-being of working age adults: Results from the California Work and Health Survey","authors":"Edward Yelin PhD, Laura Trupin MPH, Trisha Iley AB, Nari Rhee PhD, Alicia Lafrance MPH, MSW, Ima Varghese Mac AB","doi":"10.1002/ajim.23625","DOIUrl":"10.1002/ajim.23625","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is recognition of the growing prevalence of alternative work arrangements, contingent jobs, and work secured through an app. However, there have been few systematic efforts to understand the impact of these forms of work on individuals and households.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The data derive from the California Work and Health Survey administered to a sample of the working age population of the state solicited through random-digit dialing of cell phone numbers. 4014 individuals completed the survey, 26% of those with an in-service cell phone number. We present odds ratios and 95% confidence intervals from logistic regression estimating the impact of being an independent contractor, in other forms of alternative work arrangements, in contingent jobs, and in work secured through an app, on economic and health status and working conditions in main jobs, with and without adjustment for covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Several of the forms of work analyzed are associated with lower earnings and higher rates of wage theft, household poverty, benefit recipiency, and expectation of hardships in food, housing, and medical care in the immediate future. Association between the forms of work and current health status is less consistent. However, several forms of work are associated with working conditions known to be risk factors for subsequent health problems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Public policy to mitigate the adverse impacts of work, largely developed in the 20th Century when there was an identified workplace, may be insufficient to protect workers' well-being for alternative work arrangements, contingent jobs, and work secured through an app.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"67 8","pages":"753-763"},"PeriodicalIF":2.7,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23625","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330316","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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