Outbreak Associated with SARS-CoV-2 B.1.617.2 (Delta) Variant in an Elementary School - Marin County, California, May-June 2021.

On May 25, 2021, the Marin County Department of Public Health (MCPH) was notified by an elementary school that on May 23, an unvaccinated teacher had reported receiving a positive test result for SARS-CoV-2, the virus that causes COVID-19. The teacher reported becoming symptomatic on May 19, but continued to work for 2 days before receiving a test on May 21. On occasion during this time, the teacher read aloud unmasked to the class despite school requirements to mask while indoors. Beginning May 23, additional cases of COVID-19 were reported among other staff members, students, parents, and siblings connected to the school. To characterize the outbreak, on May 26, MCPH initiated case investigation and contact tracing that included whole genome sequencing (WGS) of available specimens. A total of 27 cases were identified, including that of the teacher. During May 23-26, among the teacher's 24 students, 22 students, all ineligible for vaccination because of age, received testing for SARS-CoV-2; 12 received positive test results. The attack rate in the two rows seated closest to the teacher's desk was 80% (eight of 10) and was 28% (four of 14) in the three back rows (Fisher's exact test; p = 0.036). During May 24-June 1, six of 18 students in a separate grade at the school, all also too young for vaccination, received positive SARS-CoV-2 test results. Eight additional cases were also identified, all in parents and siblings of students in these two grades. Among these additional cases, three were in persons fully vaccinated in accordance with CDC recommendations (1). Among the 27 total cases, 22 (81%) persons reported symptoms; the most frequently reported symptoms were fever (41%), cough (33%), headache (26%), and sore throat (26%). WGS of all 18 available specimens identified the B.1.617.2 (Delta) variant. Vaccines are effective against the Delta variant (2), but risk of transmission remains elevated among unvaccinated persons in schools without strict adherence to prevention strategies. In addition to vaccination for eligible persons, strict adherence to nonpharmaceutical prevention strategies, including masking, routine testing, facility ventilation, and staying home when symptomatic, are important to ensure safe in-person learning in schools (3).

Risk for Coccidioidomycosis among Hispanic Farm Workers, California, USA, 2018.

To determine occupational risk factors for coccidioidomycosis among adult Hispanic outdoor agricultural workers in California, USA, we conducted a case-control study of workers seen at the Kern County medical facility and referred to the public health laboratory for coccidioidomycosis serologic testing. Participants completed an interviewer-administered health and work questionnaire. Among 203 participants (110 case-patients with positive and 93 controls with negative serologic results), approximately half were women, and more than three quarters were born in Mexico. Associated with coccidioidomycosis were self-reported dust exposure and work with root and bulb vegetable crops. A protective factor was leaf removal, an activity associated with grape cultivation. We conclude that subjective dust exposure and work with root and bulb vegetable crops are associated with increased risk for coccidioidomycosis among Hispanic farm workers. The agricultural industry should evaluate and promote dust-reduction measures, including wetting soil and freshly harvested products.

Abortion and public health: Time for another look.

Four decades after Roe v. Wade, abortion remains highly contentious, pitting a woman's right to choose against a fetal claim to life. Public health implications are staggering: the US annual total of more than one million induced abortions equals nearly half the number of registered deaths from all causes. Sentiment regarding abortion is roughly evenly split among the general public, yet fundamental debate about abortion is largely absent in the public health community, which is predominantly supportive of its wide availability. Absence of substantive debate on abortion separates the public health community from the public we serve, jeopardizing the trust placed in us. Traditional public health values-support for vulnerable groups and opposition to the politicization of science-together with the principle of reciprocity weigh against abortion. Were aborted lives counted as are other human lives, induced abortion would be acknowledged as the largest single preventable cause of loss of human life. Lay Summary: Four decades after Roe v. Wade, abortion remains highly divisive. Public sentiment regarding abortion is roughly evenly split, yet fundamental debate is largely absent in the public health community, which supports abortion's wide availability. Absence of substantive debate separates the public health community from the public it serves. Traditional public health values-support for vulnerable populations and opposition to politicization of science-and the principle of reciprocity ("the Golden Rule") weigh against abortion. Were aborted lives counted as are other human lives, induced abortion would be acknowledged as the largest single preventable cause of loss of human life.

Cohort study of physical activity and injury among Latino farm workers.

INTRODUCTION: This study characterized physical activity and its association with injury among Latino farm workers. METHODS: An interviewer-administered questionnaire was used to collect baseline and follow-up data on 843 and 640 Latino farm workers, respectively. Participants were 18-55 years old, engaged in farm work and residing in Mendota, CA at baseline interview. The questionnaire assessed self-reported physical activity and risk of injury. RESULTS: The 12 month prevalence of injury decreased from 9.0% at baseline to 6.9% at follow up interview. In GEE models adjusted for age, follow-up time, gender, smoking, income and years working in agriculture, poor/fair self-assessed health status (OR = 1.82, 95% CI: 1.18-2.82) and 2-3 hr per day of sitting/watching TV/using a computer (OR = 0.50, 95% CI: 0.30-0.83) were significantly associated with injury. CONCLUSIONS: Physical activity was not associated with injury in this population. Efforts to reduce injuries should focus on known risk factors such as poor health status.

Agricultural work and chronic musculoskeletal pain among Latino farm workers: the MICASA study.

BACKGROUND: Agriculture poses varied dangers to hired farm workers in the U.S., but little information exists on occupational risks for chronic musculoskeletal pain. We examined common work positions, such as kneeling, carrying heavy loads, and repetitive motion that may increase the risk for chronic musculoskeletal pain. METHODS: MICASA is a population-based study of occupational exposures and health in hired farm workers in California. This analysis includes 759 participants, 18-55 years old, engaged in farm work and residing in Mendota, CA. Chronic pain was defined as pain lasting 6 weeks or longer at specific body sites (back, knee, hip, etc.) over the entire farm work career. RESULTS: Mean age was 37.9 years. Sixty-five percent participants were born in Mexico, 27.7% were born in El Salvador, and 4.2% were U.S-born. Chronic pain was associated with older age and female sex. After adjustment for age, years working in agriculture, and smoking, stooping/bending >30 hr/week among both men (OR = 2.49, 95% CI: 1.03-5.99) and women (OR = 2.15, 95% CI: 1.04-4.46) was associated with chronic hip pain. Driving tractors or other heavy farm equipment >60 hr/week was associated with increased odds of chronic hip pain (OR = 2.16, 95% CI: 1.02-4.54) among men. We also observed significant associations with kneeling or crawling >35 hr/week among women for both chronic back pain (OR = 2.96, 95% CI: 1.27-6.93) and knee pain (OR = 3.02, 95% CI: 1.07-8.50), respectively. CONCLUSIONS: Chronic musculoskeletal pain is prevalent among farm workers and is associated with common work positions. Further research should focus on developing preventive interventions for tasks associated with increased pain risk. These interventions should be targeted to specific types of agricultural tasks.

Cardiopulmonary fitness and respirator clearance: an update.

This review addresses five key questions regarding respirator clearance: What is the efficacy of different methods of respirator clearance? Which diagnostic test is most predictive of cardiac event during respirator use? Is spirometry accurate in predicting respiratory distress/insufficiency during respirator use? Is exercise tolerance testing accurate in predicting cardiac injury during respirator use? Which periodicity of clearance evaluations is most protective against cardiac event during respirator use? The medical literature was searched using PubMed, the Cochrane Library, and Web of Science. Relevant articles were reviewed to assess current recommendations and practices in respirator clearance. Between the years 1970 and 2011, 144 articles were identified, and 21 were included in this review. Current recommendations for respirator clearance are based on consensus rather than outcome studies, and opinions differed between expert sources. Many authors observed the need for cost-effective respirator clearance, but none proposed evidence-based strategies. Prospective studies on respirator clearance that evaluate cardiac and pulmonary outcomes are necessary to establish an evidence base for improving the validity, efficiency, and consistency of respirator clearance testing.

Sexual Harassment Beliefs and Myth Acceptance Among Hispanic and Indigenous Farmworkers in California (USA) and Michoacán (Mexico).

We explore workplace sexual harassment (WSH) myth acceptance, bystander discomfort, and beliefs among farmworkers in California, USA, and Michoacán, Mexico. Surveys were conducted with the guidance of community advisory boards among 197 farmworkers (38 men and 59 women in California; 40 men and 60 women in Michoacán). Men and women in Michoacán had similar discomfort and myth acceptance. California women reported more discomfort than men but were similar in myth acceptance. The highest levels of myth acceptance ranged from 66 to 88%. The majority (85-90%) believed that something must be done to prevent WSH in agriculture.

Lessons From the Field: Rapid Antigen Testing Is Efficient and Practical for Mitigation of Coronavirus Disease 2019 Outbreaks in Long-Term Care Facilities.

Background: Mitigation of coronavirus disease 2019 (COVID-19) outbreaks in long-term care facilities (LTCFs) is facilitated by rapid identification and isolation of infectious individuals to interrupt viral transmission. Immunochromatographic (IC) tests, or rapid antigen tests, have high sensitivity and specificity during the contagious period for COVID-19. Mathematical modeling predicts frequent IC surveillance will be more efficient than polymerase chain reaction (PCR)-based strategies, especially during community surges when reporting of PCR results can be delayed. However, there are few published field studies evaluating IC testing strategies in this long-term care setting. Methods: In fall and winter of 2020, the Marin Health and Human Services Department implemented thrice-weekly IC mass testing by nonlaboratory workers in outbreaks that occurred in 2 LTCFs, in addition to then-standard semiweekly PCR testing. The IC test performance was characterized using same-day PCR specimens as reference standard. Cumulative incidence and duration of transmission for the 2 IC intervention facility outbreaks were compared with 6 reference LTCFs that used weekly to semiweekly PCR alone during an outbreak response. Results: Of 123 same-day test pairs, IC test sensitivity and specificity were 75% (95% confidence interval [CI], 48%-93%) and 100% (95% CI, 97%-100%), respectively. The median duration of outbreak transmission was 19.5 days in the 2 intervention sites and 28 days in the reference facilities (P = .40). Cumulative incidence for the outbreaks among LTCF residents was 41% in the intervention facilities versus 52% in the reference facilities (P = .04, Fisher 2-sided exact). Conclusions: Thrice-weekly mass IC testing as used by nonlaboratory personnel can be highly practical and effective for COVID-19 outbreak mitigation in the LTCF setting.

Agricultural injury among rural California public high school students.

OBJECTIVES: The University of California, Davis Youth Agricultural Injury Study characterized the farm work and agricultural injury experience among rural California Central Valley public high school students enrolled in an agricultural sciences curriculum. METHODS: We conducted a cross-sectional survey of agricultural injury among students from 10 California Central Valley high schools during the 2001-2005 school years. RESULTS: Of 1,783 subjects, 946 (53.1%) reported farm work in the previous year, including 97 (10.3%) reporting at least one farm work-related injury in the preceding year. After adjustment for sex, ethnicity, and hours spent in farm work, injury risk was associated with large-animal operations (OR 4.15; 95%CI: 1.18, 14.65), feeding large animals (OR 2.38; 95%CI: 1.15, 4.96), mixing chemicals (OR 1.86; 95%CI: 1.15, 3.03), welding (OR 2.09; 95%CI: 1.17, 3.72), non-use of seatbelts, and frequent riding in the back of an uncovered pick-up truck. Risky attitudes toward farm safety were significantly associated with injury. Girls were more likely to suffer an animal-related injury and boys to suffer injury related to motor vehicles, machinery, or tool use. CONCLUSIONS: Adolescents are at similar risk to adults for agricultural injury. Although limitations on hazardous tasks and time spent on farm work are likely to be the most efficacious means for reducing injury, education will play an important role. Educational measures should include inculcating healthy safety-related attitudes and focus on hazardous tasks, such as those involving animals (for girls) and motor vehicles and machinery (for boys).

Agricultural injury risk among rural California public high school students: prospective results.

OBJECTIVES: To characterize prospective agricultural injury experience among rural California Central Valley public high school students enrolled in agricultural sciences curriculum. METHODS: The University of California, Davis Youth Agricultural Injury Study (UCD-YAIS) examined prospective farm-work injury among students from 10 California Central Valley public high schools. RESULTS: Of eligible subjects, 882 (62.5%) completed at least one annual follow-up survey. Of these, 489 reported farm work in the previous year, including 40 (8.2%) with at least one farm work-related injury. Fractures were the most common injury, especially among girls. Girls were more likely to suffer animal-related injury and boys injury from motor vehicles, machinery, or tool use. Prospective injury risk was strongly associated with prior-year farm injury (OR 8.53; 95% CI 4.02, 18.1) and farm work hours. After adjustment for farm work hours, grade level, and sex, risk was significantly associated with machinery operation, applying chemicals, number of hazardous tasks performed, riding motorcycles or mopeds, riding in back of an uncovered pick-up truck, and smoking. Risky attitude toward farm safety was associated prospectively with injury in stepwise fashion. CONCLUSIONS: Adolescents are at risk for serious farm-work injuries. Although limitations on hazardous tasks and farm work hours are likely to be the most efficacious means for reducing injury, education will play an important role. Education should include inculcating safety-related attitudes and habits and focus on hazardous tasks, such as those involving animals (for girls) and motor vehicles and machinery (for boys), especially among youth with prior farm injury.

Willingness to provide behavioral health recommendations: a cross-sectional study of entering medical students.

BACKGROUND: Behavioral factors contribute importantly to morbidity and mortality, and physicians are trusted sources for information on reducing associated risks. Unfortunately, many clinical encounters do not include prevention counseling, and medical school curriculum plays an important role in training and promoting such counseling among medical students. METHODS: We surveyed all 93 freshman medical students at entry to the University of California, Davis School of Medicine in 2009 to evaluate baseline knowledge of population health principles and examine their approach to clinical situations involving four common behavioral risk factors illustrated in brief clinical vignettes: smoking, alcohol use in a patient with indications of alcoholism, diet and exercise in an overweight sedentary patient, and a 16-year-old contemplating initiation of sexual intercourse. Based on vignette responses, we assessed willingness to (1) provide information on risks, (2) recommend elimination of the behavior as the most efficacious means for reducing risk, (3) include strategies apart from elimination of the behavior for lowering risk (i.e., harm reduction), and (4) assure of their intention to continue care whether or not recommendations are accepted. RESULTS: Students answered correctly 71.4 % (median; interquartile range 66.7 % - 85.7 %) of clinical prevention and population health knowledge questions; men scored higher than women (median 83.3 % vs. 66.7 %, p<0.02). Students showed high willingness to provide information and strategies for harm reduction apart from risk elimination, while respecting patient autonomy. Willingness to recommend elimination of high-risk behaviors "always or nearly always" was high for smoking (78.5 %), alcohol consumption in a patient with indications of alcoholism (64.5 %), and diet and exercise in a sedentary and overweight individual (87.1 %), and low for the 16-year-old considering initiating sexual intercourse (28.0 %; Friedman test, p<0.001). Willingness was not associated with the respondent's background knowledge of population health principles or gender. CONCLUSION: Students showed high willingness to educate and respect patient autonomy. There was high willingness to recommend elimination of risk behaviors for smoking, alcohol, and poor diet/exercise, but not for sexual intercourse in an adolescent considering sexual debut. Further research should address promoting appropriate science-based preventive health messages, and curriculum should include explicit discussion of content of recommendations.

Ethnic and gender differences in farm tasks and safety practices among rural California farm youth.

Agricultural work is hazardous and is common among rural youth, especially those living on farms or ranches. Previous work has shown differences in farm work and injury patterns between boys and girls, but little data exist addressing ethnic differences. This study examined ethnic and gender differences in farm tasks, safety attitudes, and use of protective measures among rural California youth working on farms or ranches. The University of California, Davis Youth Agricultural Injury Study is a longitudinal study focusing on agricultural work experience among youth enrolled in an agricultural sciences curriculum in 10 public high schools in California's Central Valley during the 2001-2005 school years. Using cross-sectional data from the initial entrance survey, we studied 946 participants who reported farm work in the previous year. Median annual hours of farm work varied significantly between boys and girls (p < 0.001) and between ethnic groups (p < 0.05) (Hispanic boys: 624 hr; Hispanic girls: 189 hr; White/Other boys: 832 hr; White/Other girls: 468 hr). Girls and Hispanic students were less likely than boys and White/Other students, respectively, to perform hazardous tasks involving tractors, machinery, and chemicals. Median age for initiating work on selected hazardous tasks was up to 3 years later for Hispanic students. Use of task-appropriate safety measures was low in all groups for most hazardous tasks. Boys were more likely than girls to use task-appropriate safety measures, with the exception of seatbelt use when in a car or truck. Hispanic students were more likely than White/Other students to employ safety measures. Girls and Hispanic youth worked fewer farm hours and had reduced exposure to selected hazardous tasks. Use of task-appropriate safety measures was low for all groups but increased for Hispanic students. Further study should explore reasons for low use of safety measures and develop educational efforts to bring about social norm changes promoting their use.

Exposure to Workplace Sexual Harassment among Women and Men Farmworkers in the U.S. and Mexico.

HIGHLIGHTS: Women and men farmworkers reported workplace sexual harassment (WSH). WSH occurred as frequently as daily. Both coworkers and leadership were perpetrators of WSH. ABSTRACT: This study explores experiences relevant to workplace sexual harassment (WSH) in agriculture among men and women farmworkers in California (U.S.) and Michoacán (Mexico). Anecdotal evidence documents women farmworkers having to endure behavioral, verbal, and physical WSH including sexual ogling, degrading language, groping, and requests for sex in exchange for work. We include survey comparisons between men and women in California and Michoacan on WSH among farmworkers. We conducted 197 farmworker surveys (38 men and 59 women in California; 40 men and 60 women in Michoacán). Community advisory boards contributed expertise and input for study strategies, materials, and dissemination. Survey participant ages ranged from 23 to 54 years old. Half worked in Mexico, 68% were married, 80% had children, and 47% had less than 7 years of education. Most farmworkers spoke Spanish and Purhépecha, an indigenous language spoken by the Purhépecha people in Michoacán. We used two strategies to measure WSH exposure in the previous year: (1) direct inquiry-based survey items (asking "Have you ever been the victim of or bystander to workplace sexual harassment?") documenting WSH among women (49%) and men (21%) in California and among women (7%) and men (13%) in Michoacán, and (2) behavior-based WSH items (using explicit examples of WSH behaviors perpetrated against the participant or witnessed by the participant as a bystander) documenting WSH among women (as high as 53%) and men (as high as 45%) in California and among women (as high as 65%) and men (as high as 68%) in Michoacán. Women farmworkers in California reported WSH experiences exceeding those of men. Reported WSH experiences in Michoacán were similar for men and women. Farmworkers identified WSH perpetrators as coworkers more than leadership. The frequency of exposure ranged from daily, weekly, monthly, and up to multiple times a year. Of 46 direct inquiry-based WSH incidents, only one perpetrator was punished, and at least half of all victims said they were forced to change their jobs. The findings of this study inform the development of WSH prevention efforts, such as education tools, support for efforts to facilitate reporting, protections against retaliation for workers, and promoting accountability for perpetrators. This information supports the promotion of policy recommendations and preventive approaches for WSH.

Use of SMS-linked electronic surveys for COVID-19 case investigation and contact tracing - Marin County, CA, USA.

OBJECTIVES: We sought to quantify the proportion of contacts reported by persons with COVID-19 through a short message service (SMS)-linked survey in comparison to the proportion of contacts reported during a follow-up phone-interview. We also sought to assess improvement in contact tracing timeliness associated with sending SMS-linked surveys. STUDY DESIGN: During December 4-15, 2020, persons identified as COVID-19 cases whose data was entered into Marin County's contact tracing database on even days received a SMS-linked survey and persons whose data was entered on odd days did not; all were called for case investigation and contact tracing. Chi-square test and Fisher's exact test were used to compare demographic data. Chi-square test was used to contrast categorical outcomes, and Wilcoxon's rank-sum test was used for continuous outcomes. RESULTS: Among 350 SMS-linked survey recipients, 85 (24%) responded and 4 (1%) reported contacts using the survey; an additional 303 contacts were reported during phone interviews. Without phone interviews, 99% of reported contacts would have been missed. There was no meaningful difference between study arms in the proportion of contacts notified within 48 h. CONCLUSIONS: This SMS-linked survey had low participation and was not useful for identifying contacts. Phone interviews remained crucial for COVID-19 contact tracing.

The health of California's immigrant hired farmworkers.

BACKGROUND: Hispanic immigrant workers dominate California's hired farm workforce. Little is known about their health status; even less is known about those lacking employment authorization. METHODS: The California Agricultural Workers Health Survey (CAWHS) was a statewide cross-sectional household survey conducted in 1999. Six hundred fifty-four workers completed in-person interviews, comprehensive physical examinations, and personal risk behavior interviews. RESULTS: The CAWHS PE Sample is comprised mostly of young Mexican men who lack health insurance and present elevated prevalence of indicators of chronic disease: overweight, obesity, high blood pressure, and high serum cholesterol. The self-reported, cumulative, farm work career incidence of paid claims for occupational injury under workers compensation was 27% for males and 11% for females. CONCLUSIONS: The survey finds elevated prevalence of indicators of chronic disease but lack of health care access. Participants without employment authorization reported a greater prevalence of high-risk behaviors, such as binge drinking, and were less knowledgeable about workplace protections.

Normal range of human red blood cell acetylcholinesterase activity.

The normal range of human erythrocyte acetylcholinesterase (RBC-AChE) activity is important when monitoring exposure to pesticides and chemical warfare agents. A modification of Michel's method measured RBC-AChE activities from 991 individuals (818 males and 173 females) presumably unexposed to nerve agents. Median age was 42 (range, 18-76) years. RBC-AChE (mean +/- SD) was 0.74 +/- 0.06 delta pH units/hour. Multivariate linear regression showed an association with age (slope +0.0008 delta pH units/hour for each year; P < 0.001) unlikely to be clinically significant. The findings represent the largest study of human RBC-AChE to date providing measures of central tendency and variation.

Comparison of unsupervised home-based pulmonary rehabilitation versus supervised hospital outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.

Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but still underutilized. The aim of this study was to compare unsupervised home PR with supervised outpatient PR in terms of various clinical variables in COPD patients.Methods: We conducted retrospective study consisting of 247 patients with COPD who were categorized into three group. 127 patients underwent unsupervised home PR, of whom 60 (47%) completed program (finishers), 67(53%) were lost to follow-up (non-finishers), 120 completed supervised outpatient PR. We compared baseline, post-treatment changes in demographic, clinical variables.Results: Sex, age were statistically similar between groups. Finishers of home PR had higher exercise capacity (p = 0.003), quality of life (p = 0.045), FEV1 (p = 0.001), lower pack-year smoking (p < 0.001) than outpatient PR.After home PR, exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea(p < 0.05), anxiety (p < 0.001), depression (p < 0.001) were improved except endurance shutte test. Improvements in exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea (p = 0.023), anxiety (p < 0.001), depression (p = 0.001) scores were different between completed PR programs, in favor of supervised outpatient PR. Non-finishers of home PR had more pack-year smoking than finishers of home PR (p = 0.039); other baseline parameters were similar.Conclusion: Unsupervised home PR was effective in terms of improving exercise capacity, quality of life, dyspnea, psychological status, but less than supervised outpatient programs.

Public health education at the University of California, Davis: past, present, and future programs.

This article reviews the history of public-health education at the University of California, Davis, from the inception of the Master of Preventive Veterinary Medicine Program in the School of Veterinary Medicine through the creation of the Master of Public Health Program offered jointly by the Schools of Medicine and Veterinary Medicine. The long history of collaborative teaching and research between the schools, as well as the university's close proximity to and relationship with numerous university-affiliated and state public-health agencies, has created remarkable opportunities for novel and creative public-health education. The university is already anticipating the approval of a School of Public Health on its campus, which will create even more educational opportunities in both human and veterinary public-health disciplines. Given the projected shortfall of veterinarians entering such fields, the opportunity of a novel Doctor of Public Health degree program specifically suited to the needs of veterinary medicine is also discussed as a means of addressing this shortage.

Differences in workers' compensation disability and impairment ratings under old and new California law.

BACKGROUND: California's workers' compensation law experienced an historic change on January 1, 2005. Previous methods used to rate permanent disability were replaced by new methods to rate permanent impairment. We sought to estimate the difference in ratings under the old and new law. METHODS: We obtained 218 reports on injured workers from attorneys who represented injured workers. A disability expert rated disability and 15 physicians rated impairment. RESULTS: Average percentage point ratings for impairment under the 2005 law were approximately one third the size of ratings for disability under the old law. This estimate showed little variation across demographic groups, physician-evaluators, or injured body part. CONCLUSION: Because cash benefits are keyed to impairment ratings, benefits for permanently disabled workers may decrease as much as 60% under the new law.

Agricultural dust exposure and respiratory symptoms among California farm operators.

OBJECTIVE: To study whether dust exposure in California agriculture is a risk factor for respiratory symptoms. METHODS: A population-based survey of 1947 California farmers collected respiratory symptoms, occupational and personal exposures. Associations between dust and respiratory symptoms were assessed by logistic regression models. RESULTS: The prevalence of persistent wheeze was 8.6%, chronic bronchitis 3.8%, chronic cough 4.2%, and asthma 7.8%. Persistent wheeze was independently associated with dust in a dose-response fashion odds ratio, 1.2 (95% confidence interval[CI]=0.8-2.0) and 1.8 (95% CI=1.1-3.2) for low and high time in dust. A borderline significant association between chronic bronchitis and dust exposure was found. Asthma was associated with keeping livestock, but not with dust exposure. CONCLUSIONS: Occupational dust exposure among California farmers, only one third of whom tended animals, was independently associated with chronic respiratory symptoms.