A longitudinal assessment of heat exposure and biomarkers of kidney function on heat shock protein 70 and antibodies among agricultural workers.

Background: Exposure to extreme heat impacts millions of people worldwide and outdoor workers are among the populations most affected by high temperatures. Heat stress induces several biological responses in humans, including the production of heat shock proteins (HSP) and antibodies against HSP (anti-HSP) which may play a central role in the body's cellular response to a hot environment. Objective: This longitudinal study investigated the impact of high temperatures and humidity on the presence of HSP70 and anti-HSP70 and examined relationships with markers of kidney function in an at-risk workforce under conditions of extreme heat and exertion in Guatemala. Methods: We collected ambient temperature and relative humidity data as well as biomarkers and clinical data from 40 sugarcane workers at the start and the end of a 6-month harvest. We used generalized mixed-effects models to estimate temperature effects on HSP70 and anti-HSP70 levels. In addition, we examined trends between HSP70 and anti-HSP70 levels and markers of kidney function across the harvest. Results: At the end of the harvest, temperatures were higher, and workers had, on average, higher levels of HSP70 and anti-HSP70 compared to the beginning of the season. We observed significant increasing trends with temperature indices and HSP70 levels. Maximum temperature was associated with HSP70 increments after controlling for age, systolic and diastolic blood pressure (ß: 0.21, 95% Confidence Interval: 0.09, 0.33). Kidney function decline across the harvest was associated with both higher levels of anti-HSP70 levels at the end of the harvest as well as greater increases in anti-HSP70 levels across the harvest. Conclusions: These results suggest that workplace heat exposure may increase the production of HSP70 and anti-HSP70 levels and that there may be a relationship between increasing anti-HSP70 antibodies and the development of renal injury. HSP70 holds promise as a biomarker of heat stress in exposed populations.

Small + Safe + Well: lessons learned from a Total Worker Health® randomized intervention to promote organizational change in small business.

BACKGROUND: Leadership commitment to worker safety and health is one of the most important factors when organizations develop and implement a Total Worker Health® approach. We aimed to assess the effectiveness of a Total Worker Health ("TWH") leadership development program that targeted owners and other senior-level leadership positions on changing organizational and worker outcomes from baseline to one-year later. METHODS: The Small + Safe + Well study included small businesses from a variety of industries in the state of Colorado, USA that were participating in Health Links™. We designed a randomized waitlisted control comparison design (RCT) to evaluate the added benefit of a TWH leadership development program. An employer assessment tool was used to assess TWH policies and programs, and an employee health and safety survey was used to assess safety leadership and health leadership practices, safety climate and health climate, safety behaviors and health behaviors, and well-being. We used a linear mixed model framework with random effects for business and employee to assess the impact of intervention on the outcomes of interest. RESULTS: Thirty-six businesses (37% retention) and 250 employees (9% retention) met the RCT study inclusion criteria and were included in the analysis. Businesses improved their TWH policies and programs score from baseline to one-year later, regardless of leadership intervention group assignment. Neither intervention group demonstrated improvements in employee-reported outcomes. CONCLUSIONS: This study sought to address a gap in the literature regarding small business senior leadership development for TWH. Our study demonstrates many of the challenges of conducting studies focused on organizational change in workplaces, specifically in small businesses. When designing TWH intervention studies, researchers should consider how to best engage small business leaders in interventions and implementations early on, as well as methods that are well matched to measuring primary and secondary outcomes longitudinally. Future research is needed to test the feasibility and sustainability of TWH interventions in small business. TRIAL REGISTRATION: The trial was retrospectively registered with ClinicalTrials.gov ( ID U19OH011227 ).

Latin American Agricultural Workers' Job Demands and Resources and the Association With Health Behaviors at Work and Overall Health.

In the present study, we describe the job demands and job resources (JD-R) experienced by agricultural workers in three Latin American countries and their relationship to proactive health behaviors at work and overall health. Following previous research on the JD-R model, we hypothesized that job demands (H1) would be negatively related to agricultural workers' self-reported overall health. On the other hand, we hypothesized that job resources (H2) would be positively related to agricultural workers' overall health. Furthermore, we hypothesized (H3) that workers' engagement in jobsite health promotion practices via their proactive health behaviors at work would partially mediate the relationship between workers' job resources and job demands and overall health. We also had a research question (R1) about whether there were differences by type of job held. The sample of workers who participated in this study (N = 1,861) worked in Mexico, Guatemala, and Nicaragua for one large agribusiness that produces sugar cane. They worked in two distinct areas: company administration and agricultural operations. We administered employee health and safety culture surveys using survey methods tailored to meet the needs of both types of workers. Stratified path analysis models were used to test study hypotheses. In general, we found support for hypotheses 1 and 2. For example, operations workers reported more physically demanding jobs and administrative workers reported more work-related stress. Regardless, the existence of high job demands was associated with poorer overall health amongst both types of workers. We found that workers in more health-supportive work environments perform more proactive health behaviors at work, regardless of their role within the organization. However, hypothesis 3 was not supported as proactive health behaviors at work was not associated with overall health. We discuss future research needs in terms of evaluating these hypotheses amongst workers employed by small- and medium-sized agribusinesses as well as those in the informal economy in Latin America. We also discuss important implications for agribusinesses seeking to develop health promotion programs that meet the needs of all workers.

Enfermedad renal crónica de causa desconocida: investigaciones en Guatemala y oportunidades para su prevención / Chronic kidney disease of unknown cause: investigations in Guatemala and opportunities for its prevention

El Centro para la Salud, el Trabajo y el Ambiente (CHWE por sus siglas en inglés) inició un proyecto de colaboración con Pantaleon, una empresa agrícola de caña de azúcar en Guatemala, para hacer frente a una epidemia de enfermedad renal crónica (ERC) de causa no tradicional (ERCnT) que afecta a las comunidades agrícolas en Centroamérica y otros lugares. Este artículo describe el conocimiento actual de la epidemia en Centroamérica, las manifestaciones clínicas, el tratamiento y el manejo; las hipótesis actuales de su etiología, la colaboración y el enfoque de CHWE-Pantaleon. Nuestro enfoque de Total Worker Health® (TWH) para abordar la salud renal en Guatemala incluye múltiples estudios de investigación con trabajadores de caña de azúcar, para evaluar la prevalencia, incidencia y factores de riesgo de la lesión renal aguda y la ERC; se incluye también el desarrollo e implementación de medidas de prevención mejoradas e intervenciones para proteger a los trabajadores abordando los factores de riesgo ya conocidos. Se examinan también las necesidades futuras de investigación y las implicaciones globales de la ERCnT, al igual que la producción de bienes y la economía, así como las recomendaciones actuales para las estrategias de prevención ocupacional y comunitaria.

The Center for Health, Work and Environment (CHWE) began a collaborative project with Pantaleon, a Guatemalan sugarcane agribusiness, to address an epidemic of chronic kidney disease of unknown cause (CKDu) that affects agricultural communities in Central America and elsewhere. This paper describes the current knowledge of the epidemic in Central America including clinical manifestations, course, and management, current etiology hypotheses, and the CHWE-Pantaleon collaboration and approach. Our Total Worker Health® (TWH) approach to addressing kidney health in Guatemala has included multiple research studies with sugarcane workers to assess prevalence, incidence and risk factors for acute kidney injury and chronic kidney disease, as well as development and implementation of enhanced prevention measures and interventions to protect workers by addressing known risk factors. Future research needs and the global implications of CKDu including for economy and commodity production are discussed, as well as current recommendations for occupational and community prevention strategies.

The impact of industry and body part injured on repeat workers' compensation claims.

BACKGROUND: Few studies investigate the influence of body part injured and industry on future workers' compensation claims. METHODS: Using claims incurred from 1 January 2005 to 31 July 2015 (n = 77 494) from the largest workers' compensation insurer in Colorado, we assessed associations between worker characteristics, second claims involving any body part and the same body part. We utilized Cox proportional hazards models to approximate the probability of a second claim. RESULTS: First claims represented 74.9% (n = 58 007) and second claims 25.2% (n = 19 487) of total claims. Sex, age, industry, and body part of the first claim were associated with the probability of second claims and the body part affected. The 5-year probabilities of second claims and same body part second claims were 27.0% (95% confidence interval [CI]: 26.6%-27.5%) and 6.2% (95% CI: 5.9%-6.5%) in males and 26.5% (95% CI: 26.0%-27.0%) and 6.7% (95% CI: 6.5%-7.0%) in females. Most second claims occurred within 3 years. CONCLUSIONS: Most second claims occur within 3 years. Body part and industry-specific injury patterns suggest missed opportunities for prevention.

Health Links™ Assessment of Total Worker Health® Practices as Indicators of Organizational Behavior in Small Business.

OBJECTIVE: The aim of this study was to conduct a cross-sectional assessment of the adoption of Total Worker Health (TWH) policies and practices by business size and evaluate extent and alignment of their safety and health. METHODS: We conducted an analysis of 382 businesses that completed the Health Links Assessment. We measured organizational adoption of TWH across six benchmarks: organizational supports, workplace assessments, health policies and programs, safety, engagement, and evaluation. RESULTS: Benchmark scores were significantly associated with business size. Larger businesses were more likely to score higher across each benchmark. CONCLUSION: Small businesses are implementing TWH in a variety of ways and the level of implementation differs by business size. Practical interventions as well as dissemination and implementation research should take business size into account to ensure that TWH is both effective and sustainable in meeting the needs of employees.

Health Risk Calculator: An Online, Interactive Tool to Estimate how Health Impacts Workers' Compensation Claim Incidence and Cost.

OBJECTIVE: The purpose of this paper is to describe and evaluate a web-based, educational Health Risk Calculator that communicates the value of investing in employee health and well-being for the prevention of work-related injuries, illnesses, and fatalities. METHODS: We developed and evaluated the calculator following the RE-AIM framework. We assessed effectiveness via focus groups (n = 15) and a post-use survey (n = 33) and reach via website analytics. RESULTS: We observed evidence for the calculator's usability, educational benefit, and encouragement of action to improve worker health and safety. Website analytics data demonstrated that we reached over 300 users equally in urban and rural areas within 3 months after launch. CONCLUSION: We urge researchers to consider the ways in which they can communicate their empirical research findings to their key stakeholders and to evaluate their communication efforts.

Reoccurring Injury, Chronic Health Conditions, and Behavioral Health: Gender Differences in the Causes of Workers' Compensation Claims.

OBJECTIVE: The aim of this study was o examine how work and nonwork health-related factors contribute to workers' compensation (WC) claims by gender. METHODS: Workers (N = 16,926) were enrolled in the Pinnacol Assurance Health Risk Management study, a multiyear, longitudinal research program assessing small and medium-sized enterprises in Colorado. Hypotheses were tested using gender-stratified logistic regression models. RESULTS: For both women and men, having incurred a prior WC claim increased the odds of a future claim. The combination of incurring a prior claim and having metabolic health conditions resulted in lower odds of a future claim. Behavioral health risk factors increased the odds of having a claim more so among women than among men. CONCLUSION: This study provides data to support multifactorial injury theories, and the need for injury prevention efforts that consider workplace conditions as well as worker health.

Health risk factors as predictors of workers' compensation claim occurrence and cost.

OBJECTIVE: The objective of this study was to examine the predictive relationships between employee health risk factors (HRFs) and workers' compensation (WC) claim occurrence and costs. METHODS: Logistic regression and generalised linear models were used to estimate the predictive association between HRFs and claim occurrence and cost among a cohort of 16 926 employees from 314 large, medium and small businesses across multiple industries. First, unadjusted (HRFs only) models were estimated, and second, adjusted (HRFs plus demographic and work organisation variables) were estimated. RESULTS: Unadjusted models demonstrated that several HRFs were predictive of WC claim occurrence and cost. After adjusting for demographic and work organisation differences between employees, many of the relationships previously established did not achieve statistical significance. Stress was the only HRF to display a consistent relationship with claim occurrence, though the type of stress mattered. Stress at work was marginally predictive of a higher odds of incurring a WC claim (p<0.10). Stress at home and stress over finances were predictive of higher and lower costs of claims, respectively (p<0.05). CONCLUSIONS: The unadjusted model results indicate that HRFs are predictive of future WC claims. However, the disparate findings between unadjusted and adjusted models indicate that future research is needed to examine the multilevel relationship between employee demographics, organisational factors, HRFs and WC claims.