Health and Safety in the Legal Cannabis Industry Before and During COVID-19.

In 2020, medical cannabis is legal in thirty-six states and adult use ("recreational") cannabis is legal in fifteen, despite cannabis remaining illegal at the federal level. Up to 250,000 individuals work as full-time employees in cannabis. During the COVID-19 pandemic, California, Colorado, and other states deemed medical cannabis business as essential, raising occupational challenges and safety issues for cannabis employees. In 2020, interviews were conducted with Ethan, an extraction lab assistant in Las Vegas; Haylee, a trainer with a cannabis company in Sacramento; and Belinda, a Wisconsin-based occupational health and safety trainer, to showcase concerns and experiences in cannabis workplaces and training programs. Findings from interviews reveal pro-worker activities to promote workplace safety and labor unionism while large multistate operators seek to optimize profits and obstruct workers' rights. Knowledge gained through the interviews contributes to discussions to lessen the potential exposure of the cannabis workforce to COVID 19.

Experience from a Singapore tertiary hospital with restructuring of a vascular surgery practice in response to national and institutional policies during the COVID-19 pandemic.

Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on January 23, 2020. For 2 weeks in February, we had the highest number of COVID-19 cases behind China. In this article, we summarize the key national and institutional policies that were implemented in response to COVID-19. We also describe in detail, with relevant data, how our vascular surgery practice has changed because of these policies and COVID-19. We show that with a segregated team model, the vascular surgery unit can still function while reducing risk of cross-contamination. We explain the various strategies adopted to reduce outpatient and inpatient volume. We provide a detailed breakdown of the type of vascular surgical cases that were performed during the COVID-19 pandemic and compare it with preceding months. We discuss our operating room and personal protective equipment protocols in managing a COVID-19 patient and share how we continue surgical training amid the pandemic. We also discuss the challenges we might face in the future as COVID-19 regresses.

Caring for Workers' Health: Do German Employers Follow a Comprehensive Approach Similar to the Total Worker Health Concept? Results of a Survey in an Economically Powerful Region in Germany.

Similar to 'Total Worker Health' in the United States (USA), 'Workplace Health Management' in Germany is a holistic strategy to protect, promote, and manage employees' health at the workplace. It consists of four subcategories. While the subcategories 'occupational health and safety' and 'reintegration management' contain measures prescribed by law, 'workplace health promotion' and 'personnel development' can be designed more individually by the companies. The present study focused on the current implementation of voluntary and legally required measures of the four subcategories, as well as companies' satisfaction with the implementation. A total of N = 222/906 companies (small, medium, and big enterprises of one German county) answered a standardized questionnaire addressing the implementation of health-related measures, satisfaction with the implementation, and several company characteristics. In the subcategory 'occupational health and safety', 23.9% of the companies fulfilled all of the legally required measures, whereas in the category 'reintegration management', that rate amounted to 50.9%. There was a positive correlation between company size and the implementation grade, and as well between company size and the fulfilling of measures required by law. Companies tended to be more satisfied with higher implementation grades. Nevertheless, a surprisingly high proportion of the companies with poor implementation indicated satisfaction with the measures' implementation.

Situation of Occupational and Environmental Health in Mexico.

BACKGROUND: Mexico has a great diversity and richness of natural resources, but evaluations of the quality of life of Mexicans show the deep inequalities and the gap between rich and poor. While 5% of families concentrate 58% of the wealth, the health spending in environment and health is 0.2 and 2.7 of the GDP respectively. This has repercussions both on the gradual deterioration of the environment and on the insufficient health and social security coverage of the working population. OBJECTIVE: To describe the current situation of occupational and environmental health in Mexico. METHODS: A bibliographic review was performed on the socioeconomic, demographic, environmental, legal and health status of the Economically Active Population (EAP). FINDINGS: There is a constant deterioration of terrestrial and marine ecosystems, accompanied by an increase in environmental pollution in large cities. The unemployment rate of the EAP has decreased in one year to 3.4%, but the informal labor rate reached 57.3%, which translates into population without social security. Compliance with legislation for the protection of workers' health is insufficient. The recent amendments to the law have meant a setback in these respects. The reported information on accidents and occupational diseases corresponds to only 34% of workers. There has been a decrease in the rate of work accidents in the last six years, but an increase in diseases and permanent disabilities. During 2016, the first cause of occupational illness was hearing loss, but the profile was dominated by musculoskeletal diseases, which together reached 36.5%. CONCLUSIONS: To improve the occupational and environmental health situation, it is necessary to implement general and particular measures against inequalities, increase the budget in health and environment, enforce legislation and expand social security coverage to the population. These measures should be part of public policies as well as actions of academics and researchers.

Creating a Future for Occupational Health.

Objectives: Economic, social, technical, and political drivers are fundamentally changing the nature of work and work environments, with profound implications for the field of occupational health. Nevertheless, researchers and practitioners entering the field are largely being trained to assess and control exposures using approaches developed under old models of work and risks. Methods: A speaker series and symposium were organized to broadly explore current challenges and future directions for the occupational health field. Broad themes identified throughout these discussions are characterized and discussed to highlight important future directions of occupational health. Findings: Despite the relatively diverse group of presenters and topics addressed, some important cross-cutting themes emerged. Changes in work organization and the resulting insecurity and precarious employment arrangements change the nature of risk to a large fraction of the workforce. Workforce demographics are changing, and economic disparities among working groups are growing. Globalization exacerbates the 'race to the bottom' for cheap labor, poor regulatory oversight, and limited labor rights. Largely, as a result of these phenomena, the historical distinction between work and non-work exposures has become largely artificial and less useful in understanding risks and developing effective public health intervention models. Additional changes related to climate change, governmental and regulatory limitations, and inadequate surveillance systems challenge and frustrate occupational health progress, while new biomedical and information technologies expand the opportunities for understanding and intervening to improve worker health. Conclusion: The ideas and evidences discussed during this project suggest that occupational health training, professional practice, and research evolve towards a more holistic, public health-oriented model of worker health. This will require engagement with a wide network of stakeholders. Research and training portfolios need to be broadened to better align with the current realities of work and health and to prepare practitioners for the changing array of occupational health challenges.

Part III: Occupational Disability Determination/Rehabilitation Best Practices and the Role of Situational Work Assessment and Simulated Work/Academic Trials.

This is the final in a series of three papers addressing common occupational disability entitlements from an Ontario motor vehicle accident (MVA) perspective, which are also applicable to long-term disability cases. The first paper supported using a holistic model in the assessment of accident injured persons who are unable to return to the pre-accident occupation (pre- 104 disability/"own occupation") because of accident-caused impairments. The second paper discussed case law, best practice and the Post-104 Week IRB Disability ("any occupation") test and demonstrated the difficulties individuals face when they are unable to return to work in the aftermath of a debilitating motor vehicle accident. In this third and final paper, the purposes and roles of the Situational Work Assessment and Simulated Work/Academic Trials are critically evaluated in the occupational disability context. These methodologies are used to determine an individual's capacity to competitively meet the physical, cognitive and interpersonal/behavioural demands of his or her pre-condition occupation, or any occupation for which he or she is suited by education, training or experience, thereby addressing entitlement to income replacement benefits (IRB). It is vital that occupational disability assessments are comprehensive, holistic, include an undestanding of the synergistic impact of the impairment on the individual's physical, cognitive and psychosocial work capacities, and are conducted through multi-modal means. To conclude, the overriding principles and themes of all three articles are synthesized.

Common Occupational Disability Tests and Case Law References: An Ontario MVA perspective on interpretation and best practice methodology supporting a holistic model, Part I of III (Pre-104 IRB).

This three-part paper presents practical holistic models of determining impairment and occupational disability with respect to common "own occupation" and "any occupation" definitions. The models consider physical, emotional and cognitive impairments in unison, and draw upon case law support for empirically based functional assessment of secondary cognitive symptoms arising from psychological conditions, including chronic pain disorders. Case law is presented, primarily in the context of Ontario motor vehicle accident legislation, to demonstrate how triers of fact have addressed occupational disability in the context of chronic pain; and interpreted the "own occupation" and "any occupation" definitions. In interpreting the definitions of "own occupation" and "any occupation", courts have considered various concepts, such as: work as an integrated whole, competitive productivity, demonstrated job performance vs. employment, work adaptation relative to impairment stability, suitable work, retraining considerations, self-employment, and remuneration/socio-economic status. The first segment of the paper reviews the above concepts largely in the context of pre-104 Income Replacement Benefit (IRB) entitlement, while the second segment focuses on post-104 IRB entitlement. In the final segment, the paper presents a critical evaluation of computerized transferable skills analysis (TSAs) in the occupational disability context. By contrast, support is offered for the notion that (neuro) psychovocational assessments and situational work assessments should play a key role in "own occupation" disability determination, even where specific vocational rehabilitation/retraining recommendations are not requested by the referral source (e.g., insurer disability examination).

Danger and Dignity: Immigrant Day Laborers and Occupational Risk.

The plight of immigrant workers in the United States has captured significant scholarly attention in recent years. Despite the prevalence of discourses regarding this population, one set of issues has received relatively little attention: immigrant workers' exposure to unhealthy and unsafe working conditions, and their corresponding susceptibility to workplace injuries and illnesses. Researchers have consistently found that immigrant workers suffer disproportionately from occupational injuries and fatalities, even when controlling for industry and occupation. Why, then, are foreign-born workers at greater risk for workplace injuries and fatalities, when compared with their native-born counterparts? This Article seeks to develop answers to that question with the aid of empirical research and to build upon a growing interdisciplinary literature. This Article presents findings from a qualitative research study designed to explore the factors that shape occupational risks for immigrants. The study, conducted over several months in 2014, centered on in-depth interviews of eighty-four immigrant day laborers seeking employment in different parts of Northern Virginia. The workers' responses present a complex picture of the immigrant worker experience, reflecting persistent dangers alongside powerful expressions of worker dignity: while the Virginia day laborers continue to encounter significant occupational risks, many comfortably asserted their rights, complicating standard narratives of immigrant worker subordination and vulnerability. The results of the study also point to ongoing economic insecurities, and regulatory failures relating to the provision of training, use of protective equipment, and oversight of smaller worksites. The findings also signal the need for a more holistic approach to workplace regulation that concomitantly examines a range of workplace concerns, including wage violations, hostile work environments, and health and safety risks. Finally, the day laborers' experiences reveal that worker centers are well positioned to insulate immigrant workers from workplace risks, by promoting transparency and accountability in the employer-employee relationship.

PART II: Case Law, Best Practice and the Post-104 Week IRB Disability Test.

The following is Part II of a three-part paper presenting holistic models of determining impairment and occupational disability with respect to common "own occupation" and "any occupation" definitions, especially in the motor vehicle accident (MVA) context. This segment of the paper is for the purpose of educating readers regarding pertinent case law and related evolving judicial/arbitral interpretations surrounding the Post 104-week income replacement entitlement within the Ontario MVA insurance system. Best practices in disa- bility assessment methodology and analysis are supported in the context of holistic occupational disability assessment models in relation to the relevant case law. Comparative analysis was also utilized to inform the reader of the emphasis upon the quality of activity engagement across pre- and post- 104 week spheres. Beyond the MVA sphere, medically-legally, the reviewed case law and related clinical best practices are fully germane to the long term disability and WSIB (workers' compensation) sectors. A specific area emphasized by authors is that the assessment of pain is more complex than is generally acknowledged in many disability assessments. Research on the impact of pain on individuals with disabilities and impairments arising from injuries sustained, clearly demonstrates that traditional pain measurements are often inadequate to fully determine the disability arising from pain. Finally, particularly in the context of In- surance Examinations (lEs and Independent Medical Assessments for LTD), the principle of competitive employability is often not considered as it should be in accordance with the existing case law.

Occupational Safety and Health in Peru.

Peru is a country located on the Pacific coast of South America with a population of more than 30 million inhabitants. In the past 10 years, Peru has had a steady economic growth. Peru is predominantly an extractive industry country, but the manufacturing and construction sectors are booming. It is in this context that regulations have been implemented to protect the safety and health of workers. One of the most important regulations is the Law on Safety and Health at Work, which has been recently promulgated. Regulations are complemented by training and education in occupational safety and health. The measures are yet to be fully implemented thus a positive effect in reducing accidents and occupational diseases at work has not yet been seen.

Apertura de la herramienta manual y fuerza de aprehensión durante el corte de flores / Manual tool grip span and grip force during flower cutting

Objetivo: Analizar la relación entre la apertura de la herramienta manual de corte de flores y la fuerza ejercida por cada dedo de la mano operante durante el gesto de aprehensión. Métodos: Se desarrolló un experimento con 11 mujeres que realizaron el corte del tallo de una flor. Las operarias no sufrían del síndrome del túnel carpiano. Se calculó el diámetro de apertura de la herramienta cuando la fuerza de aprehensión en cada dedo era máxima al realizar el corte. Resultados: El principal hallazgo del estudio revela que los dedos ejercen el pico máximo de su fuerza de aprehensión cuando el valor del diámetro de apertura de la herramienta es igual para todos los dedos. Sin embargo, debido a las características formales de la herramienta comúnmente usada en el sector floricultor colombiano (palanca de primer orden), cada dedo realiza el pico máximo de la fuerza de aprehensión en diferentes instantes en el tiempo, desaprovechando la capacidad total de la fuerza de aprehensión. Conclusiones: Este hallazgo podría ser utilizado para mejorar la ventaja mecánica de las herramientas manuales de corte y reducir los factores de riesgo del síndrome del túnel carpiano debidos al sobresfuerzo

Objective: To analyze the association between grip span of a manual flower cutting tool and maximum peak force exerted by each finger in the operating hand during apprehension. Methods: An experiment was conducted in which 11 women performed the stem cut of a flower. These women did not suffer from carpal tunnel syndrome. Grip span was calculated when they exerted the maximum peak force with each finger. Results: The main finding of the study reveals that fingers exert the maximum peak force when the grip span values are the same for everyone. However, due to the shape of the tool commonly used in the Colombian flower industry (first order level), each finger reaches its maximum peak force at different times, bypassing the full capacity of each finger’s grip force. Conclusion: These findings could be used to improve the mechanical advantage of manual cutting tools to reduce risk factors for carpal tunnel syndrome due to overexertion

[Occupational lung diseases caused by exposure to chrysotile asbestos dust and the preventive measures].

To reveal major principles in system of occupational lung diseases prevention among workers engaged into extraction and usage of chrysotile asbestos, the authors specified main criteria for diagnosis of asbestos-related pulmonary diseases and signs of exposure to chrysotile dust, with identification of risk groups for occupational diseases development. The authors formulated main principles of prevention and rehabilitation for workers with asbestos-related pulmonary diseases. Special attention was paid to harmonization of all medical and technical measures aimed at prevention and liquidation of occupational asbestos-related diseases.

[The INSuLa Project: the knowledge survey of company physicians]. / Progetto INSuLa: I'indagine conoscitiva sui medici competenti.

The technological advancements, the occurrence of new emerging occupational risks and diseases, and the changes in the regulatory framework for occupational health and safety induce a constant evolution of occupational medicine. Consequently, the skills and training needs of the occupational physicians should be periodically revalued and upgraded in order to identify technical and operational issues and problems of this discipline. In this context, the aim of this national survey, carried out using a self-administered questionnaire submitted to a sample of 1,237 occupational physicians, has been to gain helpful information to ensure a continuous improvement of the quality and effectiveness of measures aimed at protecting the health and safety of workers. The questionnaire, that consists of 43 questions divided into 5 different areas (personal and professional information, training and updating needs of occupational physicians, professional activities and relationships with the corporate prevention system, relationships with the supervisory board of the Local Health Authority, relationships with the National Health Service), allowed to obtain personal and professional data, to assess the training needs and demands of occupational physicians and to evaluate their relationships with the other stakeholders of the Italian prevention system and with the National Health Service. The preliminary results of this survey appear extremely important. In fact, this findings, highlighting the current problems of occupational physician, constitute the starting point to identify, develop and implement management methodologies, operative procedures and training programs that are effective and modern.

An overview of occupational voice disorders in Poland.

Occupational voice disorders make the most frequently certified category of occupational diseases in Poland, making up approximately 20% of all cases. This study presents the current knowledge of the etiopathogenesis of occupational voice disorders. It stresses the importance of the evaluation of vocal loading by means of objective measurements. Furthermore, this study discusses the medico-legal aspects of the procedure of certifying occupational voice disorders in Poland. The paper also describes the preventive programs addressed particularly to teachers, including multidisciplinary and holistic management of occupational dysphonia. Their role in the improvement of occupational safety and health (OSH) arrangement for vocally demanding professions is emphasized.

The future of exposure assessment: perspectives from the X2012 Conference.

The British Occupational Hygiene Society, in collaboration with the Institute of Occupational Medicine, the University of Manchester, the UK Health and Safety Executive, and the University of Aberdeen hosted the 7th International Conference on the Science of Exposure Assessment (X2012) on 2 July-5 July 2012 in Edinburgh, UK. The conference ended with a special session at which invited speakers from government, industry, independent research institutes, and academia were asked to reflect on the conference and discuss what may now constitute the important highlights or drivers of future exposure assessment research. This article summarizes these discussions with respect to current and future technical and methodological developments. For the exposure science community to continue to have an impact in protecting public health, additional efforts need to be made to improve partnerships and cross-disciplinary collaborations, although it is equally important to ensure that the traditional occupational exposure themes are still covered as these issues are becoming increasingly important in the developing world. To facilitate this the 'X' conferences should continue to retain a holistic approach to occupational and non-occupational exposures and should actively pursue collaborations with other disciplines and professional organizations to increase the presence of consumer and environmental exposure scientists.