Responsibilities of the Occupational and Environmental Medicine Provider in the Treatment and Prevention of Climate Change-Related Health Problems.

: Workers are uniquely susceptible to the health hazards imposed by environmental changes. Occupational and environmental medicine (OEM) providers are at the forefront of emerging health issues pertaining to working populations including climate change, and must be prepared to recognize, respond to, and mitigate climate change-related health effects in workers. This guidance document from the American College of Occupational and Environmental Medicine focuses on North American workers health effects that may occur as a result of climate change and describes the responsibilities of the OEM provider in responding to these health challenges.

Patterns of Opioid Prescribing and Predictors of Chronic Opioid Use in an Industrial Cohort, 2003 to 2013.

OBJECTIVE: To appreciate the impact of the opioid epidemic in workers, we described opioid prescription patterns in a US industrial cohort over a 10-year period and assessed predictors of chronic prescription. METHODS: A multiyear (2003 to 2013) cross-sectional analysis of employer-sponsored health care claims for enrolled workers (N: 21,357 to 44,769) was performed. RESULTS: The proportion of workers prescribed opioids nearly doubled in the 10-year period. The strongest predictor of chronic opioid prescribing was year, with an increase in prescriptions each year from 2003 to 2013 (odds ratio = 2.90, 95% confidence interval: 2.41 to 3.48). Additional predictors included older age, white race, hourly wage, low back pain, and osteoarthritis. CONCLUSIONS: Opioid prescribing for industrial workers substantially increased from 2003 to 2013. Occupational health professionals should be aware of the potential for chronic opioid use among workers to assess job safety and appropriate treatment of work-related injuries.

Community-based Participatory Research Is Needed to Address Pulmonary Health Disparities.

Socioeconomic and racial disparities in the outcomes of medical management remain common across pulmonary diseases in the United States and worldwide. Acknowledging this, the American Thoracic Society recently put forth recommendations to advance respiratory health equity. Through engagement of vulnerable communities in search of collaborative solutions to improve health disparities, community-based participatory research embodies concepts essential to the American Thoracic Society mission for respiratory health equity. The purpose of this commentary is to provide an overview of the principles of community-based participatory research and the application of this approach to addressing inequity in the outcomes of treatment for lung disease. Community-based participatory research aims to decrease health disparities by recognizing the social and ecological paradigms of health care and by partnering community members with academic researchers in all aspects of the research process. Community partners are uniquely poised to offer insight into local culture, circumstances that guide health behaviors, and other challenges to improve their own community's health. Sustainable interventions, either through strengthening existing community assets or through community empowerment and local capacity building throughout the research process, are essential to the success of community-based participatory research. The National Institutes of Health and other funding agencies offer funding opportunities to support specific interventions aimed at engaging community members in the research process. In pulmonary medicine, community-based initiatives have focused primarily on improving pediatric asthma outcomes. Using a community-based approach in adult asthma and other pulmonary diseases could be an ideal manner in which to decrease pulmonary health disparities.

Prevalence and prognostic role of triple-negative breast cancer by race: a surveillance study.

INTRODUCTION: Emerging research suggests a substantially greater prevalence of the adverse triple-negative (TN) subtype (human epidermal growth factor receptor [HER]2(-), estrogen receptor [ER](-), and progesterone receptor [PR])(-)) among black patients with breast cancer. No reports however have been generated from a statewide cancer registry. PATIENTS AND METHODS: The study consisted of all black patients (N = 643) and a random sample of white patients (n = 719) diagnosed with primary invasive breast cancer (2000-2003) listed in the National Cancer Institute-Surveillance Epidemiology and End Results (NCI-SEER) Connecticut Tumor Registry (CTR). HER2 status was obtained from pathology reports submitted to the registry. Remaining data were obtained from the registry database. RESULTS: TN tumors were more prevalent in black compared with white patients (30.8% vs. 11.2%, respectively; P < .001.) There was a 2-fold greater frequency of ER(-) and PR(-) phenotypes among black patients, but HER2 status did not differ by race. Patients with lobular cancer were less likely to have TN breast cancer compared with patients with ductal tumors (odds ratio [OR] = 0.23; 95% confidence interval [CI], 0.10-0.58). Among patients with regional disease, black patients exhibited increased risk of death (relative risk [RR] = 2.71; 95% CI, 1.48-4.97) independent of TN status. No survival disparity was found among patients with local disease. DISCUSSION: These registry-based data corroborate reports that TN breast cancer varies substantially by race and histologic subtype. A survival disparity among patients with advanced disease, but not local disease, casts some doubt on TN status as an explanation for differences. CONCLUSION: More research is warranted to understand why black patients with advanced breast cancer may be at increased risk for death whether or not their tumors express the TN phenotype.

Trophic transition in a lake on the Virginia coastal plain.

To examine possible connections between lake trophic status and runoff from surrounding subwatersheds, we determined patterns of sediment and nutrient deposition in a hypereutrophic, 16-ha impoundment on the Virginia coastal plain. Spatial survey of nutrients in surface sediments documented a strong correlation between total P and extractable Fe (r2 = 0.53). Elevated biogenic silica concentrations up to 0.25% by weight were measured in sections of the lake receiving perennial stream discharge. Sediment C to N ratios were > 20 in those same sections, suggesting a large allochthonous contribution to organic matter deposition. Sediment cores 0.9 to 2.3 m in length, representing 70 years of deposition, were analyzed to develop vertical profiles of changes in sediment and nutrient deposition in deltas downstream from two more-developed and three less-developed subwatersheds (with 49 and 9% commercial and residential development, respectively). The average sediment weight percent +/- standard deviation of biogenic silica (0.027 +/- 0.037 vs. 0.009 +/- 0.006%) and total P (0.040 +/- 0.025 vs. 0.024 +/- 0.019%) was significantly higher downstream of more-developed subwatersheds. Using elevated P loadings and biogenic silica deposition as proxies for algal production, transition of the lake to its current hypereutrophic state appears to have occurred in the last 70 yr. Changes in trophic status as revealed by sediment analysis of this small lake on the Virginia coastal plain reflect a common pattern of eutrophication observed for the entire Chesapeake Bay drainage basin. Analysis of sediments from stream deltas appears to be a reasonable strategy for identifying and targeting subwatershed areas needing better management of nutrient runoff that otherwise would lead to eutrophication of downstream waters.