The Covid-19 Pandemic and The Future of Work.

INTRODUCTION: The "future of work" refers to workplace modifications projected to occur following large scale events impacting workforce health and safety such as pandemics, technological advancements, or economic shifts. This paper examines the influence of the COVID-19 pandemic on the future of work. METHODS: The electronic databases PubMed, Google Scholar, and Scopus were explored using search terms such as "post-pandemic," "working force," and "future of work" to retrieve papers published between 2000 and 2023. RESULTS: The main characteristics of the future of work modification revealed are blurring of work-home boundaries, increase in telework and the gig economy, demand for artificial intelligence, smart working, quiet hiring, diversity and inclusion, and algocratic governance. Needed skills include virtual collaboration capability, cross-cultural competency, computational thinking, news media literacy, transdisciplinarity, sense making, and focusing on mental health and well-being. CONCLUSIONS: Organizations are remodeling workforces to meet employee, employer, regulatory, and market expectations to adapt to future workplace needs.

Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers' Compensation System? A 10-Year Study of Workers' Compensation Claims From a Large Nationwide Workers' Compensation Insurance Carrier.

BACKGROUND: Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population. OBJECTIVE: To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers' compensation (WC). METHOD: A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed. RESULTS: The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement. CONCLUSIONS: Undergoing an AM is associated with an increased risk of TKA in WC claimants.

Outcomes for a Heat Illness Prevention Program in Outdoor Workers: A 9-Year Overview.

OBJECTIVE: To describe the outcomes effect of removing the medical surveillance component from a heat illness prevention program (HIPP) for outdoor workers from a Central Texas municipality. METHODS: Heat-related illness (HRI) frequency and workers' compensation (WC) cost were assessed retrospectively in a cohort of 329 workers from 2011-2019. During 2011-2017, the HIPP included training, acclimatization, and medical surveillance. In 2018-2019, a modified (mHIPP) was implemented that included training and acclimatization, but without medical surveillance. RESULTS: The HRI rate during HIPP averaged 19.5 per 1000 workers during the first 4 years, dropped to 1.01 per 1,000 workers over the next 3 years, (2015-2017), and increased during mHIPP, to 7.6 per 1,000 workers. DISCUSSION: Although the case increase during the mHIPP was small, medical surveillance may be an important component in lowering workforce HRI.

Levels and in vitro functional effects of circulating anti-hinge antibodies in melanoma patients receiving the immune checkpoint inhibitor pembrolizumab.

The efficacy of PD-1 monoclonals such as pembrolizumab can be modulated by the signals delivered via their Fc region. Tumour/inflammation associated proteases can generate F(ab')2 fragments of therapeutic monoclonals, and subsequent recognition of F(ab')2 epitopes by circulating anti-hinge antibodies (AHA) can then, potentially, link F(ab')2 binding to the target antigen with novel Fc signalling. Although elevated in inflammatory diseases, AHA levels in cancer patients have not been investigated and functional studies utilising the full repertoire of AHA present in sera have been limited. AHA levels in pembrolizumab treated melanoma patients (n = 23) were therefore compared to those of normal donors and adalimumab treated patients. A subset of melanoma patients and the majority of adalimumab patients had elevated levels of AHA reactive with F(ab')2 fragments of IgG4 anti-PD-1 monoclonals (nivolumab, pembrolizumab) and IgG1 therapeutic monoclonals (rituximab, adalimumab). Survival analysis was restricted by the small patient numbers but those melanoma patients with the highest levels (>75% percentile, n = 5) of pembrolizumab-F(ab')2 reactive AHA had significantly better overall survival post pembrolizumab treatment (p = 0.039). In vitro functional studies demonstrated that the presence of AHA+ sera restored the neutrophil activating capacity of pembrolizumab to its F(ab')2 fragment. Neither pembrolizumab nor its F(ab')2 fragments can induce NK cell or complement dependent cytotoxicity (CDC). However, AHA+ sera in combination with pembrolizumab-F(ab')2 provided Fc regions that could activate NK cells. The ability of AHA+ sera to restore CDC activity was more restricted and observed using only one pembrolizumab and one adalimumab patient serum in combination with rituximab- F(ab')2. This study reports the presence of elevated AHA levels in pembrolizumab treated melanoma patients and highlight the potential for AHA to provide additional Fc signaling. The issue of whether tumour associated proteolysis of PD-1 mAbs and subsequent AHA recognition impacts on treatment efficacy requires further study.

Perceptions of the Availability of Personal Protective Equipment and Its Association With Burnout Among US Healthcare Personnel During the SARS-CoV-2 Pandemic, 2020-2021.

OBJECTIVE: The aim of the study is to explore associations among personal protective equipment (PPE) availability, workplace environment, and burnout among US healthcare personnel during the COVID-19 pandemic. METHODS: The study used an online healthcare provider (HCP) survey (December 2020-February 2021) regarding PPE confidence, availability, burnout, and workplace environment. RESULTS: Lack of appropriate PPE was reported by 27% of 799 US HCP surveyed. Burnout, reported by 77% of HCP, was more likely among females, those with fewer years of professional experience, and those with a higher desire to quit, and less likely for those who perceived PPE was adequate or their employer took all steps to minimize workplace risks. CONCLUSIONS: This study suggests that lack of adequate PPE can lead to HCP burnout, which may result in employees quitting. A pandemic preparedness plan that includes adequate PPE is essential for HCP well-being, patient health, and employer fiscal health.

COVID-19 vaccine uptake before and after a vaccine mandate at a major academic hospital: Trends by race/ethnicity and level of patient contact.

OBJECTIVES: To assess vaccine coverage rates before and after implementation of a COVID-19 vaccine mandate among Health care Personnel (HCP) and demographic characteristics associated with vaccine uptake Design, Setting, and Participants: Cohort study conducted among 10,889 hospital employees followed from Dec 16, 2020 - October 31, 2021, at a large academic hospital in Philadelphia. MAIN OUTCOME AND MEASURES: Time to COVID-19 vaccination and vaccine series completion rates before and after implementation of a COVID-19 vaccine mandate based on age, gender, race/ethnicity, and level of patient contact/occupational group. RESULTS: The vaccination series completion rate was 86.0% prior to mandate announcement, and increased to 98.7% after mandate implementation. Rates before mandate announcement were highest among Asians (96.2%), Whites (94.0%), males (89.7%), employees ≥ 65 years of age (95.2%), and employees with direct patient care (physicians, 99.0%, and nurses, 93.3%). Hospital educational initiatives (including Town Halls and discussions with Black and Hispanic employees with the lowest vaccination rates) appeared to improve uptake. The largest increase in series completion after mandate announcement occurred among Blacks, those of other/multiracial backgrounds, and Hispanics (35.6%, 22.4%, and 10.8%, respectively) as well as those with some or no direct patient contact (24.5% and 18.3%, respectively). Medical or religious exemptions were approved for 64 (<0.6%) employees and 38 (<0.4%) left their positions (8 voluntary, 30 involuntary) specifically due to the COVID-19 vaccine mandate. No clinically meaningful differences by age, gender, or race/ethnicity for those who were vaccinated under the mandate versus those who left their positions were noted. CONCLUSIONS AND RELEVANCE: These results suggest that while mandates may be challenging to institutions and enforcement unpopular, they play an important role in reducing hesitancy and securing high vaccination rates among HCP, a group at high risk of COVID-19 given their employment and who can be a source of disease transmission to patients.

Dose Escalations Among Workers' Compensation Claimants Using Opioid Medications-An 8 Year Postinjury Follow up Study.

OBJECTIVE: The aim of the study is to determine the morphine equivalent dose in milligrams (MED)/day escalation trend after initial utilization. METHODS: A total of 25,108 lost time claims filed between 1998 and 2007 were followed for 8 years from injury date. Claims were stratified by initial MED/day at 3 months after injury into four groups (0, 1 to < 15, 15 to < 30, and ≥30 MED/day). The slopes in MED/year of opioid dose escalation were determined for each initial MED/day group. RESULTS: The slopes of MED/day escalation by initial MED categories were similar ( P ≥ 0.05) ranging from 5.38 to 7.76 MED annually. On average, MED/day increased in a liner pattern with a slope at 6.28 MED/year ( P < 0.01). CONCLUSIONS: Opioid MED/day increased in a linear pattern, regardless of initial MED/day dose.

Best Practices for Implementation of an Employee Health COVID-19 Vaccine Clinic-A Model for Future Pandemic Preparedness.

OBJECTIVES: The aims of the study are to determine best practices from two large-scale, academic medical centers' employee coronavirus 2019 (COVID-19) vaccination clinics and to apply them to create scalable modules for rapid administration of 10,000 vaccinations. METHODS: The weekly number of COVID-19 vaccine doses administered was captured. Processes were compared to determine best practices, which informed the scalable financial model. RESULTS: Within the first 3 months, more than 60,000 COVID-19 vaccine doses were administered, and 70% of employees were fully vaccinated in 4 months with more than 95% by the vaccine mandate deadline. The estimated cost of delivering one dose was $29.95 ($299,505/10,000) compared with $35-$39 per dose when delivered by an on-site retail pharmacy. CONCLUSIONS: Successful, safe, and rapid delivery of more than 60,000 COVID-19 vaccine doses in 3 months is practical and scalable. Learnings go beyond COVID-19 and can be applied to future outbreaks/pandemics.

Marked Decreases in Time Lost From Work Among COVID-19 Claimants During the SARS-CoV-2 Pandemic: An Observational Study of Claims Filed at a Nationwide US Workers Compensation Insurance Carrier.

OBJECTIVE: To explore the long-term persistence of COVID-19-related impairment and the ability to work after the acute phase of the illness. METHOD: The 19,101 COVID-19 workers' compensation claims filed between January 1, 2020, and December 31, 2021, with follow-up to May 31, 2022, were analyzed. RESULTS: The average time lost from work decreased from 77 days in the first quarter of 2020 to 9.2 days in the fourth quarter of 2021, and the proportion of claims with 30 days or more of lost time decreased from 40.4% to 2.8 days in the same time frame. CONCLUSION: COVID-19 indemnity claims filed in later quarters of the SARS-CoV-2 pandemic have much lower average time lost from work and lower proportions of workers' compensation claims with more than 30, 60, and 150 days of lost time compared with earlier quarters.

Perspectivas sobre a educação de alunos com deficiência na África do Sul: desafiando a cultura do silêncio

A África do Sul estabeleceu um sistema de Educação Inclusiva que mantém escolas especiais para atender estudantes que demandam grandes necessidades de apoio e centros de apoio vizinhos às escolas comuns. Embora haja discussão sobre o que agregam ou não as escolas especiais, existem relativamente poucos estudos que se propõem a compartilhar as perspectivas de estudantes dessas escolas. Este estudo baseia-se em entrevistas com 39 estudantes de seis escolas especiais e dois de centros educacionais de apoio. As entrevistas foram transcritas e submetidas à análise temática de conteúdo, o que revelou que os estudantes se sentem desapontados, pois suas deficiências não são compreendidas pelos professores. Eles expressam a necessidade de maior apoio social e psicológico relativo às suas experiências escolares, à deficiência e aos problemas sociais. Eles também apontam a necessidade de os professores serem mais pacientes e comprometidos. Os estudantes que vivem em instituições de acolhimento destacam as condições precárias de vida e a ausência de apoio dos cuidadores dessas instituições, o que impacta sua possibilidade de aprendizagem. As necessidades que foram identificadas pelos estudantes podem subsidiar professores que se interessam em melhorar a qualidade da educação ofertada.

The Future of Occupational and Environmental Medicine.

ABSTRACT: Occupational and environmental medicine (OEM) is an ACGME-accredited preventive medicine specialty focused on work as a social determinant of health and population health. OEM providers recognize and mitigate workplace and environmental hazards, treat resultant injuries and illnesses, and promote the health, wellness and resiliency of workers and communities. Multidisciplinary residency training in clinical medicine, epidemiology, public and population health, toxicology, exposure and risk assessment, and emergency preparedness equips them with the skill set needed for leadership roles in diverse settings. These include clinical practice, academia, corporate settings, and governmental agencies. Despite robust job opportunities, a shortage of formally trained OEM physicians remains and is expected to worsen given a declining number of training programs. We examine root causes of the system-level issues impacting the supply of OEM physicians and potential solutions.

Early Drug Prescription Patterns as Predictors of Final Workers Compensation Claim Costs and Closure: An Updated Analysis on an Expanded Cohort.

OBJECTIVE: The aim of the study is to determine the associations of workers' compensation claim costs and return to work with drugs prescribed for early symptom management. METHODS: Claims filed from 1998 to 2007 were followed for 10 years from the injury date. Drugs analyzed included gabapentin, pregabalin, antipsychotics, antidepressants, sedatives, benzodiazepines, carisoprodol, and opioids, controlling for initial reserve, sex, age, physical therapy, attorney involvement, and surgery. RESULTS: Gabapentin, antipsychotics, antidepressants, and sedatives used in the first 3 months after injury were significantly associated with higher claim cost (≥$100,000). All opioid morphine equivalent doses greater than or equal to 5 mg/d for the first 6 months was significantly associated with higher cost (≥$100,000) and not being released to work at end of third year after injury with dose-response relationships. CONCLUSIONS: Prescription patterns in the first 3 months or first 6 months of workers' compensation claim development may be used as predictors of claim outcomes.

Introducing the Including Disability in Education in Africa Research Unit at the University of Cape Town.

BACKGROUND: The Including Disability in Education in Africa (IDEA) Research Unit at the University of Cape Town in South Africa was established in 2020 and focused on carrying out research studies in the field of disability and education in Africa and beyond. OBJECTIVES: The objective of this article was to introduce the research unit and highlight its vision, mission and objectives. METHOD: A general review of the research unit. RESULTS: The IDEA Research Unit plays an important role in the research arena within South Africa and Africa when it comes to disability issues in education. CONCLUSION: More networking and collaboration should take place between the IDEA Research Unit and relevant stakeholders in the field of disability and education.

Attributes of Long Duration COVID-19 Workers' Compensation Claims.

OBJECTIVE: To examine the attributes associated with long duration COVID- 19 workers' compensation (WC) claims. METHODS: A study was conducted on 13,153 COVID-19 WC claims accepted by a workers' compensation insurance carrier between January 1, 2020 and November 30, 2021. RESULTS: 1) Ninety-five percent of accepted WC claims were closed within the study period; 2) five percent of claims had 30 days or longer of lost time accounting for 65% of total paid WC costs; 3) medical costs increased 8-fold once paid days lost crossed the threshold of 60 days or greater; 4) age was the strongest risk factor associated with increased WC costs and prolonged impairment. CONCLUSION: Age at the time of infection was the major factor associated with prolonged impairment and high costs of COVID-19 related WC claims.

Clinical and Psychological Factors Associated With Return to Work Among United States Diplomats Who Sustained a Work-Related Injury While on Assignment in Havana, Cuba.

OBJECTIVE: To determine factors associated with return to work in US diplomats injured during a work assignment in Cuba. METHODS: In this case series work ability was determined at each visit. Questionnaires used included the Symptom Score Questionnaire, Beck Anxiety Inventory, Beck Depression Inventory, Quality-of-Life Inventory, and Patient Health Questionnaire. RESULTS: Of the 45 employees referred to Occupational Medicine, the mean age was 42.5 years, 60% were men, 68% were never out of work, 22% were out of work for some period, and 15% remain out of work. Vestibular, cognitive, hearing, sleep, and visual symptoms, and a higher initial symptom score were significantly associated with work inability while psychiatric symptoms were not. CONCLUSIONS: This exposure resulted in prolonged illness with cognitive impairment and other clinical manifestations associated with work inability.

Coronavirus disease 2019 (COVID-19) vaccine hesitancy among physicians, physician assistants, nurse practitioners, and nurses in two academic hospitals in Philadelphia.

OBJECTIVE: To evaluate coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare personnel (HCP) with significant clinical exposure to COVID-19 at 2 large, academic hospitals in Philadelphia, Pennsylvania. DESIGN, SETTING, AND PARTICIPANTS: HCP were surveyed in November-December 2020 about their intention to receive the COVID-19 vaccine. METHODS: The survey measured the intent among HCP to receive a COVID-19 vaccine, timing of vaccination, and reasons for or against vaccination. Among patient-facing HCP, multivariate regression evaluated the associations between healthcare positions (medical doctor, nurse practitioner or physician assistant, and registered nurse) and vaccine hesitancy (intending to decline, delay, or were unsure about vaccination), adjusting for demographic characteristics, reasons why or why not to receive the vaccine, and prior receipt of routine vaccines. RESULTS: Among 5,929 HCP (2,253 medical doctors [MDs] and doctors of osteopathy [DOs], 582 nurse practitioners [NPs], 158 physician assistants [PAs], and 2,936 nurses), a higher proportion of nurses (47.3%) were COVID-vaccine hesitant compared with 30.0% of PAs and NPs and 13.1% of MDs and DOs. The most common reasons for vaccine hesitancy included concerns about side effects, the newness of the vaccines, and lack of vaccine knowledge. Regardless of position, Black HCP were more hesitant than White HCP (odds ratio [OR], ∼5) and females were more hesitant than males (OR, ∼2). CONCLUSIONS: Although most clinical HCP intended to receive a COVID-19 vaccine, intention varied by healthcare position. Consistent with other studies, hesitancy was also significantly associated with race or ethnicity across all positions. These results highlight the importance of understanding and effectively addressing reasons for hesitancy, especially among frontline HCP who are at increased risk of COVID exposure and play a critical role in recommending vaccines to patients.

Capacity building for quality care and education for children with severe to profound intellectual disabilities in South Africa.

In the South African context, children with severe to profound intellectual disabilities are not accommodated in the compulsory education system, although steps are being taken in this direction in acknowledgement of their right to education. Critical to this development is the training of educators and caregivers. There is a paucity of studies from South Africa addressing the training of educators and caregivers. The Teacher Empowerment for Disability Inclusion (TEDI) project developed a course on the education and care of children with severe to profound intellectual disabilities to facilitate and empower teachers to provide quality education for these learners. This paper explores, through a qualitative analysis, the ways in which 30 participants attending this course developed professionally and personally. The findings show that there was personal as well as professional learning in the areas of disability approaches, collaboration, advocacy, self-care, and confidence. These findings are discussed and future implications are addressed.

Building an isoscape based on tooth enamel for human provenance estimation in Brazil.

In this study, we present a correlation between δ18OC values of carbonate in tooth enamel samples from the modern Brazilian population and the available δ18ODW data for the meteoric water from the Global Network of Isotopes in Precipitation (GNIP). Tooth enamel from 119 Brazilian individuals from five different regions of the country were analyzed. The δ18OC isoscape obtained is in good agreement with the isoscape based on regional meteoric and drinking water. The regression matrix obtained for the δ18O values of the carbonate tooth enamel and meteoric water was used to build an isoscape using the regression-kriging approach. Our data show that Brazil can be divided in two main regions with respect to the δ18O values of the carbonate tooth enamel: (1) the most easterly part of the northeast region, which is characterized by a warm and dry climate and (2) the remainder of the country, stretching from the Amazon rain forest to the more southernly regions. The data herein reported can be used for forensic purposes related to human identification.

Factors Associated With COVID-19 Vaccine Receipt by Health Care Personnel at a Major Academic Hospital During the First Months of Vaccine Availability.

Importance: Several COVID-19 vaccines have been authorized in the US, yet preliminary evidence suggests high levels of vaccine hesitancy and wide racial, ethnic, and socioeconomic disparities in uptake. Objective: To assess COVID-19 vaccine acceptance among health care personnel (HCP) during the first 4 months of availability in a large academic hospital, compare acceptance with previously measured vaccine hesitancy, and describe racial, ethnic, and socioeconomic disparities in vaccine uptake. Design, Setting, and Participants: This cross-sectional study included 12 610 HCP who were offered COVID-19 vaccination at a major academic hospital in Philadelphia between December 16, 2020, and April 16, 2021. Exposures: For each HCP, data were collected on occupational category, age, sex, race and ethnicity (Asian or Pacific Islander, Black or African American [Black], Hispanic, White, and multiracial), and social vulnerability index (SVI) at the zip code of residence. Main Outcomes and Measures: Vaccine uptake by HCP at the employee vaccination clinic. Results: The study population included 4173 men (34.8%) and 7814 women (65.2%) (623 without data). A total of 1480 were Asian or Pacific Islander (12.4%); 2563 (21.6%), Black; 452 (3.8%), Hispanic; 7086 (59.6%), White; and 192 (1.6%), multiracial; 717 had no data for race and ethnicity. The mean (SD) age was 40.9 (12.4) years, and 9573 (76.0%) received at least 1 vaccine dose during the first 4 months of vaccine availability. Adjusted for age, sex, job position, and SVI, Black (relative risk [RR], 0.69; 95% CI, 0.66-0.72) and multiracial (RR, 0.80; 95% CI, 0.73-0.89) HCP were less likely to receive vaccine compared with White HCP. When stratified by job position, Black nurses (n = 189; 62.8%), Black HCP with some patient contact (n = 466; 49.9%), and Black HCP with no patient contact (n = 636; 56.3%) all had lower vaccine uptake compared with their White and Asian or Pacific Islander counterparts. Similarly, multiracial HCP with some (n = 26; 52.0%) or no (n = 48; 58.5%) patient contact had lower vaccine uptake. In contrast, Black physicians were just as likely to receive the vaccine as physicians of other racial and ethnic groups. Conclusions and Relevance: In this cross-sectional study, more than two-thirds of HCP at a large academic hospital in Philadelphia received a COVID-19 vaccine within 4 months of vaccine availability. Although racial, ethnic, and socioeconomic disparities were seen in vaccine uptake, no such disparities were found among physicians. Better understanding of factors driving these disparities may help improve uptake.