Covid-19 and Worker Issues: Lessons From a University-based Ad-Hoc Network.

The Covid-19 pandemic has made clear the central role of the workplace in public health. Workers and working families have been particularly impacted by a public health and economic crisis that has revealed both structural shortcomings and opportunities for future preparedness. In response to the pandemic, a group of scholars, labor and anti-poverty advocates, activists, union representatives, frontline workers, and public health professionals gathered to share observations and create a forum for information sharing and collaboration. Conversations evolved with the pandemic to include policy solutions aimed at addressing the pandemic's health and economic impacts. In this paper, we summarize key lessons from the "Covid-19 and Workers" calls and suggest that ongoing collaboration among labor activists and academic and public health advocates may help to prepare for new public health crises and protect the safety and health of workers and communities.

Proposed Mitigation and Adaptation Strategies Related to Climate Change: Guidance for OEM Professionals.

Climate change is an urgent challenge amplified by socioeconomic factors that demands thoughtful public health responses from OEM professionals. This guidance statement from the American College of Occupational and Environmental Medicine focuses on the different strategies that these health professionals can implement to protect workers from health impacts associated with climate change hazards, foster workplace resilience in the face of rapidly changing environments, and take the necessary steps to mitigate the effects of global climate change.

Union Efforts to Reduce COVID-19 Infections Among Grocery Store Workers.

Grocery store workers are essential workers, but often have not been provided with appropriate protection during the current pandemic. This report describes efforts made by one union local to protect workers, including negotiated paid sick leave and specific safety practices. Union representatives from 319 stores completed 1612 in-store surveys to assess compliance between 23 April 2020 and 31 August 2020. Employers provided the union with lists of workers confirmed to have COVID-19 infection through 31 December 2020. Worker infection rates were calculated using store employees represented by the union as the denominator and compared to cumulative county infection rates; outcome was dichotomized as rates higher or lower than background rates. Restrictions on reusable bags and management enforcement of customer mask usage were most strongly associated with COVID-19 rates lower than rates in the surrounding county. Stores that responded positively to worker complaints also had better outcomes. The union is currently engaging to promote improved ventilation and vaccination uptake.

Partnering to Support Education for Midwives and Nurses in Liberia.

The midwifery and occupational health faculty of a U.S. university were approached by parish and health care leaders from Caldwell, Liberia, for assistance in addressing critical maternal health care needs in their community. Liberia has suffered setbacks in its efforts to improve health care for its people due to recent civil wars and the Ebola epidemic of 2014 to 2016. Initial discussions among international groups centered around realistic ways to help in the face of multiple compelling needs. Grant support for U.S. faculty to conduct exploratory meetings and educational workshops in Liberia was secured. Ethical principles and best practices in partnering across borders guided this partnership and include reciprocity, equity, and empowerment of health care workers, including nurses, midwives, community workers, and health center staff. Here, we describe the preparation for and implementation of these workshops, as well as plans for continuing collaborations that emerged from these workshops.

Safe at Home: A Quasi-Experimental Evaluation of a Municipal Intervention to Prevent Falls among Low-Income Elderly.

INTRODUCTION: Falls are the leading cause of fatal traumatic injury among people over 65 and the rate continues to increase. We evaluated a recently implemented municipal program providing no-cost baseline and follow-up home assessment and home modifications to reduce fall hazards among low-income elderly or disabled residents. METHODS: Program participants received writ ten invitations to return informed consent for phone interviews that included process and outcome evaluation. Data analysis used repeat measures ANOVA and non parametric Wilcoxon signed rank tests. RESULTS: During its first year, the program served 230 elderly or disabled low-income residents. Among 51 participants interviewed an average of 281 days after home modification, fear of falling was reduced, and annualized rate of falls decreased from an average of 0.92 (SD = 1.6) per person per year to 0.24 (SD = .74) (p<.001). CONCLUSION: Home assessments and modest infrastructure improvements significantly reduced falls in a non-research, municipal setting.

Building a Sustainable Construction Workforce.

The average U.S. construction worker is aged 42.6 years, and will not be eligible for full Social Security retirement benefits until age 67. Delayed retirement is largely driven by economic need, but construction workers face considerable challenges in remaining on the job. This study explores trade-specific age trends within the construction industry, and the experiences of building trade unions with aging membership. A mixed-methods approach used trade-specific age statistics from the Current Population Survey and key informant interviews with labor leaders, in order to identify union experiences and interventions. Mean and median ages for all subgroups in construction increased from 2003 to 2017. Immigrant construction workers were significantly younger than workers who were born in the U.S. (41 vs. 43, p < 0.001). Union workers were older than non-union workers (42 vs. 39 in 2017, p < 0.001); the age differential between self-employed and wage-and-salary workers was wide (49 vs. 40, p < 0.001). Union leaders described barriers, such as age discrimination and the loss of previously available light tasks, as well as current and potential solutions through union contract language requiring the inclusion of older workers, or establishing limits for lifting. Other solutions included career pathways for training and safety, with their attendant limitations; mentoring/pairing opportunities with apprentices; and the potential opportunities and training needs for site management positions.

Heat-related deaths among construction workers in the United States.

BACKGROUND: Heat is a severe hazard for construction workers and may be worsening with global warming. This study sought to explore heat-related deaths among U.S. construction workers and a possible association with climate change. METHODS: Heat-related deaths in the Census of Fatal Occupational Injuries from 1992 to 2016 were analyzed. Denominators estimated from the Current Population Survey were matched with demographic and occupational categories in rate calculations. Statistical tests were used to examine heat-related deaths in relation to time, geographic region, and temperature. RESULTS: Construction workers, comprising 6% of the total workforce, accounted for 36% (n = 285) of all occupational heat-related deaths from 1992 to 2016 in the U.S. Mean temperatures from June to August increased gradually over the study period. Increasing summer temperatures from 1997 to 2016 were associated with higher heat-related death rates (r = 0.649; 95% confidence interval: 0.290, 0.848). Compared to all construction workers (risk index = 1), statistically significant elevated risk of heat-related death was found among Hispanics (1.21), in particular workers born in Mexico (1.91). Occupations with a high risk index included cement masons (10.80), roofers (6.93), helpers (6.87), brick masons (3.33), construction laborers (1.93) and heating, air conditioning, and refrigeration mechanics (1.60). CONCLUSIONS: U.S. construction workers are at a high risk of heat-related death, and this risk has increased with climate change over time. Effective workplace interventions, enhanced surveillance, and improved regulations and enforcement should accompany broader efforts to combat global warming. The construction industry can help reduce global warming through increased implementation of green building principles.

Change in prevalence of asbestos-related disease among sheet metal workers 1986 to 2016.

BACKGROUND: A medical screening program began in 1986 for sheet metal workers exposed to asbestos, primarily while working alongside insulators applying spray-on asbestos materials, a practice banned in 1973. Exposure continues during maintenance, renovation, and repair. METHODS: Radiographic abnormalities among 26 397 sheet metal workers examined from 1986 to 2016 were analyzed by year of entry into the trade. Logistic regression was used to examine risk factors for parenchymal and pleural abnormalities among the overall study population and among the subcohort who entered the trade after 1973. RESULTS: Prevalence of parenchymal disease was 17.4% for those starting work before 1950 compared with 0.8% for those starting work after 1973 (adjusted prevalence odds ratio [pOR] = 26.65, 95% confidence interval [CI] = 18.46-38.46). For each calendar year after 1973, entering the trade 1 year later was associated with an estimated 12.7% decreased odds of acquiring asbestos-related disease (adjusted pOR = 0.873, 95% CI = 0.832-0.916). CONCLUSION: Sheet metal workers who began work after the US implemented environmental and occupational regulations develop asbestos-related disease at much reduced rates, consistent with regulatory projections made for nonmalignant asbestos-related disease by the Occupational Safety and Health Administration at the time. Cancer remains a concern among this cohort, and lung cancer screening recommendations should consider year of entry into the trade. This study highlights the importance of regulatory intervention and of continued surveillance.

Perceived Stress and Health among Home Care Aides: Caring for Older Clients in a Medicaid-Funded Home Care Program.

Home care aides (HCAs) provide housekeeping and personal care services to help older clients remain in the community. However, little is known about the health of HCAs, who themselves constitute an underserved population. The goal of this study was to investigate how HCAs' work and life contexts manifest themselves in HCAs' health as perceived by HCAs. Six focus groups were conducted with HCAs (N=45). Analysis revealed how HCAs' work-and life-related stress accumulated over time and affected HCAs' health and interaction with their older clients. Home care aides were interested in personal health promotion and client well-being. Home care aides may constitute an underused resource for the care of older adults with disabilities. Information about intricately intertwined work and life contexts should inform policymakers and home care providers in their efforts to improve the quality of publicly funded home care services.

Huntington's Disease and Employment: The Relative Contributions of Cognitive and Motor Decline to the Decision to Leave Work.

BACKGROUND: Huntington's disease (HD) presents with motor, cognitive, and behavioral symptoms that impair functional capacity and the ability to maintain employment. The relative contribution of cognitive decline to work disability remains controversial. OBJECTIVE: To evaluate the association of cognitive decline, compared with motor decline, with the decision to leave work. METHODS: Data from the Enroll-HD observational study were analyzed. The correlation of age of cognitive symptom onset and age of motor symptom onset with age at leaving work was assessed. The association of the Stroop Color Naming Test (SCNT) cognitive assessment and the Total Motor Score (TMS) assessment (reverse scored) with the Total Functional Capacity (TFC) assessment was also assessed. RESULTS: For every year delay in cognitive symptom onset, there was a 0.806 year increase in age at leaving work (SE = 0.030, p < 0.001, adj-R2 = 0.628). For every year delay of motor symptom onset, there was a 0.814 year increase in age at leaving work (SE = 0.031, p < 0.001, adj-R2 = 0.603). For every additional correct SCNT response given and for every unit increase in TMS, there was a 0.105 unit increase (SE = 0.006, p < 0.001, adj-R2 = 0.315) and a 0.104 unit decrease in TFC (SE = 0.003, p < 0.001, adj-R2 = 0.640), respectively. CONCLUSIONS: Cognitive symptoms have a significant association, comparable to that of motor symptoms, with occupational functioning and the decision to leave work, suggesting that development of therapies for both cognitive and motor decline would be important for allowing people with HD to remain in the workforce longer.

Slips, Trips, and Falls Among Home Care Aides: A Mixed-Methods Study.

OBJECTIVE: To address the gap of knowledge about slips, trips, and falls (STFs) among home care aides (HCAs) who work in clients' homes. METHODS: This mixed method study used survey and focus group data of HCAs in a Medicaid-funded homecare program. RESULTS: STFs were common with over 12% of HCAs reporting occurrence in the previous 12 months, of whom 58% fell to the ground. Both survey and focus group data identified ice, clutter, workload, rushing and other hazards. Focus group data explained the reasons for not reporting STFs, even among those who sustained injury, and added HCAs' voices to the understanding of causes, consequences and prevention strategies for STFs. CONCLUSIONS: Empowering HCAs with knowledge, training, and involvement may transform "near miss" STFs into opportunities to prevent STFs among care workers and their clients.

Occupational Health in Community Health Centers: Practitioner Challenges and Recommendations.

Primary care clinicians may be the only source of occupational healthcare for many low-wage, high-risk workers who experience disproportionate occupational hazards. The authors explored barriers to providing occupational healthcare and recommendations for overcoming these challenges. The team conducted six focus groups and eleven key-informant interviews in two community health centers and among clinicians, community health workers, and other personnel from similar settings. Clinicians reported not utilizing occupational information during clinical encounters and identified competing priorities, limited appointment time, and lack of training as key barriers. They cited workers' compensation as a source of confusion and frustration. However, most participants recognized occupation as an important social determinant of health and expressed interest in additional training and resources. Participants agreed that referral mechanisms for occupational medicine specialists and worker centers and changes in quality performance measures and electronic health records would be useful and that workers' compensation and immigration policies need reform.

Delayed respiratory fatality from trimethylsilyldiazomethane: what do workers need to know about potentially hazardous exposures?

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.

Paranitroanaline poisoning: a failure in basic prevention?

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.