Long COVID-ACOEM Guidance Statement.

ABSTRACT: Persistent symptoms are common after acute COVID-19, often referred to as long COVID. Long COVID may affect the ability to perform activities of daily living, including work. Long COVID occurs more frequently in those with severe acute COVID-19. This guidance statement reviews the pathophysiology of severe acute COVID-19 and long COVID and provides pragmatic approaches to long COVID symptoms, syndromes, and conditions in the occupational setting. Disability laws and workers' compensation are also addressed.

Occupational Medicine Physicians Transition to Retirement: An International Survey of Preparation, Plans, and Interests.

OBJECTIVE: To understand the needs and interests of occupational medicine physicians (OMPs) as they transition to retirement. METHODS: An electronic survey was distributed through member organizations in the US (ACOEM), UK (SOM/FOM), India (IAOH), South Africa (SASOM), and Medichem. RESULTS: 497 OMPs at various career stages responded, including 282 from the US, 97 from the UK, 36 from India, 30 from South Africa, and 52 from other countries. 278 work full-time, 160 part-time, and 58 are not doing paid work. ~60% serve as volunteers. 60% have a written financial plan. 35% are very comfortable with their retirement plans. After leaving full-time work, 85% plan to work part-time. There is a high level of interest in learning about opportunities for part-time work and volunteering. CONCLUSIONS: OMPs are very interested in learning more about compensated and uncompensated work in retirement.

Animal bite anaphylaxis, rarely diagnosed but underappreciated.

BACKGROUND: Animal allergies are common, with reactions ranging from rhinoconjunctivitis from respiratory exposure to anaphylaxis, usually from animal bites. Since animal bites are also common, this raises the question of how often anaphylaxis occurs following a bite. MATERIALS AND METHODS: A PubMed, Google, and Google Scholar literature review was performed using keywords such as animal bite anaphylaxis. An inquiry was made to the Anaphylaxis Registry ANAPHYLAXIE.net to see if additional cases were contained in the registry. RESULTS: Approximately 40 cases of animal bite anaphylaxis are described in the literature, mostly from rodent bites (mice, rats, hamsters, and guinea pigs). A survey of laboratory animal bite anaphylaxis in the U.S. identified previously unreported cases, suggesting that most cases are not reported. CONCLUSION: Anaphylaxis from animal bites is rarely reported, but occurs more frequently than suggested by case reports and should be considered in a symptomatic patient following a bite.

The Role and Value of Corporate Medical Directors in Employer Benefits Management: Current Perceptions of Corporate Medical Directors and Benefits Professionals.

OBJECTIVE: Knowledge of health-related employer benefits is considered a core competency by the American College of Occupational and Environmental Medicine. This study seeks to understand how this translates into practice. METHODS: An electronic survey was e-mailed to members of American College of Occupational and Environmental Medicine Corporate Medicine and Health and Human Performance Sections; Integrated Benefits Institute; and Employer Health Innovation Roundtable. RESULTS: One hundred nineteen responses were received, including 54 from corporate medical directors (CMDs) and 43 from employee benefits professionals, from a variety of industries. Fifty percent of CMDs reported expertise in designing benefits, but only 25% are engaged with health benefits. The majority of CMDs thought that their involvement was important, while the majority of benefits professionals thought that it was not important. CONCLUSIONS: Many CMDs report having benefits expertise but being underutilized while others report not having expertise.

Role and Value of the Corporate Medical Director.

ABSTRACT: The role of the Corporate Medical Director (CMD) has received increased attention during the COVID-19 pandemic and has continued to evolve. This updated guidance addresses the role and value of the CMD in: health policy, strategy, and leadership; fostering a culture of health and well-being; supporting worker health and productivity/performance; addressing mental health; collaborating on employer benefits design; developing programs for global health, travel medicine, and remote/extreme environments; overseeing on- and near-site clinics; incorporating digital technology, artificial intelligence, and telehealth in health programs; supporting critical incident preparedness and business continuity planning; addressing workplace hazards; and overseeing periodic executive health examinations.

Prevention of Laboratory Animal Allergy and Impact of COVID-19 on Prevention Programs in the United States: A National Survey 10-Year Update.

OBJECTIVE: Laboratory animal allergy (LAA) is common and preventable. This study provides a 10-year update on LAA prevention programs in the United States and the effect of COVID-19 on prevention practices. METHODS: An electronic survey was e-mailed to designated institutional officials at laboratory animal facilities identified by the National Institutes of Health Office of Laboratory Animal Welfare. Results were compared with the prior survey. RESULTS: A total of 141 institutions employing 58,224 laboratory animal workers responded. Results were similar to the prior survey with wide variation in practices. Medical surveillance increased (58%-71%), but N95 respirator use decreased (17%-13%). As before, only 25% of institutions knew their LAA incidence and prevalence rates. COVID-19 had a small time-limited effect on personal protective equipment use. CONCLUSIONS: Universal use of evidence-based practices and improved medical surveillance would provide greater worker protection from LAA.

Worksite Temperature Screening for COVID-19.

OBJECTIVE: To determine whether temperature screening is useful in detecting and reducing workplace transmission of SARS-CoV-2. METHODS: A survey was conducted to determine whether temperature screening successfully identified workers with coronavirus disease 2019 (COVID-19) among a convenience sample of medical directors of multinational corporations in a wide range of industries. RESULTS: More than 15 million screenings were performed by 14 companies. Fewer than 700 episodes of fever were identified. Of these, only about 53 cases of COVID-19 were detected. By contrast about 2000 workers with diagnosed COVID-19 were in the workplace and not detected by screening. CONCLUSIONS: One case of COVID-19 was identified by screening for approximately every 40 cases that were missed. Worksite temperature screening was ineffective for detecting workers with COVID-19 and is not recommended.

Occupational Animal Allergy.

PURPOSE OF REVIEW: This review explores animal allergen exposure in research laboratories and other work settings, focusing on causes and prevention. RECENT FINDINGS: (1) Consistent with the hygiene hypothesis, there is new evidence that early childhood exposure to pets produces changes in the gut microbiome that likely lead to a lower risk of allergy. (2) Anaphylaxis from laboratory animal bites occurs more frequently than suggested by prior literature. (3) Animal allergens represent an occupational hazard in a wide variety of work settings ranging from fields that work with animals to public settings like schools and public transportation where allergens are brought into or are present in the workplace. Exposure to animal allergens can result in allergy, asthma, and anaphylaxis. Animal allergy has been most studied in the research laboratory setting, where exposure reduction can prevent the development of allergy. Similar prevention approaches need to be considered for other animal work environments and in all settings where animal allergens are present.

Laboratory Animal Bite Anaphylaxis: A National Survey: Part 1: Case Series and Review of the Literature.

OBJECTIVE: This study documents previously unreported cases of laboratory animal bite anaphylaxis in animal laboratory facilities in the United States. METHODS: An online survey was e-mailed to designated institutional officials at laboratory animal facilities identified by the National Institutes of Health Office of Laboratory Animal Welfare. RESULTS: One hundred ninety eight organizations responded and 15 organizations indicated that workers had experienced anaphylaxis following an animal bite. Case report forms were completed by nine of these institutions for 14 cases, 13 for rodent bites, and one involving a needlestick from a horse. In half of the cases involving rodents, there was no prior history of animal allergy. All workers had uncomplicated recoveries. Treatment, testing, and work restrictions varied across cases. CONCLUSIONS: While uncommon, anaphylaxis from laboratory animal bites occurs more frequently than suggested by the literature.

Laboratory Animal Bite Anaphylaxis: A National Survey: Part 2: Treatment Protocols.

OBJECTIVE: This study documents current treatment protocols for laboratory animal bite anaphylaxis in the United States. METHODS: An online survey was e-mailed to designated institutional officials at laboratory animal facilities identified by the National Institutes of Health Office of Laboratory Animal Welfare. RESULTS: One hundred eighty-nine organizations responded to the question of whether they had a treatment protocol with 32% indicating that they had a protocol. Having a case of anaphylaxis increased the likelihood of having a protocol (61%). Of those with a protocol, 58% included treatment with injectable epinephrine, if clinically indicated. Among all respondents, only 14% reported keeping injectable epinephrine at the location where animal work is performed. CONCLUSIONS: A minority of responding organizations had protocols in place to address laboratory animal bite anaphylaxis. Organizations with workers at risk should consider implementing a protocol for assessment and treatment.

Guidance to employers on integrating e-cigarettes/electronic nicotine delivery systems into tobacco worksite policy.

In recent years, new products have entered the marketplace that complicate decisions about tobacco control policies and prevention in the workplace. These products, called electronic cigarettes (e-cigarettes) or electronic nicotine delivery systems, most often deliver nicotine as an aerosol for inhalation, without combustion of tobacco. This new mode of nicotine delivery raises several questions about the safety of the product for the user, the effects of secondhand exposure, how the public use of these products should be handled within tobacco-free and smoke-free air policies, and how their use affects tobacco cessation programs, wellness incentives, and other initiatives to prevent and control tobacco use. In this article, we provide a background on e-cigarettes and then outline key policy recommendations for employers on how the use of these new devices should be managed within worksite tobacco prevention programs and control policies.

Prevention of laboratory animal allergy in the United States: a national survey.

OBJECTIVE: Respiratory allergy to laboratory animals is a common and preventable occupational health problem. This study documents current laboratory animal allergy (LAA) prevention programs in the United States. METHODS: An online survey was e-mailed to designated institutional officials at laboratory animal facilities identified by the National Institutes of Health Office of Laboratory Animal Welfare. RESULTS: A total of 198 organizations responded and more than 80% required the use of uniforms and gloves to control exposure. Respirators were required by 25% of organizations. Medical surveillance was mandated by 58% of organizations (70% for organizations with at least 100 employees working with animals). Work restriction practices varied. Only 25% of organizations reported knowing the prevalence (range: 0% to 75%) and 29% reported knowing the incidence of LAA (range: 0% to 18%). CONCLUSIONS: There is broad variation in policy and practice to prevent LAA. An evidence-based consensus would ensure greater protection of workers.

How to align evidence-based benefit design with the employer bottom-line: a case study.

OBJECTIVE: To illustrate how to use evidence-based benefit design (EBD) by presenting the case study of a major manufacturer. METHOD: Key components of the company's measurement and management approach to EBD are introduced. Descriptive results on the direct and indirect cost and utilization trends of the company's US active workforce during 2002 to 2008 are presented. RESULTS: From 1999 to 2002 aggregated to 2008, health care costs dropped sharply, with 2006, 2008, and projected 2009 reporting decreases even as annualized increases in national expenditures approximated 10%. Annualized rates for hospitalizations, office visits, and prescriptions showed corresponding decreases from 2004 to 2008. From 2002 to 2008, workers' compensation/disability and absenteeism costs decreased 38% and 46%, respectively. CONCLUSIONS: These results support the company's direction in health benefit design although further confirmation is needed. Ongoing quality improvement processes are discussed, as are implications for implementing EBD.

Evidence-based benefit design: toward a sustainable health care future for employers.

Health care costs for employers are rising much faster than inflation. The common approach to health benefit design of increasing cost sharing has failed to contain costs. Some employers, however, have been successful at mitigating the cost trend or actually reducing health care costs. These employers have in common a dedication to data analysis, a search for cost drivers, and a willingness to adjust their approach to health benefit design to address these cost drivers. This approach has much in common with the movement in clinical practice toward evidence-based medicine. We propose that employers adopt a similar approach toward health benefits termed evidence-based benefit design, which is based on a health and productivity framework focused on direct and indirect costs. Evidence-based benefit design incorporates the relevant literature and employer-specific data that are integrated and regularly analyzed.

Effect of smoking status on productivity loss.

OBJECTIVE: The objective of this study was to describe health-related productivity losses in nonsmokers, former smokers, and current smokers using a large, cross-sectional database of U.S. employees. METHODS: Volunteers completed the Wellness Inventory, an instrument measuring productivity losses related to 11 health conditions affecting employee health. Results are aggregated, dollarized, and reported by smoking group. RESULTS: Current smokers missed more days of work and experienced more unproductive time at work compared with former smokers and nonsmokers. The average annual cost for lost productivity for nonsmokers was 2623 dollars/year compared with 3246 dollars/year for former smokers and 4430 dollars/year for current smokers. More than half the costs were due to unproductive time at work. CONCLUSION: Current smokers incurred the highest productivity losses, which translated into higher costs to employers for current smokers. Costs were lower for former smokers and nonsmokers.

Quantifiable impact of the contract for health and wellness: health behaviors, health care costs, disability, and workers' compensation.

Current literature about the long-term impacts of corporate health and wellness programs has brought to light new evidence about the cost savings associated with health-promotion interventions. A critical element in these initiatives is attracting the participation of employees at risk for high benefits use. This study presents evidence that suggests accomplishing this task has economic savings implications to large employers. A health and wellness intervention program offered at GlaxoSmithKline, entitled the Contract for Health and Wellness, is examined. Focusing on a group of 6049 employees, the study examines the impact on health behaviors and on integrated health benefits use of this continuously employed population from 1996 to 2000. Total benefits costs are examined for participants and nonparticipants, and the annual savings associated with the isolated impact of the program are, on average, $613 per participant. Reductions in disability costs accounted for the majority of these savings.

Laboratory animal allergy: an update.

Allergic reactions are among the most common conditions affecting the health of workers involved in the care and use of research animals. Between 11 and 44% of the individuals working with laboratory animals report work-related allergic symptoms. Of those who become symptomatic, 4 to 22% may eventually develop occupational asthma that can persist even after exposure ceases. Allergic symptoms consist of rashes where animals are in contact with the skin, nasal congestion and sneezing, itchy eyes, and asthma (cough, wheezing, and chest tightness). The generation of immunoglobulin E (IgE) antibodies is a prerequisite for the production of allergic symptoms. The mechanism by which IgE antibodies develop is becoming clearer. The propensity to produce IgE is genetically determined, and pre-existing allergy may be a risk factor for the development of laboratory animal allergy (LAA). However, exposure to animal allergens is the major risk factor for the development of LAA. Techniques to measure the airborne concentration of laboratory animal allergens have been developed. Research on animal allergens themselves indicates that many of the mouse and rat urinary proteins belong to a family of proteins called lipocalins, which share sequence homology with antigens of the parasitic agent that causes schistosomiasis. The fact that parasite infections also trigger IgE antibody responses may account for the development of LAA in persons who have never had any previous allergy. The prevention of LAA should be a major goal of an effective health and safety program in the animal research facility, and it can be accomplished by education and training of employees, reduction of exposure (including the use of personal protective gear), and changes in facility design. Medical surveillance programs can also play a role in improving health of individuals working with laboratory research animals. Early recognition of symptoms and evidence of sensitization can lead to interventions to reduce exposure and thereby avoid the long-term health consequences of LAA.