The 2023 Impact of Inflammatory Bowel Disease in Canada: Cancer and IBD.

Cancer is a major cause of morbidity and mortality among people with inflammatory bowel disease (IBD). Intestinal cancers may arise as a complication of IBD itself, while extra-intestinal cancers may arise due to some of the immunosuppressive therapies used to treat IBD. Colorectal cancer (CRC) and small bowel cancer risks remain elevated among persons with IBD as compared to age-and sex-matched members of the general population, and the lifetime risk of these cancers is strongly correlated to cumulative intestinal inflammatory burden. However, the cumulative risk of cancer, even among those with IBD is still low. Some studies suggest that IBD-CRC incidence has declined over the years, possibly owing to improved treatment standards and improved detection and management of early neoplastic lesions. Across studies of extra-intestinal cancers, there are generally higher incidences of melanoma, hepatobiliary cancer, and lung cancer and no higher incidences of breast cancer or prostate cancer, with equivocal risk of cervical cancer, among persons with IBD. While the relative risks of some extra-intestinal cancers are increased with treatment, the absolute risks of these cancers remain low and the decision to forego treatment in light of these risks should be carefully weighed against the increased risks of intestinal cancers and other disease-related complications with undertreated inflammatory disease. Quality improvement efforts should focus on optimized surveillance of cancers for which surveillance strategies exist (colorectal cancer, hepatobiliary cancer, cervical cancers, and skin cancers) and the development of cost-effective surveillance strategies for less common cancers associated with IBD.

The 2023 Impact of Inflammatory Bowel Disease in Canada: Special Populations-IBD in Seniors.

Approximately one out of every 88 seniors has inflammatory bowel disease (IBD), and this is expected to increase in the future. They are more likely to have left-sided disease in ulcerative colitis, and isolated colonic disease in Crohn's disease; perianal disease is less common. Other common diagnoses in the elderly must also be considered when they initially present to a healthcare provider. Treatment of the elderly is similar to younger persons with IBD, though considerations of the increased risk of infections and malignancy must be considered when using immune modulating drugs. Whether anti-TNF therapies increase the risk of infections is not definitive, though newer biologics, including vedolizumab and ustekinumab, are thought to be safer with lower risk of adverse events. Polypharmacy and frailty are other considerations in the elderly when choosing a treatment, as frailty is associated with worse outcomes. Costs for IBD-related hospitalizations are higher in the elderly compared with younger persons. When elderly persons with IBD are cared for by a gastroenterologist, their outcomes tend to be better. However, as elderly persons with IBD continue to age, they may not have access to the same care as younger people with IBD due to deficiencies in their ability to use or access technology.

"If We Don't Produce, Bring Another:" Work Organization and Tomato Worker Health.

Objectives: Specific work processes and management structures that contribute to high rates of occupational illness and injury in agricultural industries are not well described in academic literature. This qualitative study of work organization in the U.S. fresh tomato industry investigates how work processes and management structures impact tomato workers' occupational health. Methods: After conducting literature review and key informant interviews, semi-structured interviews and focus groups were conducted with 36 individuals with experience working in the U.S. fresh tomato industry. Interviews and focus groups were audio-recorded, transcribed, coded, and analyzed using a modified grounded theory approach. Results: These data indicate that participants endured income insecurity and hazardous supervisory practices, including wage theft, retaliation, intimidation, and humiliation, that put them at risk of preventable illness and injury. Support from workers' organizations and health-conscious supervisory practices helped mitigate some of these occupational hazards. Conclusion: Participants' adverse work experiences may be considered sequelae of workers' lack of job control and positions of socioeconomic structural vulnerability. Other aspects of tomato work organization, including health-conscious supervisory practices and the involvement of workers' organizations, indicate that modifying work organization to better safeguard health is possible. Such modifications present compelling opportunities for employers, employees, organizations, community and government leaders, and health care professionals to help create healthier occupational environments for tomato workers.

Assessing Heat-Related Mortality Risks among Rural Populations: A Systematic Review and Meta-Analysis of Epidemiological Evidence.

Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four continents met the selection criteria, and eleven were included in the meta-analysis. Using the random effects model, the pooled estimates of relative risks (RRs) for all-cause and cardiovascular mortality were 1.030 (95% CI: 1.013, 1.048) and 1.111 (95% CI: 1.045, 1.181) per 1 °C increase in daily mean temperature, respectively. We found excess risks in rural settings not to be smaller than risks in urban settings. Our results suggest that rural populations, like urban populations, are also vulnerable to heat-related mortality. Further evaluation of heat-related mortality among rural populations is warranted to develop public health interventions in rural communities.

Harriet Hardy and the workers of Los Alamos: a campus-community historical investigation.

Harriet Hardy, protégé of Alice Hamilton, spent 1948 in the Health Division of Los Alamos Scientific Laboratory. The contemporary campaign for federal legislation to compensate nuclear workers brought to the fore living retirees in whose cases of occupational illness Hardy had a role in diagnosis or case management. A third case is documented in archival records. Methods of participatory action research were used to better document the cases and strategize in light of the evidence, thereby assisting the workers with compensation claims. Medical and neuropsychological exams of the mercury case were conducted. Hardy's diary entries and memoirs were interpreted in light of medicolegal documentation and workers' recollections. Through these participatory research activities, Harriet Hardy's role and influence both inside and outside the atomic weapons complex have been elucidated. An important lesson learned is the ongoing need for a system of protective medical evaluations for nuclear workers with complex chemical exposures.

A campus-community partnership for farmworkers' health: interventions for tomato workers in Tennessee.

BACKGROUND: Migrant farm workers are exposed to job hazards in Tennessee, which is among the top five tomato-producing states. OBJECTIVES: This project sought to cultivate and evaluate a partnership to marshal greater resources to address migrants' concerns and to better prepare future health professionals to address occupational issues. METHODS: In the spring of 2008, an interprofessional student-faculty team at a regional university catalyzed a partnership with a clinic for migrants and a national network caring for the itinerant underserved. RESULTS: Several community-based participatory research (CBPR) activities are underway. The partnership has resulted in the following projects: Use of the Rapid Entire Body Assessment (REBA) method to identify job tasks likely to be injurious, development and use of a health screening questionnaire to capture more information about occupational health, and continuing education seminars for providers and a case-based curriculum module for third-year medical students. CONCLUSIONS: Interprofessional service learning about migrant occupational health issues may have its greatest impact as participating students enter the regional workforce, caring for patients employed in slow-to-change agricultural operations.

Genetic susceptibility testing for beryllium: worker knowledge, beliefs, and attitudes.

BACKGROUND: We sought to gain insight into workers' knowledge, beliefs, and attitudes on the subject of testing for genetic susceptibility to beryllium. METHODS: Five focus groups were held with 30 current and former beryllium workers and nine family members. Audio recordings were transcribed and assessed by hierarchical coding using an inductive approach. RESULTS: Some workers were unclear about the distinction between genotoxicity and heritability. A key finding is that they perceived the benefits of a positive test result to be related to enhanced autonomous decision-making. The major concern cited by participants was potential abuse of genetic information by employers. Complete financial separation of a prospective testing entity from the employer was seen as crucial. CONCLUSIONS: A window of opportunity exists to create regional partnerships for translational research on genetic susceptibility testing. Such partnerships would involve labor, management, public health scientists, primary care professionals, and other stakeholders. They would be critical to identifying testing strategies that maximize worker autonomy along with the public health advantages of genetic testing.

Environmental surveillance at Los Alamos: an independent reassessment of historical data.

Since 1971, a series of annual Environmental Surveillance ... reports have served as the official public record of Los Alamos National Laboratory's (LANL) environmental performance. In northern New Mexico, where past LANL emissions are a public health concern, there is public skepticism over the accuracy of information contained in these reports. To test the hypothesis that LANL Environmental Surveillance ... reports systematically understate past emissions, we compared the data on releases in LANL's own internal Occurrence Reports Collection (ORC) to the data reported to the public in the Environmental Surveillance ... reports. A data set of 89 environmental occurrences recorded in the ORC in the time period from 1971 through 1980 was assembled. We did not find a systematic pattern of quantitative underreporting of source terms. However, 17 of the 89 (19%) environmental occurrences recorded in the ORC were not reported to the public in the Environmental Surveillance ... reports. The observed discrepancies are discussed in terms of their relevance to public health concerns. Methodological caveats dictate restraint in applying these findings beyond the scope of the relative comparison performed here. Possible social origins for the rejected hypothesis are discussed. Areas for further consideration by the Centers for Disease Control's dose reconstruction study of LANL are identified.

Ethical considerations in testing workers for the -Glu69 marker of genetic susceptibility to chronic beryllium disease.

OBJECTIVE: The most compelling real-world example of genetic testing for susceptibility to a workplace exposure involves those industries that process or fabricate beryllium. We examined ethical issues associated with testing for susceptibility to chronic beryllium disease. METHODS: Using ethical and clinical criteria, we examined voluntary employer-sponsored testing programs in which individual results are reported directly to workers in a confidential manner. RESULTS: Under reasonable assumptions, the longitudinal positive predictive value of the HLA-DPB1-Glu69 marker of susceptibility to beryllium disease is 12%. Interpretive challenges further limit the utility of the test and may inadvertently suggest a false sense of safety among workers. Concerns about confidential participation and pressures to be tested also must be addressed. CONCLUSIONS: Difficulties surrounding the interpretation of the HLA-DPB1-Glu69 marker, lack of assurance regarding the protection of worker confidentiality, and the potential lowering of social barriers to the implementation of mandatory worker screening combine to make testing beryllium workers inappropriate at this time.

The Energy Employees Occupational Illness Compensation Program Act: new legislation to compensate affected employees.

Nurses make a bureaucracy work on behalf of clients. Occupational health nurses who are already versed in basic concepts applicable to EEOICPA--confidence intervals, occupational histories, exposure assessment, and dose response--can play constructive, caring roles in assisting claimants in securing benefits under this landmark program. Occupational health nurses know that chronically ill employees have a finite number of hours a week to make phone calls, visit providers, and advocate on their own behalf. Thoughtful referrals to occupational health providers who are both experienced and supportive can come from an occupational health nurse or a family physician. Involvement of university-based programs in projects to empower organizations representing EEOICP claimants would be a welcome development.