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Objectives: In addition to personal and health related factors, healthcare workers have an increased risk due to their work. We assessed the association of the score of the Occupational Vulnerability Index with the risk of suffering a severe COVID-19 and sequelae. Methods: Retrospective observational study carried out in healthcare workers. Among 119 employees infected, the COVID-19 Occupational Vulnerability Index (composed of 29 items regarding personal health, working conditions, and ability to comply with preventive measures) was calculated and correlated with COVID-19 severity/sequelae. Results: Workers with higher scores (six to seven points) had a significantly increased risk of developing severe disease (OR = 9.73; 95% CI, 1.53 to 35.56) and clinical sequelae (OR = 5.22; 95% CI, 1.80 to 15.16) than those with lower scores (0 to 3). Conclusion: The " COVID-19 Occupational Vulnerability Index " may predict the risk of severe COVID-19 disease and clinical sequelae among healthcare workers. [ABSTRACT FROM AUTHOR]

Mind–body disciplines such as yoga, Tai Chi, and Qigong have been demonstrated to activate the parasympathetic nervous system, but it remains unclear how these practices achieve these results, whether by breathing, movement, or some combination. This pilot study establishes a model to examine the individual and combined effects of paced breathing and rhythmic skeletal muscle contraction on the activation of the parasympathetic system during a cognitive stressor. Male participants were randomly assigned to one of four preconditioning groups: (a) paced breathing alone, (b) alternating upper extremity muscle contractions, (c) paced breathing synchronized with alternating contractions, or (d) a neutral control task. Autonomic response was assessed by heart rate variability during a standardized cognitive stressor. The alternating contraction group had 71.7% higher activation of parasympathetic signal over respiration alone (p <.001). Alternating contractions synchronized with breathing demonstrated 150% higher parasympathetic activation than control (p <.0001). Comparing the contraction alone and synchronized groups, the synchronized group demonstrated 45.9% higher parasympathetic response during a cognitive stressor (p <.001). In conclusion, paced breathing synchronized with rhythmic muscle contraction leads to more resilient activation of the parasympathetic response than either alternating contractions or breathing alone, which may help explain the stress reducing benefits of mind–body disciplines. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted to investigate fire-suppression activities markedly increase the risk of cardiovascular disease (CVD) events among firefighters published in this issue. It is stated that an alarm response, which produces an adrenergic fight-or-flight reaction with prominent sympathetic arousal usually precdes structural fire-suppression activities.

The article presents a survey of the American College of Occupational and Environmental Medicine (ACOEM) regarding medical screening for drivers suffering from sleep apnea. It mentions that majority of the research found out that OSA can cause impairments in executive and psychomotor function as well as in the vigilance and memory of a person. The authors concluded that more education concerning OSA and drivers are needed.

In their editorial on the challenges to well-being faced by academic staff in the UK, Kinman and Wray [[1]] highlight work changes imposed by the COVID-19 pandemic in this sector. In addition, Weisman I et al. i [[5]] found that tattoo artists and dental workers have similar musculoskeletal pain patterns. If their conclusions are correct, the readership might consider the much greater expected stressors experienced by front-line workers, not to mention those who lost their jobs or had their professions/businesses restricted by pandemic regulations and lockdowns. [Extracted from the article]

Background Heart disease causes 45% of the deaths that occur among U.S. firefighters while they are on duty. We examined duty-specific risks of death from coronary heart disease among on-duty U.S. firefighters from 1994 to 2004.Methods We reviewed summaries provided by the Federal Emergency Management Agency of the deaths of all on-duty firefighters between 1994 and 2004, except for deaths associated with the September 11, 2001, terrorist attacks. Estimates of the proportions of time spent by firefighters each year performing various duties were obtained from a municipal fire department, from 17 large metropolitan fire departments, and from a national database. Odds ratios and 95% confidence intervals for death from coronary heart disease during specific duties were calculated from the ratios of the observed odds to the expected odds, with nonemergency duties as the reference category. Results Deaths from coronary heart disease were associated with suppressing a fire (32.1% of all such deaths), responding to an alarm (13.4%), returning from an alarm (17.4%), engaging in physical training (12.5%), responding to nonfire emergencies (9.4%), and performing nonemergency duties (15.4%). As compared with the odds of death from coronary heart disease during nonemergency duties, the odds were 12.1 to 136 times as high during fire suppression, 2.8 to 14.1 times as high during alarm response, 2.2 to 10.5 times as high during alarm return, and 2.9 to 6.6 times as high during physical training. These odds were based on three estimates of the time that firefighters spend on their duties.Conclusions Certain emergency firefighting duties were associated with a risk of death from coronary heart disease that was markedly higher than the risk associated with nonemergency duties. Fire suppression was associated with the highest risk, which was approximately 10 to 100 times as high as that for nonemergency duties. [ABSTRACT FROM AUTHOR]

The article provides a retrospective chart review of all cases with arsenic testing seen between 1991 and 2004 at an occupational and environmental medicine referral clinic. Urine arsenic results were classified as total arsenic levels, special results, and whether the patient abstained from seafood prior to the collection. The study suggested that reflexive speciation could reduce unnecessary referrals, further testing, and patient anxiety.

Objective: We sought to describe outcomes for three health care workers with natural rubber latex (NRL) allergy reporting illness after exposure to latex paint. Methods: We undertook a retrospective review of medical and occupational histories, diagnostic, treatment, and work recommendations. Outcomes included lost time, workers compensation indemnity costs, and return to work. Results: None of the paints contained NRL Cases 1 and 2 initially were misdiagnosed as suffering allergic reactions to NRL, resulting in 7 and 23 months lost time, $15,790 and $139,000 indemnity costs, respectively, and both failing to return to work. Case 3 was correctly diagnosed as not exposed to NRL, with only several lost days, no indemnity costs, and continued to work. Conclusions: The failure to recognize that synthetic paints do not contain NRL can lead to misdiagnosis, inappropriate exposure, and work avoidance recommendations and iatrogenic disability. [ABSTRACT FROM AUTHOR]

Context Lead, mercury, and arsenic intoxication have been associated with the use of Ayurvedic herbal medicine product (HMPs). Objectives To determine the prevalence and concentration of heavy metals in Ayurvedic HMPs manufactured in South Asia and sold in Boston-area stores and to compare estimated daily metal ingestion with regulatory standards. Design and Setting Systematic search strategy to identify all stores 20 miles or less from Boston City Hall that sold Ayurvedic HMPs from South Asia by searching online Yellow Pages using the categories markets, supermarkets, and convenience stores, and business names containing the word India, Indian cities, and Indian words. An online national directory of Indian grocery stores, a South Asian community business directory, and a newspaper were also searched. We visited each store and purchased all unique Ayurvedic HMPs between April 25 and October 24, 2003. Main Outcome Measures Concentrations (μg/g) of lead, mercury, and arsenic in each HMP as measured by x-ray fluorescence spectroscopy. Estimates of daily metal ingestion for adults and children estimated using manufacturers’ dosage recommendations with comparisons to US Pharmacopeia and US Environmental Protection Agency regulatory standards. Results A total of 14 (20%) of 70 HMPs (95% confidence interval, 11%-31%) contained heavy metals: lead (n = 13; median concentration, 40 μg/g; range, 5-37 000), mercury (n = 6; median concentration, 20 225 μg/g; range, 28-104 000), and/or arsenic (n = 6; median concentration, 430 μg/g; range, 37-8130). If taken as recommended by the manufacturers, each of these 14 could result in heavy metal intakes above published regulatory standards. Conclusions One of 5 Ayurvedic HMPs produced in South Asia and available in Boston South Asian grocery stores contains potentially harmful levels of lead, mercury, and/or arsenic. Users of Ayurvedic medicine may be at risk for heavy metal toxicity, and testing of Ayurve... [ABSTRACT FROM AUTHOR]

The authors evaluated blood pressure and antihypertensive medication use in 334 firefighters in an occupational medical surveillance program. Firefighters received written summaries of their examination results, including blood pressures, and were encouraged to see their personal physicians for any abnormal results. The mean age of the participants was 39 years, and the vast majority were men (n=330). The prevalence of hypertension was 20% at baseline (1996), 23% in 1998, and 23% in 2000. Among firefighters with high blood pressure readings, only 17%, 25%, and 22% were taking antihypertensive medications at the baseline, 1998, and 2000 examinations, respectively. Medical surveillance was effective in detecting hypertension in firefighters; however, after 4 years of follow-up, only 42% of hypertensives were receiving treatment with medications, including only 22% of firefighters with hypertensive readings. Overall, 74% of hypertensives were not adequately controlled. Possible reasons for low treatment rates may be the inadequate recognition among primary care physicians that mild hypertension is a significant risk factor for cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Coronary heart disease (CHD) is responsible for 45% of on-duty deaths among United States firefighters. We sought to identify occupational and personal risk factors associated with on-duty CHD death. Methods: We performed a case-control study, selecting 52 male firefighters whose CHD deaths were investigated by the National Institute for Occupational Safety and Health. We selected two control populations: 51 male firefighters who died of on-duty trauma; and 310 male firefighters examined in 1996/1997, whose vital status and continued professional activity were re-documented in 1998. Results: The circadian pattern of CHD deaths was associated with emergency response calls: 77% of CHD deaths and 61% of emergency dispatches occurred between noon and midnight. Compared to non-emergency duties, fire suppression (OR = 64.1, 95% CI 7.4-556); training (OR = 7.6, 95% CI 1.8-31.3) and alarm response (OR = 5.6, 95% CI 1.1-28.8) carried significantly higher relative risks of CHD death. Compared to the active firefighters, the CHD victims had a significantly higher prevalence of cardiovascular risk factors in multivariate regression models: age ≥ 45 years (OR 6.5, 95% CI 2.6-15.9), current smoking (OR 7.0, 95% CI 2.8-17.4), hypertension (OR 4.7, 95% CI 2.0-11.1), and a prior diagnosis of arterial-occlusive disease (OR 15.6, 95% CI 3.5-68.6). Conclusions: Our findings strongly support that most on-duty CHD fatalities are work-precipitated and occur in firefighters with underlying CHD. Improved fitness promotion, medical screening and medical management could prevent many of these premature deaths. [ABSTRACT FROM AUTHOR]

Heart disease is the primary cause of on-duty deaths in firefighters, but little is known about their lipid profile. We evaluated the lipid profile in relation to other cardiovascular disease risk factors in 321 firefighters at a baseline examination. Prospective comparisons were performed for 285 firefighters, who were enrolled in a statewide medical surveillance program, and had complete follow-up data for 4 years. The average cholesterol level in firefighters declined from 224 mg/dL at baseline (1996-1997) to 214 mg/dL at the follow-up examination (P < 0.0001). Conversely, both obesity (body mass index ≥ 30; 34% versus 40%, P = 0.008) and triglycerides (≥ 200 mg/dL; 27% versus 35%, P = 0.047) increased over time. The proportion of firefighters taking lipid-lowering medications increased from 3% at baseline to 12% at follow-up (P < 0.0001). Cholesterol levels declined significantly, and treatment rates for elevated cholesterol increased over time. Despite repeated examinations, a considerable number of firefighters had persistently elevated cholesterol, and only a minority were receiving adequate treatment. [ABSTRACT FROM AUTHOR]

Presents a study that evaluated the association between hypertension and changes in employment status among hazardous materials firefighters in Massachusetts. Measurement of the blood pressure of the firefighters; Examination of the risk of an adverse event before the next follow-up examination based on the blood pressure measurement; Analysis of the prevalence of hypertension among the firefighters; Limitations of the study.

Presents information on a study which determined the use of mercury testing as a diagnostic tool for unexplained medical problems. Methods used in the study; Results and discussion.

Presents a study which analyzed spirometry results for male hazardous materials firefighters from 1996 to 1999 who underwent one or more annual medical surveillance/fitness for duty examinations. Limited potentials of support members for hazardous materials exposure; Comparison between technicians and support members; Factors that support continued annual spirometry testing.

Presents a study which investigated firefighters' hearing relative to general population data to adjust for age-expected hearing loss. Details on the medical examinations performed for firefighters; Analysis of audiograms; Comparison of firefighters' threshold data with those of a highly screened otologically normal population.

According to our present study on healthcare workers 3 years after COVID-19 outbreak, "long COVID" is associated with reduced quality of life ratings, as well as increased levels of anxiety, depression, stress, and insomnia. Targeted behavioral and cognitive interventions can help safeguard those who are at risk. Objective: This study aimed to evaluate the long-term, symptomatic recovery of healthcare workers from acute COVID-19 infections up to 3 years after the initial COVID-19 outbreak. Methods: A cross-sectional study was performed among employees of a community-based healthcare system in Massachusetts who had a recorded positive COVID-19 test. Survey responses were collected between September 2022 and January 2023. The survey included validated questionnaires: WHOQOL-BREF, EQ-5D-5 L, DASS-21, FCV-19S, K6+, and the Insomnia Severity Index. We compared the long-COVID (ie, symptoms lasting >28 days) and non–long-COVID groups. Results: Among the 280 respondents (15.2% response rate), those with long COVID (73.4%) reported significantly worse quality of life and greater levels of depression, anxiety, and stress metrics. However, no significant difference was found between the two groups' fear of COVID-19. Conclusions: Targeted support for healthcare workers with prolonged symptoms after COVID-19 is warranted. [ABSTRACT FROM AUTHOR]

This article presents a reply to letters to the editor in response to "Emergency duties and deaths from heart disease among firefighters in the United States," by S.N. Kales and colleagues in the March 22, 2007 issue.

Background Substantial evidence supports the inverse association between adherence to healthy dietary patterns and frailty risk. However, the role of plant-based diets, particularly their quality, is poorly known. Objective To examine the association of two plant-based diets with incidence of physical frailty in middle-aged and older adults. Design Prospective cohort. Setting United Kingdom Subjects 24,996 individuals aged 40–70 years, followed from 2009–12 to 2019–22. Methods Based on at least two 24-h diet assessments, we built two diet indices: (i) the healthful Plant-based Diet Index (hPDI) and (ii) the unhealthful Plant-based Diet Index (uPDI). Incident frailty was defined as developing ≥3 out of 5 of the Fried criteria. We used Cox models to estimate relative risks (RR), and their 95% confidence interval (CI), of incident frailty adjusted for the main potential confounders. Results After a median follow-up of 6.72 years, 428 cases of frailty were ascertained. The RR (95% CI) of frailty was 0.62 (0.48–0.80) for the highest versus lowest tertile of the hPDI and 1.61 (1.26–2.05) for the uPDI. The consumption of healthy plant foods was associated with lower frailty risk (RR per serving 0.93 (0.90–0.96)). The hPDI was directly, and the uPDI inversely, associated with higher risk of low physical activity, slow walking speed and weak hand grip, and the uPDI with higher risk of exhaustion. Conclusions In British middle-age and older adults, greater adherence to the hPDI was associated with lower risk of frailty, whereas greater adherence to the uPDI was associated with higher risk. [ABSTRACT FROM AUTHOR]

The article presents questions and answers related to mercury toxicity including the health risks of the patient's exposure to elemental, inorganic and organic mercury, the clinical assessment of mercury and the use of dental amalgam.

Background: Telomere Length (TL), a marker of cellular aging, holds promise as a biomarker to elucidate the molecular mechanism of diabetes. This study aimed to investigate whether shorter telomeres are associated with a higher risk of type 2 diabetes mellitus (T2DM) incidence in patients with coronary heart disease; and to determine whether the most suitable dietary patterns, particularly a Mediterranean diet or a low-fat diet, can mitigate the development of diabetes in these patients after a follow-up period of five years. Methods: The CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (CORDIOPREV study) was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20–75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive two healthy diets. Clinical investigators were masked to treatment assignment; participants were not. Quantitative-PCR was used to assess TL measurements. Findings: 1002 patients (59.5 ± 8.7 years and 82.5% men) were enrolled into Mediterranean diet (n = 502) or a low-fat diet (n = 500) groups. In this analysis, we included all 462 patients who did not have T2DM at baseline. Among them, 107 patients developed T2DM after a median of 60 months. Cox regression analyses showed that patients at risk of short telomeres (TL < percentile 20th) are more likely to experience T2DM than those at no risk of short telomeres (HR 1.65, p-value 0.023). In terms of diet, patients at high risk of short telomeres had a higher risk of T2DM incidence after consuming a low-fat diet compared to patients at no risk of short telomeres (HR 2.43, 95CI% 1.26 to 4.69, p-value 0.008), while no differences were observed in the Mediterranean diet group. Conclusion: Patients with shorter TL presented a higher risk of developing T2DM. This association could be mitigated with a specific dietary pattern, in our case a Mediterranean diet, to prevent T2DM in patients with coronary heart disease. Trial Registration: Clinicaltrials.gov number NCT00924937. [ABSTRACT FROM AUTHOR]

Background and objectives: A Mediterranean lifestyle may prevent and mitigate cardiometabolic disorders. We explored whether adherence to a Mediterranean lifestyle was prospectively associated with the risk of metabolic syndrome (MetS) among coronary heart disease (CHD) patients. Methods: The Coronary Diet Intervention with Olive Oil and Cardiovascular Prevention (CORDIOPREV) study was an interventional diet study to compare a Mediterranean diet with a low‐fat diet, in 1002 CHD patients. The Mediterranean lifestyle (MEDLIFE) index was used to assess adherence to a MEDLIFE at baseline, and after 5 years, in 851 participants from the CORDIOPREV study. Subjects were classified as having high (>13 points), moderate (12–13 points), and low (<12 points) adherence to the MEDLIFE. Multivariable logistic regression models were used to determine the association between MEDLIFE adherence and the risk of MetS development or reversal. Results: During the 5‐year follow‐up, CORDIOPREV participants with high adherence to MEDLIFE had a lower risk of MetS development (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.19–0.75, p < 0.01) and a higher likelihood of reversing preexisting MetS (OR 2.08 CI 95% 1.11–3.91, p = 0.02) compared with participants in the low MEDLIFE adherence group. Each additional one‐point increment in the MEDLIFE index was associated with a 24% lower risk of MetS development (OR 0.76, 95% CI 0.64–0.90, p < 0.01) and a 21% higher likelihood of reversing preexisting MetS (OR 1.21 CI 95% 1.04–1.41, p = 0.01). Conclusions: Our results showed that greater adherence to a MEDLIFE reduced the risk of subsequent MetS development and increased the likelihood of reversing preexisting MetS among patients with CHD at baseline. [ABSTRACT FROM AUTHOR]

Simple Summary: Firefighting has been identified as a high-risk occupation with increased risks for several types of cancers. Exposure to carcinogens in fire smoke and within the fire station, occupational factors such as shift work, and lifestyle are all plausible contributors to disease development. Prevention strategies and a change to fire service culture are crucial for primary cancer prevention among career firefighters. Career firefighters are at considerable risk for chronic diseases, including an increased risk of various cancers, compared to the general population. Over the last two decades, several systematic reviews and large cohort studies have demonstrated that firefighters have statistically significant increases in overall and site-specific cancer incidence and site-specific cancer mortality compared to the general population. Exposure assessment and other studies have documented exposures to a variety of carcinogens in fire smoke and within the fire station. Other occupational factors such as shift work, sedentary behavior, and the fire service food culture may also contribute to this working population's increased cancer risk. Furthermore, obesity and other lifestyle behaviors such as tobacco use, excessive alcohol consumption, poor diet, inadequate physical activity, and short sleep duration have also been associated with an increased risk of certain firefighting-associated cancers. Putative prevention strategies are proposed based on suspected occupational and lifestyle risk factors. [ABSTRACT FROM AUTHOR]

The authors reply to a letter written in response to the article "Lead, Mercury, and Arsenic in US- and Indian-manufactured Ayurvedic Medicines Sold Via the Internet."

A response by S.N. Kales and D.C. Christiani to a letter to the editor about their article "Acute chemical emergencies," in the February 19, 2004 issue is presented.

Examines the problem of acute chemical emergencies. General principles for handling chemical emergencies; Symptoms and treatments for asphyxiants as a cause of chemical emergencies; Treatments for emergencies involving cholinesterase inhibitors, also known as nerve agents; Treatment for respiratory tract irritants; Treatment for vesicants and skin caustics; Importance of community preparedness.

Background: Data on COVID-19 vaccine effectiveness (VE) among healthcare workers (HCWs) during periods of delta variant predominance are limited.Methods: We followed a population of urban Massachusetts HCWs (45% non-White) subject to epidemiologic surveillance. We accounted for covariates such as demographics and community background infection incidence, as well as information bias regarding COVID-19 diagnosis and vaccination status.Results: During the study period (December 16, 2020 to September 30, 2021), 4615 HCWs contributed to a total of 1,152,486 person-days at risk (excluding 309 HCWs with prior infection) and had a COVID-19 incidence rate of 5.2/10,000 (114 infections out of 219,842 person-days) for unvaccinated person-days and 0.6/10,000 (49 infections out of 830,084 person-days) for fully vaccinated person-days, resulting in an adjusted VE of 82.3% (95% CI 75.1-87.4%). For the secondary analysis limited to the period of delta variant predominance in Massachusetts (i.e., July 1 to September 30, 2021), we observed an adjusted VE of 76.5% (95% CI 40.9-90.6%). Independently, we found no re-infection among those with prior COVID-19, contributing to 74,557 re-infection-free person-days, adding to the evidence base for the robustness of naturally acquired immunity.Conclusions: We found a VE of 76.5% against the delta variant. Our work also provides further evidence of naturally acquired immunity. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) continues as the most important cause of mortality. Better risk screening and prediction are needed to reduce the cardiovascular disease burden. The aim of the study was to assess the role of serum biomarkers in the prediction of CVD among asymptomatic middle-aged adults with no prior CVD history. A systematic review and meta-analysis were carried out using literature from PubMed and following PRISMA reporting guidelines. Twenty-five studies met our inclusion criteria and were included in the systematic review. The most commonly studied biomarker was high-sensitivity C reactive protein (hs-CRP) (10 studies), which showed that higher hs-CRP levels are associated with an increased risk of subsequent CVD events and mortality. In addition, several less-studied biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), fibrinogen, gamma-glutamyl transferase (GGT), and others) also showed significant associations with greater future risk of CVD. A meta-analysis was possible to perform for hs-CRP and NT-proBNP, which showed statistically significant results for the ability of hs-CRP (hazard ratio (HR) 1.19, (95% CI: 1.09–1.30), p < 0.05) and NT-proBNP (HR 1.22, (1.13–1.32), p < 0.05) to predict incident CVD among middle-aged adults without a prior CVD history or symptoms. Several serum biomarkers, particularly hs-CRP and NT-proBNP, have the potential to improve primary CVD risk prevention among asymptomatic middle-aged adults. [ABSTRACT FROM AUTHOR]

The article discusses the integration of Lifestyle Medicine Residency Curriculum (LMRC) into an Occupational Medicine Training Program. Topics include the LMRC's educational and practical components, its implementation within an accredited Occupational and Environmental Medicine Residency (OEMR), and residents' positive feedback on its value and influence on their careers.

Approximately 100 United States (US) firefighters die in the line of duty each year. Sudden cardiac death (SCD) accounts for 45 to 50% of all duty-related fatalities. Many aspects of fire fighting increase cardiovascular strain including activation of the sympathetic nervous system, strenuous physical activity, heat stress and dehydration, and severe environmental conditions. High levels of cardiovascular strain can trigger sudden cardiac events in susceptible individuals with underlying cardiovascular disease (CVD). This article presents a theoretical model for the interaction between underlying CVD in firefighters and the multifactorial psychophysiological strain of fire fighting. Recommendations to decrease CVD deaths in the fire service are offered. [ABSTRACT FROM AUTHOR]

Background: Data on COVID-19 vaccine effectiveness (VE) among healthcare workers (HCWs) during periods of delta variant predominance are limited. Methods: We followed a population of urban Massachusetts HCWs (45% non-White) subject to epidemiologic surveillance. We accounted for covariates such as demographics and community background infection incidence, as well as information bias regarding COVID-19 diagnosis and vaccination status. Results: During the study period (December 16, 2020 to September 30, 2021), 4615 HCWs contributed to a total of 1,152,486 person-days at risk (excluding 309 HCWs with prior infection) and had a COVID-19 incidence rate of 5.2/10,000 (114 infections out of 219,842 person-days) for unvaccinated person-days and 0.6/10,000 (49 infections out of 830,084 person-days) for fully vaccinated person-days, resulting in an adjusted VE of 82.3% (95% CI 75.1–87.4%). For the secondary analysis limited to the period of delta variant predominance in Massachusetts (i.e., July 1 to September 30, 2021), we observed an adjusted VE of 76.5% (95% CI 40.9–90.6%). Independently, we found no re-infection among those with prior COVID-19, contributing to 74,557 re-infection-free person-days, adding to the evidence base for the robustness of naturally acquired immunity. Conclusions: We found a VE of 76.5% against the delta variant. Our work also provides further evidence of naturally acquired immunity. [ABSTRACT FROM AUTHOR]

Exposure to inorganic arsenic (As) through drinking water is a major international public health issue. We carried out a systematic review of the existing literature examining the association between the risk of bladder cancer in humans and exposure to arsenic through drinking water. We searched electronic databases for studies published from January 2000 up to April 2013. Eight ecological studies, six case-control studies, four cohort studies and two meta-analyses were identified. The vast majority of the studies were carried out in areas with high arsenic concentrations in drinking water such as southwestern and northeastern Taiwan, Pakistan, Bangladesh, Argentina (Cordoba Province), USA (southeastern Michigan, Florida, Idaho) and Chile. Most of the studies reported higher risks of bladder cancer incidence or mortality in areas with high arsenic concentrations in drinking water compared to the general population or a low arsenic exposed control group. The quality assessment showed that among the studies identified, arsenic exposure was assessed at the individual level only in half of them and only three assessed exposure using a biomarker. Further, five out of eight ecological studies presented results with adjustment for potential confounders except for age; all cohort and case-control studies presented results with adjustment for cigarette smoking status in the analysis. The majority of the studies with varying study designs carried out in different areas provided evidence of statistically siginificant increases in bladder cancer risk at high concentrations of arsenic (>50 μg L−1). Assessing bladder cancer risk at lower exposure concentrations requires further investigation. [ABSTRACT FROM AUTHOR]

The article discusses research investigating the relationship between metabolic syndrome (MetSyn) and cardiorespiratory fitness (CRF) in firefighters. The authors note that cardiovascular disease (CVD) occurs primarily in firefighters with high CVD risk factors in patterns resembling metabolic syndrome (MetSyn). Researchers found a higher prevalence of MetSyn in firefighters who scored low on a maximal exercise tolerance test (METS) versus colleagues in the high fitness category.

Background: Restrictive patterns of pulmonary function abnormalities associated with asbestos exposure are well described. Studies are less consistent, however, regarding the association of asbestos inhalation with airway dysfunction and obstructive impairment. Methods: We compared pulmonary function test results between 277 chrysotile exposed workers (22% non-smokers) and 177 unexposed controls (50.3% non-smokers). Information on exposure and smoking were collected using a standardized questionnaire. Standardized spirometric and DCLO Measurement methods were utilized. CXRs were read based on ILO pneumoconiosis guidelines. Results: Asbestos exposed subjects had significantly reduced FVC, FEV1, FEV1/FVC and DLCO. Restricting the analysis to non-smokers, asbestos workers still had about 3% lower FEV1/FVC ratio than controls, but this difference did not reach statistical significance. Among exposed workers, the presence of radiographic evidence of asbestosis further lowered FVC and DLCO but not FEV1/FVC compared to asbestos exposure without radiographic asbestosis. Additionally, smoking asbestos workers had significantly lower DLCO compared to non-smoking workers. Conclusion: Asbestos exposure, especially when radiographic evidence of interstitial fibrosis from asbestosis is present, leads to significant decreases in FVC, FEV1 and the DLCO. However, asbestos exposure alone is not significantly associated with a reduction of the FEV1/FVC. Smoking-asbestos workers had significantly lower DLCO than their nonsmoking counterparts. Whether asbestos interacts with smoking additively or synergistically on DLCO needs further investigation. Similarly, further studies are needed to assess the progression and clinical significance of asbestos induced airway dysfunction. [ABSTRACT FROM AUTHOR]

The traditional Mediterranean diet is considered the world's most evidence-based eating pattern for promoting health and longevity. However, institutional food environments and their busy consumers often sacrifice health benefits for the convenience of faster and cheaper foods that generally are of lower quality and are more processed, and thus, contribute to the current epidemics of obesity and diabetes. Expert consensus has even identified the Mediterranean diet as the easiest to follow among healthy eating patterns. Nonetheless, fewer American families cook at home and many food services have been slow to implement healthier food options compatible with the Mediterranean diet. In September 2019, we convened a group of thought leaders at an exploratory seminar entitled: "Mediterranean Diet: Promotion and Dissemination of Healthy Eating", hosted by the Radcliffe Institute for Advanced Studies at Harvard University. The multidisciplinary faculty discussed best practices for translating traditional Mediterranean lifestyle principles to modern society. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a common cause of hypertension. Previous studies have demonstrated beneficial short-term effects of continuous positive airway pressure (CPAP) therapy on blood pressure. However, long-term antihypertensive effects of CPAP have not been properly verified. This study examined the longitudinal effect of CPAP therapy adherence on blood pressure among OSA patients. All patients diagnosed with OSA and undergoing subsequent CPAP therapy at a Kanagawa-area sleep clinic were clinically followed for 24 months to examine CPAP adherence, as well as longitudinal changes in blood pressure and body weight because it may become a confound factor for changes in blood pressure. The hours of CPAP usage were collected over the course of 30 nights prior to each follow-up visit (1st, 3rd, 6th, 12th, and 24th month). The relationship between CPAP adherence and blood pressure was analyzed using mixed-effect logistic regression models. A total of 918 OSA patients were enrolled in the study. We found a significant reduction in diastolic blood pressure among patients with good CPAP adherence during the 24-month follow-up period (β = − 0.13, p = 0.03), when compared to the group with poor CPAP adherence. No significant association was found between CPAP adherence and weight loss (β = − 0.02, p = 0.59). Long-term, good CPAP therapy adherence was associated with lower diastolic blood pressure without significant weight loss. [ABSTRACT FROM AUTHOR]

Epidemiological studies have yielded conflicting results regarding climate and incident SARS-CoV-2 infection, and seasonality of infection rates is debated. Moreover, few studies have focused on COVD-19 deaths. We studied the association of average ambient temperature with subsequent COVID-19 mortality in the OECD countries and the individual United States (US), while accounting for other important meteorological and non-meteorological co-variates. The exposure of interest was average temperature and other weather conditions, measured at 25 days prior and 25 days after the first reported COVID-19 death was collected in the OECD countries and US states. The outcome of interest was cumulative COVID-19 mortality, assessed for each region at 25, 30, 35, and 40 days after the first reported death. Analyses were performed with negative binomial regression and adjusted for other weather conditions, particulate matter, sociodemographic factors, smoking, obesity, ICU beds, and social distancing. A 1 °C increase in ambient temperature was associated with 6% lower COVID-19 mortality at 30 days following the first reported death (multivariate-adjusted mortality rate ratio: 0.94, 95% CI 0.90, 0.99, p = 0.016). The results were robust for COVID-19 mortality at 25, 35 and 40 days after the first death, as well as other sensitivity analyses. The results provide consistent evidence across various models of an inverse association between higher average temperatures and subsequent COVID-19 mortality rates after accounting for other meteorological variables and predictors of SARS-CoV-2 infection or death. This suggests potentially decreased viral transmission in warmer regions and during the summer season. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Purpose: This study aimed to investigate changes in firefighter recruits' select health and fitness measurements, from academy training to the early probationary firefighter period. Methods: Firefighter recruits from two New England fire academies were followed up prospectively from enrollment at the academy to graduation after 15- to 16-wk training programs, and then for an average of 8 months as probationary firefighters. The participants' demographic, lifestyle, and mental health information was collected using a questionnaire. Body mass index, percent body fat, blood pressure, and push-ups were also measured at each time point. Furthermore, the academies tested the recruits on selected fitness measures (push-ups, pull-ups, and 1.5-mile running time) at academy entry, midtraining, and at graduation. Results: Ninety-two recruits consented and were included in the analyses. The recruits' percent body fat significantly decreased (median, 21.0%–18.2%) from baseline to graduation, and push-up capacity significantly improved (median, 34–53 per minute) in the same period, along with pull-ups and 1.5-mile running time. However, the recruits' blood pressure, both systolic and diastolic, increased significantly by an average of 3 mm Hg during the training. Those completing probationary follow-up (45/92 recruits) showed that most health/fitness improvements declined after graduation. From academy graduation to probationary follow-up, recruits' physical activity decreased and TV screen time increased significantly, leading to a lower healthy lifestyle score (median, 4–3). After multivariate adjustments, the recruits' diastolic blood pressure increased by 2 mm Hg per measuring time throughout the study period. Conclusions: Fire academy training improved recruits' select health and fitness measurements, but the benefits dissipated as probationary firefighters, and blood pressures increased throughout the study period. Further interventions regarding blood pressure and to maintain training benefits after joining fire departments are warranted. [ABSTRACT FROM AUTHOR]

Oncologic patients often suffer from malnutrition which in turn, might have negative impact on treatment outcomes. The Geriatric Nutritional Risk Index (GNRI), as an index of impaired nutritional status, has emerged as a significant prognostic factor for short-and long-term outcomes in cancer patients. The aim of the current systematic review is to determine whether the GNRI is an independent prognostic factor of postoperative complications and survival in cancer patients. A systematic search was conducted to identify studies, published from 2005 to 2019, which assessed associations between GNRI and short- and long-term outcomes in cancer patients. Eighteen studies fulfilled the eligibility criteria and were included in the analysis. Low scores of GNRI were associated with increased risk for developing postoperative complications and impaired survival of cancer patients in most studies. Our findings support the use of the GNRI in the clinical practice, since it is a simple and reliable tool for assessing nutritional status in oncologic patients. More prospective, multi-centered studies are warranted to confirm the current results, as well as the role of nutritional support in improving the prognosis of cancer patients. [ABSTRACT FROM AUTHOR]

Commercial Motor Vehicle drivers must be medically certified to obtain/maintain a commercial driver license. 88,246 exams from 2005 to 2012 were analyzed for relationships between health and certification length. Relationships were quantified using adjusted odds ratios (ORs). Most conditions and/or examination findings had statically significantly limited medical certification. Obesity > 35 kg/m², hypertension and diabetes mellitus requiring medication were most common. Significant and meaningful relationships were found for opioid or benzodiazepine use (OR = 7.30), heart disease (OR = 5.19), musculoskeletal conditions (OR = 5.13), seizures (10.18), stroke (OR = 6.73), neurological (OR = 18.51) and vascular (OR = 11.83). Drivers with 2 or more of 13 medical conditions were statistically significantly more likely to have limited medical certification (OR = 122.35) or disqualification (OR = 4.91). Drivers with any condition are more likely to have limited medical certification. There is variability in medical certification lengths related to medical conditions and differences between examiners. [ABSTRACT FROM AUTHOR]

Objective: Examine the association between healthy Mediterranean life-style practices and cardiovascular disease (CVD) risk factors among New England firefighter recruits. Methods: A MEDI-Lifestyle score was used to measure adherence to a Mediterranean lifestyle (not smoking, increased physical activity, high adherence to Mediterranean diet, non-obese body mass index, decreased screen time, adequate nightly sleep, and napping) among the recruits. MEDI-Lifestyle scores were cross-sectionally analyzed with blood pressure, aerobic capacity, and other CVD risk factors. Results: Among 92 recruits, high adherence to MEDI-Lifestyle was significantly associated with a decreased risk of prevalent hypertension (odds ratio [OR] = 0.14 [0.03-0.71]) and a greater probability of high aerobic capacity (OR = 5.80 [1.05-32.05]) as compared with low adherence in age- and sex-adjusted analyses. Conclusions: Increased adherence to MEDI-Lifestyle is associated with a better CVD risk profile in firefighter recruits. [ABSTRACT FROM AUTHOR]

Background: Coronavirus 2019 disease (COVID-19) is caused by the virus SARS-CoV-2, transmissible both person-to-person and from contaminated surfaces. Early COVID-19 detection among healthcare workers (HCWs) is crucial for protecting patients and the healthcare workforce. Because of limited testing capacity, symptom-based screening may prioritize testing and increase diagnostic accuracy. Methods and findings: We performed a retrospective study of HCWs undergoing both COVID-19 telephonic symptom screening and nasopharyngeal SARS-CoV-2 assays during the period, March 9—April 15, 2020. HCWs with negative assays but progressive symptoms were re-tested for SARS-CoV-2. Among 592 HCWs tested, 83 (14%) had an initial positive SARS-CoV-2 assay. Fifty-nine of 61 HCWs (97%) who were asymptomatic or reported only sore throat/nasal congestion had negative SARS-CoV-2 assays (P = 0.006). HCWs reporting three or more symptoms had an increased multivariate-adjusted odds of having positive assays, 1.95 (95% CI: 1.10–3.64), which increased to 2.61 (95% CI: 1.50–4.45) for six or more symptoms. The multivariate-adjusted odds of a positive assay were also increased for HCWs reporting fever and a measured temperature ≥ 37.5°C (3.49 (95% CI: 1.95–6.21)), and those with myalgias (1.83 (95% CI: 1.04–3.23)). Anosmia/ageusia (i.e. loss of smell/loss of taste) was reported less frequently (16%) than other symptoms by HCWs with positive assays, but was associated with more than a seven-fold multivariate-adjusted odds of a positive test: OR = 7.21 (95% CI: 2.95–17.67). Of 509 HCWs with initial negative SARS-CoV-2 assays, nine had symptom progression and positive re-tests, yielding an estimated negative predictive value of 98.2% (95% CI: 96.8–99.0%) for the exclusion of clinically relevant COVID-19. Conclusions: Symptom and temperature reports are useful screening tools for predicting SARS-CoV-2 assay results in HCWs. Anosmia/ageusia, fever, and myalgia were the strongest independent predictors of positive assays. The absence of symptoms or symptoms limited to nasal congestion/sore throat were associated with negative assays. [ABSTRACT FROM AUTHOR]

Objective: There is limited evidence of work-related transmission in the emerging coronaviral pandemic. We aimed to identify high-risk occupations for early coronavirus disease 2019 (COVID-19) local transmission. Methods: In this observational study, we extracted confirmed COVID-19 cases from governmental investigation reports in Hong Kong, Japan, Singapore, Taiwan, Thailand, and Vietnam. We followed each country/area for 40 days after its first locally transmitted case, and excluded all imported cases. We defined a possible work-related case as a worker with evidence of close contact with another confirmed case due to work, or an unknown contact history but likely to be infected in the working environment (e.g. an airport taxi driver). We calculated the case number for each occupation, and illustrated the temporal distribution of all possible work-related cases and healthcare worker (HCW) cases. The temporal distribution was further defined as early outbreak (the earliest 10 days of the following period) and late outbreak (11th to 40th days of the following period). Results: We identified 103 possible work-related cases (14.9%) among a total of 690 local transmissions. The five occupation groups with the most cases were healthcare workers (HCWs) (22%), drivers and transport workers (18%), services and sales workers (18%), cleaning and domestic workers (9%) and public safety workers (7%). Possible work-related transmission played a substantial role in early outbreak (47.7% of early cases). Occupations at risk varied from early outbreak (predominantly services and sales workers, drivers, construction laborers, and religious professionals) to late outbreak (predominantly HCWs, drivers, cleaning and domestic workers, police officers, and religious professionals). Conclusions: Work-related transmission is considerable in early COVID-19 outbreaks, and the elevated risk of infection was not limited to HCW. Implementing preventive/surveillance strategies for high-risk working populations is warranted. [ABSTRACT FROM AUTHOR]

Background: Obesity is a major risk factor for many chronic diseases, including reduced lung function. The role of polymorphisms of the adiponectin gene, though linked with cardiometabolic consequences of obesity, has not been studied in relation to lung function. Objectives: The aim of this study is to examine polymorphisms in the ADIPOQ, ADIPOR1, and ADIPOR2 genes in relation to adiponectin serum levels, BMI, and adiposity in 18-year old Cypriot males, as well as determine whether BMI, adipokines levels and polymorphisms in adipokine related genes are associated with lung function levels. Results: From the participants, 8% were classified as obese, 22% as overweight, and the remaining 71% as normal. We found that rs266729 and rs1501299 in ADIPOQ and rs10920531 in ADIPOR1 were significantly associated with serum adiponectin levels, after adjusting for ever smoking. In addition, there was an overall significant increase in FEV1% predicted with increasing BMI (β = 0.53, 95% CI: 0.27, 0.78) and in FVC % predicted (β = 1.02, 95% CI: 0.73, 1.30). There was also a decrease in FEV1/FVC with increasing BMI (β = -0.53, 95% CI: -0.71, -0.35). Finally, rs1501299 was associated with lung function measures. Discussion: Functional variants in the ADIPOQ gene were linked with lung function in young males. Further studies should concentrate on the role of adipokines on lung function which may direct novel therapeutic approaches. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to measure the association of burnout syndrome with insulin resistance in the context of a workplace health intervention. Methods: One-year intervention program (2015 to 2016) within a university workplace. Participants ( n = 55) were categorized by the presence or absence of burnout syndrome at baseline using the Maslach Burnout Inventory. Insulin resistance was calculated by the triglyceride glucose index (TyG). The Mediterranean Diet adherence score and several fitness tests were completed by the participants. Results: Although participants with prevalent burnout syndrome at baseline improved their physical fitness and diet scores more than participants without burnout syndrome, multiple linear regression analyses showed that participants with prevalent burnout syndrome at baseline had increased TyG index compared with participants without burnout syndrome (/)=0.18; 95% Cl, 0.01 to 0.34). Conclusion: Burnout syndrome may be associated with insulin resistance, despite improvements in diet and fitness. [ABSTRACT FROM AUTHOR]