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As climate change alters environmental conditions, the incidence and global patterns of human diseases are changing. These modifications to disease profiles and the effects upon human pharmaceutical usage are discussed. Climate-related environmental changes are associated with a rise in the incidence of chronic diseases already prevalent in the Northern Hemisphere, for example, cardiovascular disease and mental illness, leading to greater use of associated heavily used Western medications. Sufferers of respiratory diseases may exhibit exacerbated symptoms due to altered environmental conditions (e.g., pollen). Respiratory, water-borne, and food-borne toxicants and infections, including those that are vector borne, may become more common in Western countries, central and eastern Asia, and across North America. As new disease threats emerge, substantially higher pharmaceutical use appears inevitable, especially of pharmaceuticals not commonly employed at present (e.g., antiprotozoals). The use of medications for the treatment of general symptoms (e.g., analgesics) will also rise. These developments need to be viewed in the context of other major environmental changes (e.g., industrial chemical pollution, biodiversity loss, reduced water and food security) as well as marked shifts in human demographics, including aging of the population. To identify, prevent, mitigate, and adapt to potential threats, one needs to be aware of the major factors underlying changes in the use of pharmaceuticals and their subsequent release, deliberately or unintentionally, into the environment. This review explores the likely consequences of climate change upon the use of medical pharmaceuticals in the Northern Hemisphere., (© Clare H. Redshaw, Will M. Stahl-Timmins, Lora E. Fleming, Iain Davidson, and Michael H. Depledge.)

Infectious diseases attributable to unsafe water supply, sanitation and hygiene (e.g. Cholera, Leptospirosis, Giardiasis) remain an important cause of morbidity and mortality, especially in low-income countries. Climate and weather factors are known to affect the transmission and distribution of infectious diseases and statistical and mathematical modelling are continuously developing to investigate the impact of weather and climate on water-associated diseases. There have been little critical analyses of the methodological approaches. Our objective is to review and summarize statistical and modelling methods used to investigate the effects of weather and climate on infectious diseases associated with water, in order to identify limitations and knowledge gaps in developing of new methods. We conducted a systematic review of English-language papers published from 2000 to 2015. Search terms included concepts related to water-associated diseases, weather and climate, statistical, epidemiological and modelling methods. We found 102 full text papers that met our criteria and were included in the analysis. The most commonly used methods were grouped in two clusters: process-based models (PBM) and time series and spatial epidemiology (TS-SE). In general, PBM methods were employed when the bio-physical mechanism of the pathogen under study was relatively well known (e.g. Vibrio cholerae); TS-SE tended to be used when the specific environmental mechanisms were unclear (e.g. Campylobacter). Important data and methodological challenges emerged, with implications for surveillance and control of water-associated infections. The most common limitations comprised: non-inclusion of key factors (e.g. biological mechanism, demographic heterogeneity, human behavior), reporting bias, poor data quality, and collinearity in exposures. Furthermore, the methods often did not distinguish among the multiple sources of time-lags (e.g. patient physiology, reporting bias, healthcare access) between environmental drivers/exposures and disease detection. Key areas of future research include: disentangling the complex effects of weather/climate on each exposure-health outcome pathway (e.g. person-to-person vs environment-to-person), and linking weather data to individual cases longitudinally. [ABSTRACT FROM AUTHOR]

Background Green jobs are a rapidly emerging category of very heterogeneous occupations that typically involve engagement with new technologies and changing job demands predisposing them to physical stressors that may contribute to the development of joint pain. Methods We estimated and compared the prevalence of self-reported acute (past 30 days) joint pain between green and non-green collar workers using pooled 2004-2012 National Health Interview Survey (NHIS) data linked to the Occupational Information Network Database (O*NET). Results Green collar workers have a higher prevalence of acute joint pain as compared to non-green collar workers. Green collar workers with pain in the upper extremity joints were significantly greater than in the non-green collar workforce, for example, right shoulder [23.2% vs 21.1%], right elbow [13.7% vs 12.0%], left shoulder [20.1% vs 18.2%], and left elbow [12.0% vs 10.7%]. Conclusions Acute joint pain reported by the emerging green collar workforce can assist in identifying at risk worker subgroups for musculoskeletal pain interventions. [ABSTRACT FROM AUTHOR]

Background: We sought to identify high-risk areas of pancreatic cancer incidence, and determine if clusters of persons diagnosed with pancreatic cancer were more likely to be located near arsenic-contaminated drinking water wells. Methods: A total of 5,707 arsenic samples were collected from December 2000 to May 2008 by the Florida Department of Health, representing more than 5,000 individual privately owned wells. During that period, 0.010 ppm (10 ppb) or greater arsenic levels in private well water were considered as the threshold based on standard of United States Environmental Protection Agency (EPA). Spatial modeling was applied to pancreatic cancer cases diagnosed between 1998-2002 in Florida (n = 11,405). Multivariable logistic regression was used to determine if sociodemographic indicators, smoking history, and proximity to arsenic-contaminated well sites were associated with residence at the time of pancreatic cancer diagnosis occurring within versus outside a cluster. Results: Spatial modeling identified 16 clusters in which 22.6% of all pancreatic cancer cases were located. Cases living within 1 mile of known arsenic-contaminated wells were significantly more likely to be diagnosed within a cluster of pancreatic cancers relative to cases living more than 3 miles from known sites (odds ratio = 2.1 [95% CI = 1.9, 2.4]). Conclusions: Exposure to arsenic-contaminated drinking water wells may be associated with an increased risk of pancreatic cancer. However, case-control studies are needed in order to confirm the findings of this ecological analysis. These cluster areas may be appropriate to evaluate pancreatic cancer risk factors, and to perform targeted screening and prevention studies. [ABSTRACT FROM AUTHOR]

Objectives. The working poor sometimes delay retirement to survive. However, their higher risk of disease and disability threatens both their financial survival and their ability to work through the retirement years. We used the burden of disease attributable to arthritis by occupational class to illustrate the challenges faced by the older poor. Methods. We merged data from the National Health Interview Survey, Medical Expenditure Panel Survey, and the National Death Index into a single database. We then calculated and compared age- and occupational class-specific quality-adjusted life years (QALYs) between workers with and without arthritis by using unabridged life tables. Results. White-collar workers have a higher overall health-related quality of life than do other workers, and suffer fewer QALYs lost to arthritis at all ages. For instance, whereas 65-year-old white-collar workers without arthritis look forward to 17 QALYs of future life, blue-collar workers with arthritis experience only 11, and are much less likely to remain in the workforce than are those in service, farming, or white-collar jobs. Conclusions. To meet the needs of the aging workforce, more extensive health and disability insurance will be needed. [ABSTRACT FROM AUTHOR]

To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators. [ABSTRACT FROM AUTHOR]

Construction workers are frequently exposed to awkward work postures and physical demands that can lead to work-related musculoskeletal disorders. There has been limited development of assessment and outreach strategies targeting this highly mobile workforce in general and especially among Hispanic construction workers. We report the prevalence of joint pain from a convenience sample of Hispanic construction workers. A workplace musculoskeletal disorder assessment was undertaken coinciding with construction-site lunch truck visits among 54 workers employed at two large South Florida construction sites. A 45-item questionnaire preloaded onto handheld devices was utilized to record field data. Forty-seven percent of Hispanic workers reported joint pain 30 days prior to interview date, of whom 87% indicated these joint problems interfered with work activities. Over 63% reported experiencing low back pain that lasted at least a whole day during the past 3 months. Right and left knees were the most frequently reported painful joints (both 34%). Musculoskeletal disorders as evident by joint pain, appears to be prevalent among Hispanic construction workers. Workplace ergonomic prevention strategies that reduce musculoskeletal disorders using innovative recruitment and engagement methods (such as during lunch truck construction-site visits) may improve opportunities to reduce joint pain and damage. [ABSTRACT FROM AUTHOR]

The United States Environmental Protection Agency is committed to developing new recreational water quality criteria for coastal waters by 2012 to provide increased protection to swimmers. We review the uncertainties and shortcomings of the current recreational water quality criteria, describe critical research needs for the development of new criteria, as well as recommend a path forward for new criteria development. We believe that among the most needed research needs are the completion of epidemiology studies in tropical waters and in waters adversely impacted by urban runoff and animal feces, as well as studies aimed to validate the use of models for indicator and pathogen concentration and health risk predictions. [ABSTRACT FROM AUTHOR]

Objective: Among workers in dusty occupations, tobacco use is particularly detrimental to health because of the potential synergistic effects of occupational exposures (for example, asbestos) in causing disease. This study explored the prevalence of smoking and the reported smoking cessation discussion with a primary healthcare provider (HCP) among a representative sample of currently employed US worker groups. Methods: Pooled data from the 1997-2003 National Health Interview Survey (NHIS) were used to estimate occupation specific smoking rates (n= 135 412). The 2000 NHIS Cancer Control Module was used to determine (among employed smokers with HCP visits) the prevalence of being advised to quit smoking by article for occupation (n = 3454). Results: The average annual prevalence of current smoking was 25% in all workers. In 2000, 84% of smokers reported visiting an HCP during the past 12 months; 53% reported being advised by their physician to quit smoking (range 42%-66% among 30 occupations). However, an estimated 10.5 million smokers were not advised to quit smoking by their HCP. Workers with potentially increased occupational exposure to dusty of Miami School of " work environments (including asbestos, silica, particulates, etc), at high risk for occupational lung disease and with high smoking prevalence, had relatively low reported discussions with an HCP about smoking cessation, Epidemiology and Public including farm workers (30% overall smoking prevalence; 42% told to quit), construction and extractive trades (39%; 46%), and machine operators/tenderers (34%; 44%). Conclusion: The relatively low reported prevalence of HCP initiated smoking cessation discussion, particularly among currently employed workers with potentially synergistic occupational exposures and high current smoking prevalence, needs to be addressed through educational campaigns targeting physicians and other HCPs. [ABSTRACT FROM AUTHOR]

Background: Case studies and anecdotal reports have documented a range of acute illnesses associated with exposure to cyanobacteria and their toxins in recreational waters. The epidemiological data to date are limited; we sought to improve on the design of some previously conducted studies in order to facilitate revision and refinement of guidelines for exposure to cyanobacteria in recreational waters. Methods: A prospective cohort study was conducted to investigate the incidence of acute symptoms in individuals exposed, through recreational activities, to low (cell surface area <2.4 mm²/mL), medium (2.4-12.0 mm²/mL) and high (>12.0 mm²/mL) levels of cyanobacteria in lakes and rivers in southeast Queensland, the central coast area of New South Wales, and northeast and central Florida. Multivariable logistic regression analyses were employed; models adjusted for region, age, smoking, prior history of asthma, hay fever or skin disease (eczema or dermatitis) and clustering by household. Results: Of individuals approached, 3,595 met the eligibility criteria, 3,193 (89%) agreed to participate and 1,331 (37%) completed both the questionnaire and follow-up interview. Respiratory symptoms were 2.1 (95%CI: 1.1-4.0) times more likely to be reported by subjects exposed to high levels of cyanobacteria than by those exposed to low levels. Similarly, when grouping all reported symptoms, individuals exposed to high levels of cyanobacteria were 1.7 (95%CI: 1.0-2.8) times more likely to report symptoms than their low-level cyanobacteria-exposed counterparts. Conclusion: A significant increase in reporting of minor self-limiting symptoms, particularly respiratory symptoms, was associated with exposure to higher levels of cyanobacteria of mixed genera. We suggest that exposure to cyanobacteria based on total cell surface area above 12 mm²/mL could result in increased incidence of symptoms. The potential for severe, life-threatening cyanobacteria-related illness is likely to be greater in recreational waters that have significant levels of cyanobacterial toxins, so future epidemiological investigations should be directed towards recreational exposure to cyanotoxins. [ABSTRACT FROM AUTHOR]

Purpose: Cancer affects a growing proportion of US workers. Factors contributing to whether they continue or return to work after cancer diagnosis include: age, physical and mental health, health insurance, education, and cancer site. The purpose of this study was to assess the complex relationships between health indicators and employment status for adult cancer survivors.Methods: We analyzed pooled data from the 1997-2012 US National Health Interview Survey (NHIS). Our sample included adults with a self-reported physician diagnosis of cancer (n = 24,810) and adults with no cancer history (n = 382,837). Using structural equation modeling (SEM), we evaluated the relationship between sociodemographic factors, cancer site, and physical and mental health indicators on the overall health and employment status among adults with a cancer history.Results: The overall model for cancer survivors fit the data well (χ(2) (374) = 3654.7, P < .001; comparative fit index = 0.98; root mean square error of approximation = 0.04). Although black cancer survivors were less likely to report good-to-excellent health, along with Hispanic survivors, they were more likely to continue to work after diagnosis compared with their white counterparts. Health insurance status and educational level were strongly and positively associated with health status and current employment. Age and time since diagnosis were not significantly associated with health status or employment, but there were significant differences by cancer site.Conclusions: A proportion of cancer survivors may continue to work because of employment-based health insurance despite reporting poor health and significant physical and mental health limitations. Acute and long-term health and social support are essential for the continued productive employment and quality of life of all cancer survivors. [ABSTRACT FROM AUTHOR]

Neurotoxic shellfish poisoning (NSP) is caused by the consumption of molluscan shellfish meat contaminated with brevetoxins produced by the dinoflagellate, Karenia brevis ( K. brevis ). During a prolonged and intermittent K. brevis bloom starting in 2005 lasting through early 2007 in the Gulf of Mexico off southwest Florida coast, there were 24 confirmed cases of NSP linked to the consumption of clams recreationally harvested in, or in close proximity to, regulated shellfish harvesting areas; these shellfish beds had already been officially closed to harvesting due to the presence of the K. brevis bloom. The majority of NSP cases (78%) were in “visitors,” either non-Florida residents or Florida residents living outside the county of harvest. The number of confirmed NSP cases was likely an underestimate of the actual number of cases. Current management strategy appears to be effective in limiting the number of NSP cases associated with shellfish harvested commercially during red tide events. In contrast, public notification that shellfish beds are closed to harvest, due to red tides or pathogens, is not reaching all recreational shellfish harvesters and consumers, particularly visitors from outside the county or state. The constantly changing closure status of shellfish harvesting areas in combination with overlooked notifications may lead to an apparent disregard of harvesting restrictions. It is important, therefore, to provide the general public, including visitors and those with language barriers, with improved access to up-to-date information concerning the daily openings and closings of shellfish harvesting areas. Furthermore, the risks of consuming potentially toxic shellfish should be disseminated more broadly. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Approximately 40% of Americans annually diagnosed with cancer are working-age adults. Using a nationally representative database, we characterized differences in health status and occupation of working cancer survivors and persons without cancer. Methods: Cross-sectional data pooled from the 1997–2009 US National Health Interview Survey for adults with self-reported physician-diagnosed cancer (n=22,952) and those without (n=358,495), were analyzed. Multivariable logistic regression was used to compare the health and disability status of employed cancer survivors across occupational sectors relative to workers without a cancer history and unemployed cancer survivors. Results: Relative to workers with no cancer history, cancer survivors were more likely (OR; 95%CI) to be white-collar workers and less likely to be service workers. Working cancer survivors were significantly less likely than unemployed survivors, but more likely than workers with no cancer history, to report poor–fair health (0.25; 0.24–0.26) and (2.06; 1.96–2.17) respectively, and ≥2 functional limitations (0.37; 0.35–0.38) and (1.72; 1.64–1.80) respectively. Among employed cancer survivors, blue-collar workers reported worse health outcomes, yet they reported fewer workdays missed than white-collar workers. Conclusion: Blue-collar cancer survivors are working with high levels of poor health and disability. These findings support the need for workplace accommodations for cancer survivors in all occupational sectors, especially blue-collar workers. [Copyright &y& Elsevier]

The article reports on the study which has identified that cardiovascular fitness (CVF) is low for U.S. employees with limited physical activity. It notes that the frequency and descriptive statistics of sociodemographic variables of interest have been calculated. It mentions that the age of the respondents ranged from 18 to 49 years.

The article discusses the increased risk of acquiring chronic illnesses among young adults in the U.S. It notes that the unhealthy activities of employed youth include high levels of smoking, French fries consumption, and low fruit and vegetable consumption. It mentions that risky drinking and nonengagement in leisure-time physical activity are common among unemployed youth.

Objectives: Hypertension is the most common modifiable cardiovascular risk factor. Blood pressure (BP) reduction, particularly among smokers, is highly effective at preventing cardiovascular diseases. We examined the association between patient smoking status and hypertension management advice. Methods: Adults who participated in the 2007 Behavioral Risk Factor Surveillance System with self-reported hypertension were examined (n =51,063). Multivariable logistic regression analysis controlling for age, gender, race/ethnicity, education, marital status, insurance status, body mass index, alcohol use, self-reported general health and survey design were conducted to examine the association between smoking status (never, former, or current) and receipt of hypertension control advice. Results: After controlling for potential confounders, being a current smoker was significantly associated with lower odds of receiving advice to lower salt intake (Adjusted Odds Ratio, AOR, 0.91 [95% confidence interval=0.84–0.99]), exercise (AOR 0.89 [0.80–0.98]), and to take hypertensive medication (AOR 0.80 [0.66–0.98]) compared to never smokers. However, hypertensive smokers had greater odds of receiving advice to reduce alcohol consumption (AOR 1.23 [1.10–1.45]). Conclusions: Although healthcare providers are in an optimal position to provide patient education to improve BP control, hypertensive smokers may be less likely to receive important BP control lifestyle modification messages from their healthcare provider than non-smokers. [Copyright &y& Elsevier]

Abstract: Introduction: A substantial morbidity and mortality burden attributable to the influenza virus is observed annually in the United States. Healthcare workers are an occupational group at increased risk of exposure, demonstrated to transmit influenza to their patient populations, and vital to the care of these patient populations. The prevention of the spread of the flu is a significant public health concern. In the present study, we examined influenza vaccination rates and their 5-year trends within the major occupational healthcare worker groups and compared them to non-Healthcare Workers. Methods: Using data from the nationally representative 2004–2008 National Health Interview Survey (NHIS), US healthcare workers (n =6349) were analyzed. Results: Seasonal influenza vaccination coverage estimates remain low among all healthcare workers, highest among the health diagnosing and treating practitioners (52.3%), and lowest among other healthcare support occupations (32.0%). Among all other occupational groups, pooled influenza vaccination rates were highest for white collar workers (24.7%), and lowest for farm workers (11.7%). There were no significant upward or downward trends in influenza vaccination rates for any healthcare or other occupational worker group during the 5-year survey period. Conclusion: Improving these low vaccination rates among healthcare workers warrants a comprehensive national approach to influenza prevention that includes education and strong encouragement of routine annual vaccination among healthcare workers. Policy enhancements such as free provision of seasonal influenza vaccine, coverage for treatment and workers compensation for vaccine-related complications are needed. [Copyright &y& Elsevier]

The article offers observations on the health impacts of hydraulic fracturing. Particular focus is given to status of fracking in Great Britain. Key factors that contribute to environmental contamination in U.S. gas wells are discussed. Also mentioned are the need for exposure and epidemiological studies along the shale gas supply chain, contribution of shale gas extraction to climate change, and important issues surrounding health impact assessments on fracking.