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This article discusses the myth that biology is destiny and explores the consequences of this belief throughout history. It highlights the harmful effects of eugenics and the involuntary sterilization of thousands of Americans. The article also examines the impact of illness denial on individual and public health, presenting both maladaptive and adaptive responses to illness denial. The authors emphasize the importance of considering a person's biography, including their perception and sense-making of life events, in understanding health and illness. They argue that a strictly biological model is insufficient and that a broader conceptual framework is needed to provide personalized care. [Extracted from the article]

Coronavirus disease 2019 (COVID‐19) is an ongoing global pandemic affecting all levels of health systems. This includes the care of patients with noncommunicable diseases (NCDs) who bear a disproportionate burden of both COVID‐19 itself and the public health measures enacted to combat it. In this review, we summarize major COVID‐19‐related considerations for NCD patients and their care providers, focusing on cardiovascular, pulmonary, renal, haematologic, oncologic, traumatic, obstetric/gynaecologic, operative, psychiatric, rheumatologic/immunologic, neurologic, gastrointestinal, ophthalmologic and endocrine disorders. Additionally, we offer a general framework for categorizing the pandemic's disruptions by disease‐specific factors, direct health system factors and indirect health system factors. We also provide references to major NCD medical specialty professional society statements and guidelines on COVID‐19. COVID‐19 and its control policies have already resulted in major disruptions to the screening, treatment and surveillance of NCD patients. In addition, it differentially impacts those with pre‐existing NCDs and may lead to de novo NCD sequelae. Likely, there will be long‐term effects from this pandemic that will continue to affect practitioners and patients in this field for years to come. [ABSTRACT FROM AUTHOR]

Diversity in clinical trials (CTs) has the potential to improve health equity and close health disparities. Underrepresentation of historically underserved groups compromises the generalizability of trial findings to the target population, hinders innovation, and contributes to low accrual. The aim of this study was to establish a transparent and reproducible process for setting trial diversity enrollment goals informed by the disease epidemiology. An advisory board of epidemiologists with expertise in health disparities, equity, diversity, and social determinants of health was convened to evaluate and strengthen the initial goal-setting framework. Data sources used were the epidemiologic literature, US Census, and real-world data (RWD); limitations were considered and addressed where appropriate. A framework was designed to safeguard against the underrepresentation of historically medically underserved groups. A stepwise approach was created with Y/N decisions based on empirical data. We compared race and ethnicity distributions in the RWD of six diseases from Pfizer's portfolio chosen to represent different therapeutic areas (multiple myeloma, fungal infections, Crohn's disease, Gaucher disease, COVID-19, and Lyme disease) to the distributions in the US Census and established trial enrollment goals. Enrollment goals for potential CTs were based on RWD for multiple myeloma, Gaucher disease, and COVID-19; enrollment goals were based on the Census for fungal infections, Crohn's disease, and Lyme disease. We developed a transparent and reproducible framework for setting CT diversity enrollment goals. We note how limitations due to data sources can be mitigated and consider several ethical decisions in setting equitable enrollment goals. • Lack of participant diversity in clinical trials compounds health disparities • A framework to establish diverse enrollment goals for clinical trials was built • Building blocks were the epidemiologic literature, US Census, and RWD sources. • Limitations of data sources and ethical decisions must be navigated. • Setting enrollment goals clearly and transparently creates quantifiable accountability [ABSTRACT FROM AUTHOR]

Despite the growth in health insurance products that differentially cover preventive care and nonpreventive care, little is known about how preventive care utilization responds to targeted changes in coverage. Using administrative data from a large company, this paper examines the implementation of an insurance benefit design which differentially increased the price of nonpreventive care while decreasing the price of prevention. Leveraging a difference-in-differences research strategy, we find that preventive care utilization did not increase and even declined due to the differential price change. This evidence indicates a meaningful negative cross-price effect, suggesting that nonpreventive care and preventive care are complements. ( JEL I13, I11) [ABSTRACT FROM AUTHOR]

Background: Is retirement good or bad for health? Disentangling causality is difficult. Much of the previous quasi-experimental research on the effect of health on retirement used self-reported health and relied upon discontinuities in public retirement incentives across Europe. The current study investigated the effect of retirement on health by exploiting discontinuities in private retirement incentives to test the effect of retirement on health using a quasi-experimental study design.Methods: Secondary data (1997-2009) on a cohort of male manufacturing workers in a United States setting. Health status was determined using claims data from private insurance and Medicare. Analyses used employer-based administrative and claims data and claim data from Medicare.Results: Widely used selection on observables models overstate the negative impact of retirement due to the endogeneity of the decision to retire. In addition, health status as measured by administrative claims data provide some advantages over the more commonly used survey items. Using an instrument and administrative health records, we find null to positive effects from retirement on all fronts, with a possible exception of increased risk for diabetes.Conclusions: This study provides evidence that retirement is not detrimental and may be beneficial to health for a sample of manufacturing workers. In addition, it supports previous research indicating that quasi-experimental methodologies are necessary to evaluate the relationship between retirement and health, as any selection on observable model will overstate the negative relationship of retirement on health. Further, it provides a model for how such research could be implemented in countries like the United States that do not have a strong public pension program. Finally, it demonstrates that such research need-not rely upon survey data, which has certain shortcomings and is not always available for homogenous samples. [ABSTRACT FROM AUTHOR]

Background: Researchers investigating health outcomes for populations over age 65 can utilize Medicare claims data, but these data include no direct information about individuals' health prior to age 65 and are not typically linkable to files containing data on exposures and behaviors during their worklives. The current paper is a proof-of-concept, of merging employers' administrative data and private, employment-based health claims with Medicare data. Characteristics of the linked data, including sensitivity and specificity, are evaluated with an eye toward potential uses of such linked data. This paper uses a sample of former manufacturing workers from an industrial cohort as a test case. The dataset created by this integration could be useful to research in areas such as social epidemiology and occupational health.Methods: Medicare and employment administrative data were linked for a large cohort of manufacturing workers (employed at some point during 1996-2008) who transitioned onto Medicare between 2001-2009. Data on work-life health, including biometric indicators, were used to predict health at age 65 and to investigate the concordance of employment-based insurance claims with subsequent Medicare insurance claims.Results: Chronic diseases were found to have relatively high levels of concordance between employment-based private insurance and subsequent Medicare insurance. Information about patient health prior to receipt of Medicare, including biometric indicators, were found to predict health at age 65.Conclusions: Combining these data allows for evaluation of continuous health trajectories, as well as modeling later-life health as a function of work-life behaviors and exposures. It also provides a potential endpoint for occupational health research. This is the first harmonization of its kind, providing a proof-of-concept. The dataset created by this integration could be useful for research in areas such as social epidemiology and occupational health. [ABSTRACT FROM AUTHOR]

Objective: This study examined the ability of social, demographic, environmental and health-related factors to explain geographic variability in preterm delivery among black and white women in the US and whether these factors explain black-white disparities in preterm delivery. Methods: We examined county-level prevalence of preterm delivery (20–31 or 32–36 weeks gestation) among singletons born 1998–2002. We conducted multivariable linear regression analysis to estimate the association of selected variables with preterm delivery separately for each preterm/race-ethnicity group. Results: The prevalence of preterm delivery varied two- to three-fold across U.S. counties, and the distributions were strikingly distinct for blacks and whites. Among births to blacks, regression models explained 46% of the variability in county-level risk of delivery at 20–31 weeks and 55% for delivery at 32–36 weeks (based on R-squared values). Respective percentages for whites were 67% and 71%. Models included socio-environmental/demographic and health-related variables and explained similar amounts of variability overall. Conclusions: Much of the geographic variability in preterm delivery in the US can be explained by socioeconomic, demographic and health-related characteristics of the population, but less so for blacks than whites. [ABSTRACT FROM AUTHOR]

Background: Prior research has shown increased risk of injury for female employees compared to male employees after controlling for job and tasks, but have not explored whether this increased risk might be moderated by manager gender. The gender of one’s manager could in theory affect injury rates among male and female employees through their managers’ response to an employee’s psychosocial stress or through how employees differentially report injuries. Other explanations for the gender disparity in injury experience, such as ergonomic factors or differential training, are unlikely to be impacted by supervisor gender. This study seeks to explore whether an employee’s manager’s gender modifies the effect of employee gender with regards to risk of acute injury. Methods: A cohort of employees and managers were identified using human resources and injury management data between January 1, 2002 and December 31, 2007 for six facilities of a large US aluminum manufacturing company. Cox proportional hazards models were employed to examine the interaction between employee gender and whether the employee had female only manager(s), male only manager(s), or both male and female managers on injury risk. Manager gender category was included as a time varying covariate and reassessed for each employee at the midpoint of each year. Results: The percentage of departments with both female and male managers increased dramatically during the study period due to corporate efforts to increase female representation in management. After adjustment for fixed effects at the facility level and shared frailty by department, manager gender category does not appear to moderate the effect of employee gender (p = 0.717). Manager category was not a significant predictor (p = 0.093) of time to first acute injury. Similarly, having at least one female manager did not modify the hazard of injury for female employees compared to males (p = 0.899) and was not a significant predictor of time to first acute injury (p = 0.601). Conclusions: Prior findings suggest that female manufacturing employees are at higher risk for acute injury compared to males; this analysis suggests that this relationship is not affected by the gender of the employee’s manager(s). [ABSTRACT FROM AUTHOR]

Background: Previous studies show a variety of negative health consequences for the remaining workforce after downsizing events. This study examined self-reported work stress from 2009–2012 in the context of a large multi-site aluminum manufacturing company that underwent severe downsizing in 2009. Methods: This study examined the association between work stress and working at a work site that underwent severe downsizing. We assessed the level of downsizing across thirty plants in 2009 and categorized seven as having undergone severe downsizing. We linked plant-level downsizing information to individual workers’ responses to an annual work engagement survey, which included three work stress questions. From 2009 to 2012 over 14, 000 employees were asked about their experience of work stress. Though the surveys were anonymous, the surveys captured employees’ demographic and employment characteristic as well as plant location. We used hierarchical logistic regressions to compare responses of workers at severely downsized plants to workers at all other plant while controlling for demographic and plant characteristics. Responses to the work stress questions and one control question were examined. Results: In all yearly surveys salaried workers consistently reported having more work stress than hourly workers. There was no differential in work stress for workers at severely downsized plants in 2009. In 2010 to 2012, salaried workers who remained at severely downsized plants reported significantly higher work stress than salaried workers at all other plants across multiple work stress questions. Examination of the 2006 survey confirmed that there were no pre-existing differences in work stress among salaried employees working at plants that would eventually experience severe downsizing. In addition, there was no difference in responses to the control question at severely downsized plants. Conclusion: Salaried workers at plants with high layoffs experienced more work stress after 2009 than their counterparts at non-high layoff plants. Increased work stress is important to monitor and may be a mediating pathway through which the external economic environment leads to adverse health outcomes. [ABSTRACT FROM AUTHOR]

Abstract: While the negative effects of unemployment have been well studied, the consequences of layoffs and downsizing for those who remain employed are less well understood. This study uses human resources and health claims data from a large multi-site fully insured aluminum company to explore the health consequences of downsizing on the remaining workforce. We exploit the variation in the timing and intensity of layoff to categorize 30 plants as high or low layoff plants. Next, we select a stably employed cohort of workers with history of health insurance going back to 2006 to 1) describe the selection process into layoff and 2) explore the association between the severity of plant level layoffs and the incidence of four chronic conditions in the remaining workforce. We examine four health outcomes: incident hypertension, diabetes, asthma/COPD and depression for a cohort of approximately 13,000 employees. Results suggest that there was an increased risk of developing hypertension for all workers and an increased risk of developing diabetes for salaried workers that remain at the plants with the highest level of layoffs. The hypertension results were robust to a several specification tests. In addition, the study design selected only healthy workers, therefore our estimates are likely to be a lower bound and suggest that adverse health consequences of the 2007–2009 recession may have affected a broader proportion of the population than previously expected. [ABSTRACT FROM AUTHOR]

Abstract: While the negative effects of unemployment have been well studied, the consequences of layoffs and downsizing for those who remain employed are less well understood. This study uses human resources and health claims data from a large multi-site fully insured aluminum company to explore the health consequences of downsizing on the remaining workforce. We exploit the variation in the timing and intensity of layoff to categorize 30 plants as high or low layoff plants. Next, we select a stably employed cohort of workers with history of health insurance going back to 2006 to 1) describe the selection process into layoff and 2) explore the association between the severity of plant level layoffs and the incidence of four chronic conditions in the remaining workforce. We examine four health outcomes: incident hypertension, diabetes, asthma/COPD and depression for a cohort of approximately 13,000 employees. Results suggest that there was an increased risk of developing hypertension for all workers and an increased risk of developing diabetes for salaried workers that remain at the plants with the highest level of layoffs. The hypertension results were robust to a several specification tests. In addition, the study design selected only healthy workers, therefore our estimates are likely to be a lower bound and suggest that adverse health consequences of the 2007–2009 recession may have affected a broader proportion of the population than previously expected. [Copyright &y& Elsevier]

Background: An inverse relationship between experience and risk of injury has been observed in many occupations. Due to statistical challenges, however, it has been difficult to characterize the role of experience on the hazard of injury. In particular, because the time observed up to injury is equivalent to the amount of experience accumulated, the baseline hazard of injury becomes the main parameter of interest, excluding Cox proportional hazards models as applicable methods for consideration. Methods: Using a data set of 81,301 hourly production workers of a global aluminum company at 207 US facilities, we compared competing parametric models for the baseline hazard to assess whether experience affected the hazard of injury at hire and after later job changes. Specific models considered included the exponential, Weibull, and two (a hypothesis-driven and a data-driven) two-piece exponential models to formally test the null hypothesis that experience does not impact the hazard of injury. Results: We highlighted the advantages of our comparative approach and the interpretability of our selected model: a two-piece exponential model that allowed the baseline hazard of injury to change with experience. Our findings suggested a 30% increase in the hazard in the first year after job initiation and/or change. Conclusions: Piecewise exponential models may be particularly useful in modeling risk of injury as a function of experience and have the additional benefit of interpretability over other similarly flexible models. [ABSTRACT FROM AUTHOR]

Background Both genetic and environmental factors contribute to triglyceride, low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C) levels. Although genome-wide association studies are currently testing the genetic factors systematically, testing and reporting one or a few factors at a time can lead to fragmented literature for environmental chemical factors. We screened for correlation between environmental factors and lipid levels, utilizing four independent surveys with information on 188 environmental factors from the Centers of Disease Control, National Health and Nutrition Examination Survey, collected between 1999 and 2006.Methods We used linear regression to correlate each environmental chemical factor to triglycerides, LDL-C and HDL-C adjusting for age, age2, sex, ethnicity, socio-economic status and body mass index. Final estimates were adjusted for waist circumference, diabetes status, blood pressure and survey. Multiple comparisons were controlled for by estimating the false discovery rate and significant findings were tentatively validated in an independent survey.Results We identified and validated 29, 9 and 17 environmental factors correlated with triglycerides, LDL-C and HDL-C levels, respectively. Findings include hydrocarbons and nicotine associated with lower HDL-C and vitamin E (γ-tocopherol) associated with unfavourable lipid levels. Higher triglycerides and lower HDL-C were correlated with higher levels of fat-soluble contaminants (e.g. polychlorinated biphenyls and dibenzofurans). Nutrients and vitamin markers (e.g. vitamins B, D and carotenes), were associated with favourable triglyceride and HDL-C levels.Conclusions Our systematic association study has enabled us to postulate about broad environmental correlation to lipid levels. Although subject to confounding and reverse causality bias, these findings merit evaluation in additional cohorts. [ABSTRACT FROM AUTHOR]

Life expectancy at birth, estimated from United States period life tables, has been shown to vary systematically and widely by region and race. We use the same tables to estimate the probability of survival from birth to age 70 (S70), a measure of mortality more sensitive to disparities and more reliably calculated for small populations, to describe the variation and identify its sources in greater detail to assess the patterns of this variation. Examination of the unadjusted probability of S70 for each US county with a sufficient population of whites and blacks reveals large geographic differences for each race-sex group. For example, white males born in the ten percent healthiest counties have a 77 percent probability of survival to age 70, but only a 61 percent chance if born in the ten percent least healthy counties. Similar geographical disparities face white women and blacks of each sex. Moreover, within each county, large differences in S70 prevail between blacks and whites, on average 17 percentage points for men and 12 percentage points for women. In linear regressions for each race-sex group, nearly all of the geographic variation is accounted for by a common set of 22 socio-economic and environmental variables, selected for previously suspected impact on mortality; R² ranges from 0.86 for white males to 0.72 for black females. Analysis of black-white survival chances within each county reveals that the same variables account for most of the race gap in S70 as well. When actual white male values for each explanatory variable are substituted for black in the black male prediction equation to assess the role explanatory variables play in the black-white survival difference, residual black-white differences at the county level shrink markedly to a mean of -2.4% (+/-2.4); for women the mean difference is -3.7% (+/-2.3). [ABSTRACT FROM AUTHOR]

Background: The World Health Organization's Global Burden of Disease (GBD) reports are an important tool for global health policy makers, however the accuracy of estimates for countries undergoing an epidemiologic transition is unclear. We attempted to validate the life table model used to generate estimates for all-cause mortality in developing countries. Methods and Results: Data were obtained for males and females from the Human Mortality Database for all countries with available data every ten years from 1900 to 2000. These provided inputs for the GBD life table model and served as comparison observed data. Above age sixty model estimates of survival for both sexes differed substantially from those observed. Prior to the year 1960 for males and 1930 for females, estimated survival tended to be greater than observed; following 1960 for both males and females estimated survival tended to be less than observed. Viewing observed and estimated survival separately, observed survival past sixty increased over the years considered. For males, the increase was from a mean (sd) probability of 0.22 (0.06) to 0.46 (0.1). For females, the increase was from 0.26 (0.06) to 0.65 (0.08). By contrast, estimated survival past sixty decreased over the same period. Among males, estimated survival probability declined from 0.54 (0.2) to 0.09 (0.06). Among females, the decline was from 0.36 (0.12) to 0.15 (0.08). Conclusions: These results show that the GBD mortality model did not accurately estimate survival at older ages as developed countries transitioned in the twentieth century and may be similarly flawed in developing countries now undergoing transition. Estimates of the size of older-age populations and their attributable disease burden should be reconsidered. [ABSTRACT FROM AUTHOR]

This study examined whether externally rated job demand and control were associated with depression diagnosis claims in a heavy industrial cohort. The retrospective cohort sample consisted of 7,566 hourly workers aged 18–64 years who were actively employed at 11 US plants between January 1, 1996, and December 31, 2003, and free of depression diagnosis claims during an initial 2-year run-in period. Logistic regression analysis was used to model the effect of tertiles of demand and control exposure on depression diagnosis claims. Demand had a significant positive association with depression diagnosis claims in bivariate models and models adjusted for demographic (age, gender, race, education, job grade, tenure) and lifestyle (smoking status, body mass index, cholesterol level) variables (high demand odds ratio = 1.39, 95% confidence interval: 1.04, 1.86). Control was associated with greater risk of depression diagnosis at moderate levels in unadjusted models only (odds ratio = 1.47, 95% confidence interval: 1.12, 1.93), while low control, contrary to expectation, was not associated with depression. The effects of the externally rated demand exposure were lost with adjustment for location. This may reflect differences in measurement or classification of exposure, differences in depression diagnosis by location, or other location-specific factors. [ABSTRACT FROM PUBLISHER]

The incidence and mortality of the major cardiovascular disorders vary sharply by occupation, but this is usually attributed to broad socioeconomic factors; the contributions of physical and psychosocial stressors at work remain obscure or controversial. Review of the ongoing studies of cardiovascular disease in the United States in this issue of the Journal demonstrates that few have either collected sufficient occupational data or used these data in published analyses to address this issue. There are compelling reasons to study this issue, starting with the sheer magnitude of the occupational gradient and disease prevalence. If only 5%–15% prove causally linked to preventable factors, an enormous disease-control opportunity would present itself. Moreover, the most suspect work factors—job stress, fine particulate dust, heat, noise, and shiftwork—are highly prevalent in the US workforce. Thankfully, there is evidence that many of the large ongoing studies are moving toward enhancing their occupational data and using what they have already collected. However, because of the complexity of studying these relations, the better solution is not retrofitting but designing studies in the future that combine de novo the conceptual frameworks and technical skills of occupational and social epidemiologists with those of more biologically focused investigators. [ABSTRACT FROM PUBLISHER]

Consumer-directed health plans (CDHPs) hold the promise of reining in health spending by giving consumers a greater stake in health care purchasing, yet little is known about employers' experience with these products. In examining the characteristics of those selecting a CDHP offered by one large employer, we found stronger evidence of selection than has been identified in prior research. Our findings suggest that in the context of plan choice, CDHPs may offer little opportunity to greatly lower employers' cost burden, and they highlight concerns about the potential for risk segmentation and the value of conferring preferential tax treatment to CDHPs. [ABSTRACT FROM AUTHOR]

The article cites an environmental case study that investigated the relationship between the emissions coming from Wagerup Alumina Refinery in Australia and the symptoms of chemical sensitivity exhibited by employees and community members. It discusses several investigations associated with air dispersion and modeling, health risk assessment, ambient air quality monitoring, and complaints analysis . Moreover, the study concluded that refinery emissions are directly associated with acute or chronic health conditions including cancer.

The article presents a study which demonstrates that health claims data can be linked to other relevant databases such as personnel files and exposure data maintained by large employers. To get the desired result, the data of its employees who have already worked in the company for two years on smoking status, education, cholesterol, and body mass index taken from the occupational clinic records were considerably linked to environmental exposure data which was likewise abstracted from the company's industrial hygiene. The results later have demonstrated the ability to replicate previously published findings using commonly maintained data sets. It was then concluded that health claims files can offer potential for epidemiologic research in the U.S.

Objectives: Working conditions in the developing world seldom meet the minimum standards required by international agencies. This article addresses some of the major obstacles to occupational and environmental health and suggests methods by which they can be overcome. Methods: International agencies such as the World Health Organization (WHO) and the International Labor Organization (ILO) offer a number of programs that address the problem. Results: The results of international efforts to date have been disappointing. There is a need for renewed efforts on the part of international agencies and the developed countries. Conclusions: Occupational health and safety can be advanced in the developing world with modest funding of innovative programs. [ABSTRACT FROM AUTHOR]

Medicine has separated the two cultures of biological science and social science in research, even though they are intimately connected in the lives of our patients. To understand the cause, progression, and treatment of long COVID , biology and biography, the patient's lived experience, must be studied together. [ABSTRACT FROM AUTHOR]

An editorial is presented on the limitations of current randomized controlled trials (RCTs) due to randomization bias, multi-morbidity, and the composite clinical score. Topics include the challenges highlighted by the Food and Drug Administration (FDA) regarding clinical trial design, the importance of addressing patient heterogeneity in estimating treatment effects, and the development of composite clinical scores to improve trial accuracy and efficiency.

Assesses the false positive rate of blood lead (BPb) determinations on samples obtained by fingerstick from children screened in an urban clinic in the United States. Process of the blood collection in the determination of lead concentration; Efficacy of screening for lead poisoning by fingerstick process.

The author focuses on the role of the workplace in promoting worker health. He notes that a global movement exists in which worker health is being improved in light of the increased prevalence of chronic diseases and health insurance costs. Benefits of occupational health programs are cited which include reduced absenteeism and lesser unproductive presenteeism. He also mentions several work stressors that contribute to the risk of arteriosclerotic cardiovascular disease (ASCVD) such as night shifts and job insecurity.

Looks at health care system changes after independence and transition to black majority rule in Zimbabwe. Political history of Zimbabwe; Efforts to expand rural health services during 1927=1965; Aim of the post-independence health policy to improve the health status of the nation's black majority; Creation of a national village health worker program; Socioeconomic and political factors that challenges the progress and development of primary health care in Zimbabwe.

The ongoing emergence of novel severe acute respiratory syndrome coronavirus 2 strains such as the Omicron variant amplifies the need for precision in predicting severe COVID-19 outcomes. This study presents a machine learning model, tailored to the evolving COVID-19 landscape, emphasizing novel risk factors and refining the definition of severe outcomes to predict the risk of a patient experiencing severe disease more accurately. Utilizing electronic health records from the Healthjump database, this retrospective study examined over 1 million US COVID-19 diagnoses from March 2020 to September 2022. Our model predicts severe outcomes, including acute respiratory failure, intensive care unit admission, or ventilator use, circumventing biases associated with hospitalization, which exhibited ∼4× geographical variance of the new outcome. The model exceeded similar predictors with an area under the curve of 0.83 without lab data to predict patient risk. It identifies new risk factors, including acute care history, health care encounters, and distinct medication use. An increase in severe outcomes, typically 2-3× higher than subsequent months, was observed at the onset of each new strain era, followed by a plateau phase, but the risk factors remain consistent across strain eras. We offer an improved machine learning model and risk score for predicting severe outcomes during changing COVID-19 strain eras. By emphasizing a more clinically precise definition of severe outcomes, the study provides insights for resource allocation and intervention strategies, aiming to better patient outcomes and reduce health care strain. The necessity for regular model updates is highlighted to maintain relevance amidst the rapidly evolving COVID-19 epidemic. [ABSTRACT FROM AUTHOR]

The authors present their thoughts on why the medical profession in the U.S. is likely to become more complicated as physicians transition to salaried employment, capitation payment, and chronic care services. They state that medical practice has become more a business and suggest this may have adverse effects on the professionalism of physicians.

The article discusses the need to integrate clinical, social, and environmental data with genomic and molecular information in personalized medicine. The authors argue that personalized medicine could become depersonalized unless the clinical, social, and environmental features affecting disease outcomes are incorporated into the existing genomics-based approach. Topics include differences in scientific inference embedded in some of the earliest demonstrations of personalized medicine, data from the Beta-Blocker Heart Attack Trial (BHAT) in the U.S. illustrating these differences, and instances in which environmental features dominate genetic ones, such as in cases of cardiovascular disease.

The article discusses the amphibole hypothesis of asbestos-related cancer in relation to the study "Occupational Exposure to Chrysotile Asbestos and Cancer Risk: A Review of the Amphibole Hypothesis," conducted by L. T. Stayner, D. A. Dankovic and R. A. Lement and published in a 1996 issue of the "American Journal of Public Health." The underlying idea for the amphibole hypothesis results from two significant observations in the 1970s including the observation that serpentine fibers are cleared more quickly than amphiboles in the human lung.

Shift work is a common occupational exposure, however, few studies have examined aspects of shift work beyond night work and long hours, such as rotational patterns or weekend work, which may contribute to poor health through disruption of the body's circadian rhythms. In this manuscript, we calculated the prevalence of working hour characteristics using algorithms for type (e.g., day), duration, intensity, rotational direction, and social aspects (e.g., weekend work) in a nationwide cohort of American manufacturing workers (N = 23,044) between 2003 and 2014. Distributions of working hour characteristics were examined by schedules (e.g., permanent day, day/night) and demographics, and were cross-classified in a matrix to examine co-occurrence. Approximately 55% of shifts may cause circadian rhythm disruption as they were non-day shifts or day shifts with a quick return or rotation, or were 13 h or longer. Older workers, female workers, and White workers worked permanent day shifts most often, while workers of color worked more day/night schedules. Night and evening shifts had more frequent shift rotations, quick returns, and longer hours than day shifts. Yet, day shifts, which are presumed to have little negative circadian impact, may cause circadian rhythm disruption as long hours, quick returns and rotations also occurred within day shifts. [ABSTRACT FROM AUTHOR]

Background: An inverse relationship between experience and risk of injury has been observed in many occupations. Due to statistical challenges, however, it has been difficult to characterize the role of experience on the hazard of injury. In particular, because the time observed up to injury is equivalent to the amount of experience accumulated, the baseline hazard of injury becomes the main parameter of interest, excluding Cox proportional hazards models as applicable methods for consideration.Methods: Using a data set of 81,301 hourly production workers of a global aluminum company at 207 US facilities, we compared competing parametric models for the baseline hazard to assess whether experience affected the hazard of injury at hire and after later job changes. Specific models considered included the exponential, Weibull, and two (a hypothesis-driven and a data-driven) two-piece exponential models to formally test the null hypothesis that experience does not impact the hazard of injury.Results: We highlighted the advantages of our comparative approach and the interpretability of our selected model: a two-piece exponential model that allowed the baseline hazard of injury to change with experience. Our findings suggested a 30% increase in the hazard in the first year after job initiation and/or change.Conclusions: Piecewise exponential models may be particularly useful in modeling risk of injury as a function of experience and have the additional benefit of interpretability over other similarly flexible models. [ABSTRACT FROM AUTHOR]

Background: Previous studies show a variety of negative health consequences for the remaining workforce after downsizing events. This study examined self-reported work stress from 2009-2012 in the context of a large multi-site aluminum manufacturing company that underwent severe downsizing in 2009.Methods: This study examined the association between work stress and working at a work site that underwent severe downsizing. We assessed the level of downsizing across thirty plants in 2009 and categorized seven as having undergone severe downsizing. We linked plant-level downsizing information to individual workers' responses to an annual work engagement survey, which included three work stress questions. From 2009 to 2012 over 14, 000 employees were asked about their experience of work stress. Though the surveys were anonymous, the surveys captured employees' demographic and employment characteristic as well as plant location. We used hierarchical logistic regressions to compare responses of workers at severely downsized plants to workers at all other plant while controlling for demographic and plant characteristics. Responses to the work stress questions and one control question were examined.Results: In all yearly surveys salaried workers consistently reported having more work stress than hourly workers. There was no differential in work stress for workers at severely downsized plants in 2009. In 2010 to 2012, salaried workers who remained at severely downsized plants reported significantly higher work stress than salaried workers at all other plants across multiple work stress questions. Examination of the 2006 survey confirmed that there were no pre-existing differences in work stress among salaried employees working at plants that would eventually experience severe downsizing. In addition, there was no difference in responses to the control question at severely downsized plants.Conclusion: Salaried workers at plants with high layoffs experienced more work stress after 2009 than their counterparts at non-high layoff plants. Increased work stress is important to monitor and may be a mediating pathway through which the external economic environment leads to adverse health outcomes. [ABSTRACT FROM AUTHOR]

Background: Prior research has shown increased risk of injury for female employees compared to male employees after controlling for job and tasks, but have not explored whether this increased risk might be moderated by manager gender. The gender of one's manager could in theory affect injury rates among male and female employees through their managers' response to an employee's psychosocial stress or through how employees differentially report injuries. Other explanations for the gender disparity in injury experience, such as ergonomic factors or differential training, are unlikely to be impacted by supervisor gender. This study seeks to explore whether an employee's manager's gender modifies the effect of employee gender with regards to risk of acute injury.Methods: A cohort of employees and managers were identified using human resources and injury management data between January 1, 2002 and December 31, 2007 for six facilities of a large US aluminum manufacturing company. Cox proportional hazards models were employed to examine the interaction between employee gender and whether the employee had female only manager(s), male only manager(s), or both male and female managers on injury risk. Manager gender category was included as a time varying covariate and reassessed for each employee at the midpoint of each year.Results: The percentage of departments with both female and male managers increased dramatically during the study period due to corporate efforts to increase female representation in management. After adjustment for fixed effects at the facility level and shared frailty by department, manager gender category does not appear to moderate the effect of employee gender (p = 0.717). Manager category was not a significant predictor (p = 0.093) of time to first acute injury. Similarly, having at least one female manager did not modify the hazard of injury for female employees compared to males (p = 0.899) and was not a significant predictor of time to first acute injury (p = 0.601).Conclusions: Prior findings suggest that female manufacturing employees are at higher risk for acute injury compared to males; this analysis suggests that this relationship is not affected by the gender of the employee's manager(s). [ABSTRACT FROM AUTHOR]

The article presents the comments of the author on the prevention of mesothelioma. Exposure to asbestos is a primary cause of the disease. According to the author, most potential sources of human exposure to asbestos have been removed in the developed countries. Those who had been exposed to asbestos in the past are still at risk of the disease.

Objective: To examine the impacts of job insecurity during the recession of 2007-2009 on health care utilization among a panel of U.S. employees.Data Sources/study Setting: Linked administrative and claims datasets on a panel of continuously employed, continuously insured individuals at a large multisite manufacturing firm that experienced widespread layoffs (N = 9,486).Study Design: We employed segmented regressions to examine temporal discontinuities in utilization during 2006-2012. To assess the effects of job insecurity, we compared individuals at high- and low-layoff plants. Because the dataset includes multiple observations for each individual, we included individual-level fixed effects.Principal Findings: We found discontinuous increases in outpatient (3.5 visits/month/10,000 individuals, p = .002) and emergency (0.4 visits/month/10,000 individuals, p = .05) utilization in the panel of all employees. Compared with individuals at low-layoff plants, individuals at high-layoff plants decreased outpatient utilization (-4.0 visits/month/10,000 individuals, p = .008), suggesting foregone preventive care, with a marginally significant increase in emergency utilization (0.4 visits/month/10,000 individuals, p = .08).Conclusions: These results suggest changes in health care utilization and potentially adverse impacts on employee health in response to job insecurity during the latest recession. This study contributes to our understanding of the impacts of economic crises on the health of the U.S. working population. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of chronic medical conditions of men with infertility.Design: Retrospective cohort study.Setting: Not applicable.Patient(s): Subjects contained within the Truven Health MarketScan claims database from 2001 to 2009.Intervention(s): Not applicable.Main Outcome Measure(s): The development of chronic medical conditions including hypertension, diabetes, hyperlipidemia, renal disease, pulmonary disease, liver disease, depression, peripheral vascular disease, cerebrovascular disease, heart disease, injury, alcohol abuse, drug abuse, anxiety disorders, and bipolar disorder.Result(s): In all, 13,027 men diagnosed with male factor infertility were identified with an additional 23,860 receiving only fertility testing. The average age was 33.1 years for men diagnosed with infertility and 32.8 years for men receiving testing alone. After adjusting for confounding factors, men diagnosed with male factor infertility had a higher risk of developing diabetes (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.10-1.53), ischemic heart disease (HR 1.48, 95% CI 1.19-1.84), alcohol abuse (HR 1.48, 95% CI 1.07-2.05), and drug abuse (1.67, 95% CI 1.06-2.63) compared with men who only received infertility testing. Similar patterns were identified when comparing those with male factor infertility to vasectomized men. The association between male factor infertility and later health outcomes were strongest for men with longer follow-up.Conclusion(s): In this cohort of patients in a national insurance database, men diagnosed with male factor infertility had a significantly higher risk of adverse health outcomes in the years after an infertility evaluation. These findings suggest the overall importance of men's reproductive health and warrant additional investigation to understand the association and identify interventions to improve outcomes for these patients. [ABSTRACT FROM AUTHOR]

There is an association between chronic disease and geography, and there is evidence that the environment plays a critical role in this relationship. Yet at the same time, there is known to be substantial geographic variation by ancestry across the United States. Resulting geographic genetic variation—that is, the extent to which single nucleotide polymorphisms (SNPs) related to chronic disease vary spatially—could thus drive some part of the association between geography and disease. We describe the variation in chronic disease genetic risk by state of birth by taking risk SNPs from genome-wide association study meta-analyses for coronary artery disease, diabetes, and ischemic stroke and creating polygenic risk scores. We compare the amount of variability across state of birth in these polygenic scores to the variability in parental education, own education, earnings, and wealth. Our primary finding is that the polygenic risk scores are only weakly differentially distributed across U.S. states. The magnitude of the differences in geographic distribution is very small in comparison to the distribution of social and economic factors and thus is not likely sufficient to have a meaningful effect on geographic disease differences by U.S. state. [ABSTRACT FROM AUTHOR]

Reports on the intoxication of children employed in roof tile and ceramic cottage industries in a village in Ecuador. Evaluation of a convenience sample of children; Collection of blood specimen for whole blood lead level; Participants of the stud y; Evidence of unacceptable lead exposure in children.

Evaluates endocrine and reproductive dysfunction in men associated with occupational inorganic lead intoxification in the United States. Use of flameless atomic absorption spectrophotometry to determine blood lead levels; Measurement of adrenocortical function; Display of defect in spermatogenesis.

Focuses on the development of a bone marrow injury in lithographers exposed to organic solvents. Clinical manifestations of the disease; Toxicity of glycol ethers in bone marrow specimens; Presence of immature megakaryocyte precursors in the blood counts of patients.

Looks at publications that have added to the work on cancer risks associated with exposure to chrysotile asbestos. Findings about exposure to amphibole asbestos fibers; Information about lung cancer and mesothelioma; Thoughts about the asbestos already in the environment and about the proposition of adding more asbestos to the environment.

Aim: To determine the association with cardiovascular (CV) outcomes of sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors compared with dipeptidyl peptidase‐4 (DPP‐4) inhibitors in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). Materials and Methods: We conducted a population‐based cohort study of new users of SGLT‐2 inhibitors and DPP‐4 inhibitors with T2D and CKD using data from Optum Clinformatics DataMart. We assembled three cohorts: T2D/no CKD, T2D/CKD 1‐2, and T2D/CKD 3a. The study outcomes were (a) time to first heart failure (HF) hospitalization and (b) time to a composite CV endpoint comprised of non‐fatal myocardial infarction (MI) or stroke. After inverse probability of treatment weighting, we used proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: New users of SGLT‐2 inhibitors versus DPP‐4 inhibitors had lower risks of HF hospitalization in the T2D/no CKD (HR, 0.76; 95% CI, 0.70, 0.82) and T2D/CKD 1‐2 (HR, 0.63; 95% CI, 0.48, 0.84) cohorts, but no significant association was present in the T2D/CKD 3a cohort. Compared with prescription of DPP‐4 inhibitors, SGLT‐2 inhibitors were associated with lower risks of non‐fatal MI or stroke of 23% (HR, 0.77; 95% CI, 0.70, 0.85) in the T2D/no CKD cohort, but no significant associations were present in the T2D/CKD 1‐2 and T2D/CKD 3a cohorts. Conclusions: Incident prescription of SGLT‐2 inhibitors was associated with lower risks of HF hospitalization but not with non‐fatal MI or stroke despite suggesting benefit, relative to prescription of DPP‐4 inhibitor across different stages of CKD. [ABSTRACT FROM AUTHOR]

Objective: To determine the relative contributions of tinnitus, asymmetrical hearing loss, low frequency hearing loss (pure tone average of 0.5, 1, 2, 3 kHz; PTA.5123), or high frequency hearing loss (pure tone average of 4, 6 kHz; PTA46), to acute injury risk among a cohort of production and maintenance workers at six aluminum manufacturing plants, adjusting for ambient noise exposure and other recognized predictors of injury risk. Design: Retrospective analysis. Study sample: The study considered 9920 workers employed during 2003 to 2008. The cohort consisted of 8818 workers (89%) whose complete records were available. Results: Adjusting for noise exposure and other recognized injury predictors, a 25% increased acute injury risk was observed among workers with a history of tinnitus in conjunction with high-frequency hearing loss (PTA46). Low frequency hearing loss may be associated with minor, yet less serious, injury risk. We did not find evidence that asymmetry contributes to injury risk. Conclusion: These results provide evidence that tinnitus, combined with high-frequency hearing loss, may pose an important safety threat to workers, especially those who work in high-noise exposed environments. These at risk workers may require careful examination of their communication and hearing protection needs. [ABSTRACT FROM AUTHOR]

Objectives. We examined the mental health effects of the Great Recession of 2008 to 2009 on workers who remained continuously employed and insured. Methods. We examined utilization trends for mental health services and medications during 2007 to 2012 among a panel of workers in the 25 largest plants, located in 15 states, of a US manufacturing firm. We used piecewise regression to compare trends from 2007 to 2010 in service and medication use before and after 2009, the year of mass layoffs at the firm and the peak of the recession. Our models accounted for changes in county-level unemployment rates and individual-level fixed effects. Results. Mental health inpatient and outpatient visits and the yearly supply of mental health–related medications increased among all workers after 2009. The magnitude of the increase in medication usage was higher for workers at plants with more layoffs. Conclusions. The negative effects of the recession on mental health extend to employed individuals, a group considered at lower risk of psychological distress. [ABSTRACT FROM AUTHOR]

A fuller understanding of the social epidemiology of disease requires an extended description of the relationships between social factors and health indicators in a systematic manner. In the present study, we investigated the correlations between income and 330 indicators of physiological, biochemical, and environmental health in participants in the US National Health and Nutrition Examination Survey (NHANES) (1999–2006). We combined data from 3 survey waves (n = 249–23,649 for various indicators) to search for linear and nonlinear (quadratic) correlates of income, and we validated significant (P < 0.00015) correlations in an independent testing data set (n = 255–7,855). We validated 66 out of 330 factors, including infectious (e.g., hepatitis A), biochemical (e.g., carotenoids, high-density lipoprotein cholesterol), physiological (e.g., upper leg length), and environmental (e.g., lead, cotinine) measures. We found only a modest amount of association modification by age, race/ethnicity, and gender, and there was no association modification for blacks. The present study is descriptive, not causal. We have shown in our systematic investigation the crucial place income has in relation to health risk factors. Future research can use these correlations to better inform theory and studies of pathways to disease, as well as utilize these findings to understand when confounding by income is most likely to introduce bias. [ABSTRACT FROM AUTHOR]

Biosocial pathogenesis is a critical new way of thinking about disease origin and progression because we need biosocial approaches to disease prevention and treatment. Is Different than Current Model of Disease Pathogenesis The current model of a strictly biological disease pathogenesis is wrong: it is insufficient to account for all of the factors that make individuals susceptible to disease, resilient when disease occurs, and variably responsive to treatment. Only by integrating biology with biography can we have a complete appreciation for disease pathogenesis, and a successful development of treatments that will create the maximum benefit for our patients [[28]]. A strictly biological model of pathogenesis that ignores a person's life experience and social context is insufficient to account for all of the factors that make individuals susceptible to disease, resilient when disease occurs, and variably responsive to treatment. [Extracted from the article]

Background: Triclosan—a ubiquitous chemical in toothpastes, soaps, and household cleaning supplies—has the potential to alter both gut microbiota and endocrine function and thereby affect body weight. Methods: We investigated the relationship between triclosan and body mass index (BMI) using National Health and Nutrition Examination Surveys (NHANES) from 2003–2008. BMI and spot urinary triclosan levels were obtained from adults. Using two different exposure measures—either presence vs. absence or quartiles of triclosan—we assessed the association between triclosan and BMI. We also screened all NHANES serum and urine biomarkers to identify correlated factors that might confound observed associations. Results: Compared with undetectable triclosan, a detectable level was associated with a 0.9-point increase in BMI (p<0.001). In analysis by quartile, compared to the lowest quartile, the 2nd, 3rd and 4th quartiles of urinary triclosan were associated with BMI increases of 1.5 (p<0.001), 1.0 (p = 0.002), and 0.3 (p = 0.33) respectively. The one strong correlate of triclosan identified in NHANES was its metabolite, 2,4-dichlorophenol (ρ = 0.4); its association with BMI, however, was weaker than that of triclosan. No other likely confounder was identified. Conclusions: Triclosan exposure is associated with increased BMI. Stronger effect at moderate than high levels suggests a complex mechanism of action. [ABSTRACT FROM AUTHOR]

Adults with better jobs enjoy better health: job title was, in fact, the social gradient metric first used to study the relationship between social class and chronic disease etiology, a core finding now replicated in most developed countries. What has been less well proved is whether this correlation is causal, and if so, through what mechanisms. During the past decade, much research has been directed at these issues. Best evidence in 2009 suggests that occupation does affect health. Most recent research on the relationship has been directed at disentangling the pathways through which lower-status work leads to adverse health outcomes. This review focuses on six areas of recent progress: (1) the role of status in a hierarchical occupational system; (2) the roles of psychosocial job stressors; (3) effects of workplace physical and chemical hazard exposures; (4) evidence that work organization matters as a contextual factor; (5) implications for the gradient of new forms of nonstandard or “precarious” employment such as contract and shift work; and (6) emerging evidence that women may be impacted differently by adverse working conditions, and possibly more strongly, than men. [ABSTRACT FROM AUTHOR]