Search

BackgroundHot, desert Gulf countries are host to millions of migrant workers doing outdoor jobs such as construction and hospitality. The Gulf countries apply a summertime ban on midday work to protect workers from extreme heat, although without clear evidence of effectiveness. We assessed the risk of occupational injuries associated with extreme hot temperatures during the summertime ban on midday work in Kuwait.MethodsWe collected daily occupational injuries in the summer months that are reported to the Ministry of Health’s Occupational Health Department for 5 years from 2015 to 2019. We fitted generalised additive models with a quasi-Poisson distribution in a time series design. A 7-day moving average of daily temperature was modelled with penalised splines adjusted for relative humidity, time trend and day of the week.ResultsDuring the summertime ban, the daily average temperature was 39.4°C (±1.8°C). There were 7.2, 7.6 and 9.4 reported injuries per day in the summer months of June, July and August, respectively. Compared with the 10th percentile of summer temperatures in Kuwait (37.0°C), the average day with a temperature of 39.4°C increased the relative risk of injury to 1.44 (95% CI 1.34 to 1.53). Similarly, temperatures of 40°C and 41°C were associated with relative risks of 1.48 (95% CI 1.39 to 1.59) and 1.44 (95% CI 1.27 to 1.63), respectively. At the 90th percentile (42°C), the risks levelled off (relative risk 1.21; 95% CI 0.93 to 1.57).ConclusionWe found substantial increases in the risk of occupational injury from extremely hot temperatures despite the ban on midday work policy in Kuwait. ‘Calendar-based’ regulations may be inadequate to provide occupational heat protections, especially for migrant workers.

OBJECTIVE: High-quality longitudinal evidence exploring the mental health risk associated with low-quality employment trajectories is scarce. We therefore aimed to investigate the risk of being diagnosed with common mental disorders, substance use disorders, or suicide attempt according to low-quality employment trajectories. METHODS: A longitudinal register-study based on the working population of Sweden (N=2 743 764). Employment trajectories (2005–2009) characterized by employment quality and pattern (constancy, fluctuation, mobility) were created. Hazard ratios (HR) were estimated using Cox proportional hazards regression models for first incidence (2010–2017) diagnosis of common mental disorders, substance use disorders and suicide attempt as dependent on employment trajectories. RESULTS: We identified 21 employment trajectories, 10 of which were low quality (21%). With the exception of constant solo self-employment, there was an increased risk of common mental disorders (HR 1.07–1.62) and substance use disorders (HR 1.05–2.19) for all low-quality trajectories. Constant solo self-employment increased the risk for substance use disorders among women, while it reduced the risk of both disorders for men. Half of the low-quality trajectories were associated with a risk increase of suicide attempt (HR 1.08–1.76). CONCLUSIONS: Low-quality employment trajectories represent risk factors for mental disorders and suicide attempt in Sweden, and there might be differential effects according to sex – especially in terms of self-employment. Policies ensuring and maintaining high-quality employment characteristics over time are imperative. Similar prospective studies are needed, also in other contexts, which cover the effects of the Covid-19 pandemic as well as the mechanisms linking employment trajectories with mental health.

BackgroundUnder-reporting of occupational injuries (OIs) among precariously employed workers in Sweden challenges effective surveillance of OIs and targeted preventive measures.ObjectiveTo estimate the magnitude of under-reporting of OIs among precarious and non-precarious workers in Sweden in 2013.MethodsCapture–recapture methods were applied using the national OIs register and records from a labour market insurance company. Employed workers 18–65 resident in Sweden in 2013 were included in the study (n=82 949 OIs). Precarious employment was operationalised using the national labour market register, while injury severity was constructed from the National Patient Register. Under-reporting estimates were computed stratifying by OIs severity and by sociodemographic characteristics, occupations and precarious employment.ResultsUnder-reporting of OIs followed a dose–response pattern according to the levels of precariousness (the higher the precarious level, the higher the under-reporting) being for the precarious group (22.6%, 95% CI 21.3% to 23.8%), followed by the borderline precarious (17.6%, 95% CI 17.1% to 18.2%) and lastly the non-precarious (15.0%, 95% CI 14.7% to 15.3%). Under-reporting of OIs, decreased as the injury severity increased and was higher with highest level of precariousness in all groups of severity. We also observed higher under-reporting estimates among all occupations in the precarious and borderline precarious groups as compared with the non-precarious ones.ConclusionsThis is the first register-based study to empirically demonstrate in Sweden that under-reporting of OIs is 50% higher among precariously employed workers. OIs under-reporting may represent unrecognised injuries that especially burden precariously employed workers as financial, health and social consequences shift from the employer to the employee.

Occupational heat exposure is linked to the development of kidney injury and disease in individuals who frequently perform physically demanding work in the heat. For instance, in Central America, an epidemic of chronic kidney disease of nontraditional origin (CKDnt) is occurring among manual laborers, whereas potentially related epidemics have emerged in India and Sri Lanka. There is growing concern that workers in the United States suffer with CKDnt, but reports are limited. One of the leading hypotheses is that repetitive kidney injury caused by physical work in the heat can progress to CKDnt. Whether heat stress is the primary causal agent or accelerates existing underlying pathology remains contested. However, the current evidence supports that heat stress induces tubular kidney injury, which is worsened by higher core temperatures, dehydration, longer work durations, muscle damaging exercise, and consumption of beverages containing high levels of fructose. The purpose of this narrative review is to identify occupations that may place US workers at greater risk of kidney injury and CKDnt. Specifically, we reviewed the scientific literature to characterize the demographics, environmental conditions, physiological strain (i.e., core temperature increase, dehydration, heart rate), and work durations in sectors typically experiencing occupational heat exposure, including farming, wildland firefighting, landscaping, and utilities. Overall, the surprisingly limited available evidence characterizing occupational heat exposure in US workers supports the need for future investigations to understand this risk of CKDnt.

BackgroundPrecarious employment (PE) has been suggested as a risk factor for occupational injuries (OIs). However, several issues such as under-reporting and time at risk pose obstacles to obtaining unbiased estimates of riskObjectiveTo investigate if PE is a risk factor for OIs in Sweden.MethodsThis register-based study included employed workers aged 18–65, resident in Sweden between 2006 and 2014. PE was operationalised as a multidimensional construct (score) and by its five items (contract insecurity, contractual temporariness, multiple jobs/multiple sectors, income level, collective bargaining agreement). Our outcome was OI in the following year. Pooled ORs for OIs in relation to PE and PE items were calculated by means of multivariate logistic regression models for women and men separately.ResultsPrecarious workers were at lower risk of OIs as compared with non-precarious workers among both males and females (OR ConclusionsWhile several mechanisms may explain why precarious workers in Sweden present lower risks of OIs, several dimensions of PE such as temp agency work and multiple job-holding could be important risk factors for OIs and merit further research.

ObjectivesTo assess if improvement of working conditions related to heat stress was associated with improved kidney health outcomes among sugarcane harvest workers in Chichigalpa, Nicaragua, a region heavily affected by the epidemic of chronic kidney disease of non-traditional origin.MethodsBased on our findings during the 2017–2018 harvest (harvest 1), recommendations that enhanced the rest schedule and improved access to hydration and shade were given before the 2018–2019 harvest (harvest 2). Actual work conditions during harvest 2 were then observed. Serum creatinine (SCr) was measured before and at end-harvest, and cross-harvest changes in estimated glomerular filtration rate (eGFR) and incident kidney injury (IKI, ie, SCr increase by ≥0.30 mg/dL or ≥1.5 times the baseline value) were compared between harvest 1 and harvest 2 for three jobs with different physical workloads using regression modelling. Workers who left during harvest were contacted at home, to address the healthy worker selection effect.ResultsIn burned cane cutters, mean cross-harvest eGFR decreased 6 mL/min/1.73 m2 (95% CI 2 to 9 mL/min/1.73 m2) less and IKI was 70% (95% CI 90% to 50%) lower in harvest 2 as compared with harvest 1 data. No such improvements were seen among seed cutters groups with less successful intervention implementation.ConclusionKidney injury risk was again elevated in workers with strenuous jobs. The results support further efforts to prevent kidney injury among sugarcane workers, and other heat-stressed workers, by improving access to water, rest and shade. The distinction between design and implementation of such interventions should be recognised.

The prevalence of precarious employment has increased in recent decades and aspects such as employment insecurity and income inadequacy have intensified during the COVID-19 pandemic. The purpose of this systematic review was to identify, appraise, and synthesise existing evidence pertaining to implemented initiatives addressing precarious employment that have evaluated and reported health and well-being outcomes. We used the PRISMA framework to guide this review and identified 11 relevant initiatives through searches in PubMed, Scopus, Web of Science, and three sources of grey literature. We found very few evaluated interventions addressing precarious employment and its impact on the health and well-being of workers globally. Ten out of 11 initiatives were not purposefully designed to address precarious employment in general, nor specific dimensions of it. Seven out of 11 initiatives evaluated outcomes related to the occupational health and safety of precariously employed workers and six out of 11 evaluated worker health and well-being outcomes. Most initiatives showed the potential to improve the health of workers, although the evaluation component was often described with less detail than the initiative itself. Given the heterogeneity of the 11 initiatives regarding study design, sample size, implementation, evaluation, economic and political contexts, and target population, we found insufficient evidence to compare outcomes across types of initiatives, generalize findings, or make specific recommendations for the adoption of initiatives.

Objective: To identify patterns in business performance and occupational injuries (OIs) in the Swedish construction sector between 2003 and 2015 and investigate associations between these trajectories. Methods: Company-level data were gathered from national registers. An open cohort of 13,089 private construction companies were classified by size. Yearly business performance indicators were return on equity, operating margin, and labor-to-revenue ratio. OIs rate was defined as number of injuries divided by number of employees. Group-based trajectory models were performed to identify companies with similar patterns in business performance and OIs rate over time. Associations were investigated with binomial regression models. Results: The model identified two main patterns (high/low) of injuries and business indicators for all company sizes. Trends in low labor-to-revenue ratio were associated with a high injury rate with a pooled estimate of 1.43 (95% CI 1.22–1.64) with some variation by company size: super small OR 1.3 (95% CI 1.01–1.62), small, OR 1.74 (95% CI 1.39–2.18), medium OR 1.3 (95% CI 0.9–1.8) and large OR 2.1 (95% CI 0.77–5.7). Similarly, low patterns of returns on equity were associated with high injury rate patterns across all company sizes, excluding small enterprises. No associations were found for operating margin patterns. Conclusions: Low returns on equity and labor-to-revenue ratio were associated with higher OIs rate trajectories in the Swedish construction sector, which has implications for injury prevention as well as targeted surveillance and inspection. Further studies could investigate other economic sectors and possible mechanisms for this association.

ObjectivesTo examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury.MethodsBiological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), drip irrigation workers (moderate), seed cutters (high) and burned sugarcane cutters (very high). Dropouts were contacted (87%) and reported the reason for leaving work. Cross-harvest incident kidney injury (IKI) was defined as serum creatinine increase ≥0.30 mg/dL or ≥1.5 times the baseline value, or among dropouts reporting kidney injury leading to leaving work.ResultsMean cross-harvest estimated glomerular filtration rate change was significantly associated with workload, increasing from 0 mL/min/1.73 m2 in the low-moderate category to −5 mL/min/1.73 m2 in the high and −9 mL/min/1.73 m2 in the very high workload group. A similar pattern occurred with IKI, where low-moderate workload had 2% compared with 27% in the very high workload category. A healthy worker selection effect was detected, with 32% of dropouts reporting kidney injury. Fever and C reactive protein elevation were associated with kidney injury.ConclusionsWorkers considered to have the highest workload had more cross-harvest kidney damage than workers with less workload. Work practices preventing heat stress should be strengthened and their role in preventing kidney damage examined further. Future occupational studies on chronic kidney disease of unknown aetiology should account for a healthy worker effect by pursuing those lost to follow-up.

ObjectivesExcessive heat exposure poses significant risks to workers in hot climates. This study assessed the intensity and duration of heat stress exposure among workers performing residential construction in southeastern Saudi Arabia (SA) during the summer, June–September 2016. Objectives were to: identify work factors related to heat stress exposure; measure environmental heat exposure at the construction sites; assess the heat stress risk among workers using the wet bulb globe temperature (WBGT) index; and determine if temperature-humidity indices can be appropriate alternatives to WBGT for managing heat stress risk at the construction sites.MethodsWorksite walkthrough surveys and environmental monitoring were performed, indoors and outdoors, at 10 construction sites in Al-Ahsa Province. A heat stress exposure assessment was conducted according to the American Conference of Governmental Industrial Hygienists (ACGIH®) guidelines, which uses the WBGT index. WBGT measurements from two instruments were compared. Alternative heat stress indices were compared to the WBGT: the heat index (HI) and humidex (HD) index.ResultsConstruction workers were exposed to excessive heat stress, indoors and outdoors over a large part of the work day. Complying with a midday outdoor work ban (12–3 p.m.) was not effective in reducing heat stress risk. The highest intensity of exposure was outdoors from 9 a.m. to 12 p.m.; a period identified with the highest hourly mean WBGT values (31–33°C) and the least allowable working time according to ACGIH® guidelines. Comparison of the alternative indices showed that the HI is more reliable than the HD as a surrogate for the WBGT index in the climate studied.ConclusionThe extreme heat exposure represents a serious risk. The severity of heat stress and its impact are projected to increase due to climate change, emphasizing the need for immediate improvement of the current required protective measures and the development of occupational heat stress exposure guidelines in SA.

The aim of this case study was to explore the abilities and limitations of trade unions in their response to undeclared work, which has received scant attention in research on working conditions and industrial relations. The authors use power resource theory to examine the outcome of a Swedish government initiative aimed to boost the ability of the social partners to tackle undeclared work. The findings confirm previous literature suggesting cross-sectoral differences in the extent and nature of undeclared work and an association between low levels of power resources and high risk of undeclared work. The authors recommend that future initiatives take account of cross-sectoral differences in the nature and extent of undeclared work and available power resources. Future research should consider how different actors can contribute to the ability of the social partners in different sectors to engage in the battle against undeclared work.

BACKGROUND AND AIM: Expensive, often inaccessible, treatment, early death, and economic hardship faces millions of workers in Latin America and Asia due to Chronic Kidney Disease of nontraditional ...

The world of work is facing an ongoing pandemic and an economic downturn with severe effects worldwide. Workers trapped in precarious employment (PE), both formal and informal, are among those most affected by the COVID-19 pandemic. Here we call attention to at least 5 critical ways that the consequences of the crisis among workers in PE will be felt globally: ( a) PE will increase, ( b) workers in PE will become more precarious, ( c) workers in PE will face unemployment without being officially laid off, ( d) workers in PE will be exposed to serious stressors and dramatic life changes that may lead to a rise in diseases of despair, and ( e) PE might be a factor in deterring the control of or in generating new COVID-19 outbreaks. We conclude that what we really need is a new social contract, where the work of all workers is recognized and protected with adequate job contracts, employment security, and social protection in a new economy, both during and after the COVID-19 crisis.

ObjectiveTo estimate the magnitude of under-reporting of non-fatal occupational injuries (OIs) by different organisational factors in Sweden for the year 2013.MethodsCapture–recapture methods were applied using two data sources: (1) the national OI register and (2) records from a labour market insurance company. To assure comparability of data sources, the analysis was restricted to the public sector and private companies with at least 50 employees. OIs were matched using personal identification number and reported injury dates (±7 days). Organisational factors were obtained from the national labour market register and injury severity (no healthcare/only outpatient/hospitalised) from the National Patient Register. Total number of OIs and ascertainment by data sources were estimated assuming data source independence.ResultsThere were an estimated 98 493 OIs in 2013. Completeness of reporting OIs to the national register and to the insurance company was estimated at 73% and 43%, respectively. No report to either source was estimated at 15 000 OIs (~15%). Under-reporting to the national register differed by selected organisational factors, being higher among organisations in the public sector, those with more females, with a younger workforce and with a higher proportion of immigrants. Overall under-reporting was more common in agriculture (19.7%), other services (19.3%), commerce and hospitality (19.1%), health (18.4%) and education (18.4%). Under-reporting decreased as injury severity increased, with little variations across sectors of economic activity.ConclusionsResults suggest considerable under-reporting of OIs in Sweden and differential under-reporting by organisational factors. Results are relevant for official estimates of burden and for setting priorities for workplace safety and prevention.

BackgroundPrecarious employment is a significant determinant of population health and health inequities and has complex public health consequences both for a given nation and internationally. Precarious employment is conceptualized as a multi-dimensional construct including but not limited to employment insecurity, income inadequacy, and lack of rights and protection in the employment relation, which could affect both informal and formal workers. The purpose of this review is to identify, appraise, and synthesize existing research on the effectiveness of initiatives aiming to or having the potential to eliminate, reduce, or mitigate workers’ exposure to precarious employment conditions and its effects on the health and well-being of workers and their families.MethodsThe electronic databases searched (from January 2000 onwards) are Scopus, Web of Science Core Collection, and PubMed, along with three institutional databases as sources of grey literature. We will include any study (e.g. quantitative, qualitative, or mixed-methods design) evaluating the effects of initiatives that aim to or have the potential to address workers’ exposure to precarious employment or its effects on the health and well-being of workers and their families, whether or not such initiatives were designed specifically to address precarious employment. The primary outcomes will be changes in (i) the prevalence of precarious employment and workers’ exposure to precarious employment and (ii) the health and well-being of precariously employed workers and their families. No secondary outcomes will be included. Given the large body of evidence screened, the initial screening of each study will be done by one reviewer, after implementing several strategies to ensure decision-making consistency across reviewers. The screening of full-text articles, data extraction, and critical appraisal will be done independently by two reviewers. Potential conflicts will be resolved through discussion. Established checklists will be used to assess a study’s methodological quality or bias. A narrative synthesis will be employed to describe and summarize the included studies’ characteristics and findings and to explore relationships both within and between the included studies.DiscussionWe expect that this review’s findings will provide stakeholders interested in tackling precarious employment and its harmful health effects with evidence on effectiveness of solutions that have been implemented to inform considerations for adaptation of these to their unique contexts. In addition, the review will increase our understanding of existing research gaps and enable us to make recommendations to address them. Our work aligns with the sustainable development agenda to protect workers, promote decent work and economic growth, eliminate poverty, and reduce inequalities.Systematic review registrationPROSPEROCRD42020187544.

This chapter raises several issues of importance when seeking to identify these relationships for early stages of a disease process. It calls attention to considerations that need to be addressed in future development and use of exposure indices. Qualitative or semiquantitative relationships are generally sufficient. Although the epidemiologist probably examines these relationships with the idea of prevention in mind, it is uncommon to see epidemiological studies of the effectiveness of environmental controls. The focus of early studies of exposure–effect relationships for hazardous work environments was on areas with both substantial exposure and substantial disease. Close collaboration between environmental scientists and epidemiologists in study design, data collection, and analysis was neither significant nor was its absence of great consequence. The evaluation of acute effects has several advantages over studies of chronic disease in the workplace. Epidemiologists have been able to make good use of information on type and duration of jobs when exposure is closely associated with job.

Objective The aim of this study was to investigate risk factors for retinal detachment or tear (RD/T), and follow up two studies that found increased risk from work-related heavy lifting. Methods We conducted a case-control study including 200 cases of RD/T and 415 controls. Participants completed a questionnaire covering general health, vision, and physical exertion. Multiple logistic regression and propensity score matching was used to control confounding and estimate independent effects. Results RD/T risk was increased by one lifting measure: current regular lifting of more than 30 lbs (>13.6 kg). In the population aged less than 65 years, the odds ratio comparing those with/without heavy lifting was 1.81, 95% confidence interval = 1.08 to 3.04. Conclusion Occupational heavy lifting may represent a risk factor for RD/T, but further research is needed in populations with frequent heavy physical exertion to more precisely quantify the risk.

A single paragraph of about 200 words maximum. For research articles, abstracts should give a pertinent overview of the work. We strongly encourage authors to use the following style of structured abstracts, but without headings: (1) Introduction: Place the question addressed in a broad context and highlight the purpose of the study, (2) Methods: Describe briefly the main methods or treatments applied, (3) Results: Summarize the article&rsquo, s main findings, and (4) Conclusions: Indicate the main conclusions or interpretations. The abstract should be an objective representation of the article, it must not contain results which are not presented and substantiated in the main text and should not exaggerate the main conclusions.

Saudi Arabia (SA) is one of the hottest countries in the world. This study was conducted to assess the impact of summer heat stress in Southeastern SA on short-term kidney injury (KI) among building construction workers and to identify relevant risk factors. Measurements of urinary albumin-creatinine ratio (ACR), height, weight, hydration, symptoms, daily work and behavioral factors were collected in June and September of 2016 from a cohort of construction workers (n = 65) in Al-Ahsa Province, SA. KI was defined as ACR &ge, 30 mg/g. Multivariate linear regression analysis was used to assess factors related to cross-summer changes in ACR. A significant increase in ACR occurred among most workers over the study period, incidence of KI was 18%. Risk factors associated with an increased ACR included dehydration, short sleep, and obesity. The findings suggest that exposure to summer heat may lead to the development of KI among construction workers in this region. Adequate hydration and promotion of healthy habits among workers may help reduce the risk of KI. A reduction in work hours may be the most effective intervention because this action can reduce heat exposure and improve sleep quality.

Heat stress is associated with numerous health effects that potentially harm workers, especially in a warming world. This investigation occurred in a setting where laborers are confronted with occupational heat stress from physically demanding work in high environmental temperatures. Collaboration with a major Nicaraguan sugarcane producer offered the opportunity to study interventions to prevent occupational heat-stress-related kidney disease. Two aims for this study of a rest-shade-water intervention program were: (1) describe the evolving intervention, summarize findings that motivated proposed improvements, assess impact of those improvements, and identify challenges to successful implementation and (2) extract primary lessons learned about intervention research that have both general relevance to investigations of work-related disease prevention and specific relevance to this setting. The learning curve for the various stakeholders as well as the barriers to success demonstrate that effectiveness of an intervention cannot be adequately assessed without considerations of implementation. Designing, effectively implementing, and assessing both health impacts and implementation quality is a resource-intensive endeavor requiring a transdisciplinary approach. Both general and specific lessons learned are presented for decisions on study design and study elements, implementation assessment, and management engagement in understanding how productivity and health can be successfully balanced and for building effective communication between investigators and all levels of management.

ObjectivesSerum creatinine (SCr) is a routine marker of kidney injury but also increases with dehydration and muscular work. This study was to elucidate whether increase in SCr is associated with more specific markers of kidney tubular and interstitial injury and function, during prolonged heat stress among workers at high risk of chronic kidney disease of non-traditional origin (CKDnt).MethodsUrine monocyte chemoattractant protein-1 (MCP-1), kidney injury molecule-1 (KIM-1), calbindin, glutathione S-transferase-π (GST-π), clusterin, interleukin 18 and albumin, fractional excretion of potassium (FEK), blood haemoglobin, serum potassium, ferritin and erythropoietin were measured before and after harvest in a sample of 30 workers with a ≥0.3 mg/dL SCr increase across harvest (cases), and 53 workers with stable SCr (controls).ResultsUrine MCP-1 (p for differential cross-harvest trend ConclusionSeveral markers of tubular and interstitial injury and function changed as SCr increased across a harvest season, supporting the use of SCr as an indicator of kidney injury in physically active workers regularly exposed to heat stress. Repeated injury similar to that described here, and continued work under strenuous and hot conditions with similarly elevated injury markers is likely to worsen and possibly initiate CKDnt.

OBJECTIVE: The aim of this study was to assess the potential to reduce kidney function damage during the implementation of a water, rest, shade (WRS) and efficiency intervention program among sugarcane workers. METHODS: A WRS intervention program adapted from the US Occupational Safety and Health Administration (OSHA) coupled with an efficiency program began two months into the 5-month harvest. One of the two groups of workers studied was provided with portable water reservoirs, mobile shaded tents, and scheduled rest periods. Health data (anthropometric and questionnaires), blood, and urine were collected at baseline and at three subsequent times over the course of the harvest. Daily wet bulb globe temperatures (WBGT) were recorded. RESULTS: Across a working day there were changes in biomarkers indicating dehydration (urine osmolality) and serum albumin and reduced estimated glomerular filtration rate (eGFR). Cross-shift eGFR decrease was present in both groups; -10.5 mL/min/1.73m2 [95% confidence interval (95% CI) -11.8– -9.1], but smaller for the intervention group after receiving the program. Decreased eGFR over the 5-month harvest was seen in both groups: in the one receiving the intervention -3.4 mL/min/1.73m^2 (95% CI -5.5– -1.3) and in the other -5.3 (95% CI -7.9– -2.7). The decrease appeared to halt after the introduction of the intervention in the group receiving the program. CONCLUSION: A WRS and efficiency intervention program was successfully introduced for workers in sugarcane fields and appears to reduce the impact of heat stress on acute and over-harvest biomarkers of kidney function. Further research is needed to determine whether biomarker changes predict reduced risk of chronic kidney disease in this type of work.

Incorrect analysis results that are close to expected might not be recognized in scientific studies or routine patient care. In two field studies we obtained unexpected results in a large number of samples. The present study aimed to identify the source of error in the samples from these studies and to validate a method to obtain correct results. Pre-analytical procedures were scrutinized, giving no indications of inappropriate pre-analytical sample handling in the field or during transport in a tropical climate. Using a new set of samples from volunteers in simulation experiments, we observed the known concentration gradient of analytes sampled in gel as well as plain tubes after freezer storage and thawing. Experiments demonstrated that mixing of samples by vortexing alone was not sufficient to disrupt the gradient formed by freezing and thawing, which appeared to cause the problem encountered when we in field studies analyzed and biobanked large sample sets by robot pipetting. A correction procedure was introduced, in which the obtained value of an analyte was multiplied by a correction factor calculated for each sample using the expected sodium level (140 mmol/L) divided by the measured sodium value. When it was validated on results from the simulation experiments, we repeatedly found that the correction lead to results very close to true values for analytes of different size and charge. Usefulness of the procedure was demonstrated when applied to a large set of field study results.

Objectives Assess the impact of summer heat exposure (June–September) on residential construction workers in Al-Ahsa, Saudi Arabia by evaluating (i) heart rate (HR) responses, hydration status, and physical workload among workers in indoor and outdoor construction settings, (ii) factors related to physiological responses to work in hot conditions, and (iii) how well wet-bulb globe temperature-based occupational exposure limits (WBGTOELs) predict measures of heat strain. Methods Twenty-three construction workers (plasterers, tilers, and laborers) contributed 260 person-days of monitoring. Workload energy expenditure, HR, fluid intake, and pre- and postshift urine specific gravity (USG) were measured. Indoor and outdoor heat exposures (WBGT) were measured continuously and a WBGTOEL was calculated. The effects of heat exposure and workload on heart rate reserve (HRR), a measure of cardiovascular strain, were examined with linear mixed models. A metric called ‘heat stress exceedance’ (HSE) was constructed to summarize whether the environmental heat exposure (WBGT) exceeded the heat stress exposure limit (WBGTOEL). The sensitivity and specificity of the HSE as a predictor of cardiovascular strain (HRR ≥30%) were determined. Results The WBGTOEL was exceeded frequently, on 63 person-days indoors (44%) and 91(78%) outdoors. High-risk HRR occurred on 26 and 36 person-days indoors and outdoors, respectively. The HSE metric showed higher sensitivity for HRR ≥30% outdoors (89%) than indoors (58%) and greater specificity indoors (59%) than outdoors (27%). Workload intensity was generally moderate, with light intensity work more common outdoors. The ability to self-pace work was associated with a lower frequency of HRR ≥30%. USG concentrations indicated that workers began and ended their shifts dehydrated (USG ≥1.020). Conclusions Construction work where WBGTOEL is commonly exceeded poses health risks. The ability of workers to self-pace may help reduce risks.

IntroductionThere is uncertainty regarding the trends in occupational injuries (OIs) in Sweden due to a significant and increasing problem with under-reporting to injury registers. Under-reporting, in general, is likely to be exacerbated by the rise in precarious employment (PE), a set of unfavourable employment characteristics that would benefit from formal definition and study. PE and global trends are believed also to affect companies and their commitment to health and safety. The present study attempts to bridge these knowledge gaps and presents a study protocol for planned studies, with three main objectives: first, to review the literature for definitions of PE emphasising those that are multidimensional and operationalise components in routinely collected register data; second, to estimate the under-reporting of OI in Swedish registers and third, using results from the first objective, to conduct large, register-based prospective studies, designed to measure effect sizes and interactions between PE, business performance and OI.Methods and analysisFirst, a scientific literature review will be conducted, including scientific databases and grey literature. Second, data from two major OI registers will be used to estimate the magnitude of under-reporting using capture–recapture methodology. Finally, all residents aged 18–65 in Sweden with any registered income during 2003–2015 will be included. Data sources encompass Swedish population and labour market registers with linkage to both the main OI register with national coverage and hospital records. Trends in PE and OI will be explored, together with risk of OI associated with PE and business performance.Ethics and disseminationThe project has been approved by the Regional Ethics Committee, Stockholm (dnr: 2016/2325–31; 2017/2173–32). Dissemination of study results will include a series of peer-reviewed papers, at least one PhD thesis and one report in Swedish, engaging relevant stakeholders. Results will be presented in national and international conferences and through press releases to mass media.

The ways historians assemble primary material from which to learn how industry has failed to protect workers and the environment is changing dramatically. Increasingly, historians focus concern on the evolution of the internet and the demise of paper records. The authors of "Monsanto, PCBs," and the Creation of a "World-Wide Ecological Problem" (2018) are also founders of ToxicDocs.org. This web-based resource provides an entirely new degree of transparency. Readers of their article may look at any document they cite by clicking on the reference. Those with or without expertise in science can now judge these authors' analysis, and much more: entertain new lines of inquiry, ask new questions, obtain new insights, and publish well-documented pieces that offer new knowledge and insight to enrich our understanding, not only of the PCB story, but also industry's general behavior when using or marketing toxic substances.

This chapter describes various approaches to recognizing and preventing occupational and environmental disease and injury from primarily a clinical perspective. It describes in detail the occupational and environmental health history, including what questions to ask and when to ask them. It also describes recognizing occupational or environmental disease clusters or outbreaks. The chapter describes in detail the options that health and safety professionals have for implementing and facilitating preventive measures, including substitution of hazardous substances, installation of engineering controls, changes in job design and work practices and organization, education and training, use of personal protective equipment, and screening surveillance. Prevention options are discussed both at the individual and organizational levels.

This chapter describes the basic principles of epidemiology, emphasizing the aspects most relevant to studies of health effects from occupational and environmental exposures. Numerous examples are provided of how epidemiology can be used to identify and quantify the relations between recent or long-term exposure and health outcomes, such as prevalence or incidence of disease, injury, or mortality. The chapter describes the common study designs, including cohort studies, case-control studies, and cross-sectional studies, with examples of their application. Key aspects of exposure assessment and characterizing and quantifying exposure, are described. The three types of bias in epidemiology, information, selection, and confounding, are defined as well as the healthy worker effect, a potential source of bias unique in occupational studies. Study designs and analytic methods that can reduce or eliminate specific types of bias are also described. Finally, the chapter provides guidance on how to interpret the results of studies, with an eye toward causal inference.

Occupational and environmental health covers a wide spectrum and presents many challenges and opportunities. This chapter describes categories of occupational and environmental hazards, the nature and magnitude of problems, the contexts in which occupational and environmental health problems occur, and the prevention of occupational and environmental disease and injury. In addition, the chapter covers the changing nature of work and the workforce, evolving roles of government, liability, climate change, new directions for research, and economic globalization. It also discusses additional challenges for low- and middle-income countries. A final section of the chapter describes disciplines and careers in occupational and environmental health sciences and basic sources of information.

There is a long and continuing legacy of epidemiologists from high income countries conducting occupational health research in low and middle income countries. Opportunities to investigate occupational hazards in relatively high exposure settings and to develop multi-country research partnerships that can lead to disease prevention globally are the main motivations for this type of research. However, it should be appreciated that changes in the cultural, economic, and political environment of the country where the research is conducted can have profound influences on the likelihood of research success. Our research groups have long histories of conducting epidemiologic investigations among textile workers in Shanghai, China. The research includes studies of multiple different cancers and parkinsonism (HC) and respiratory disorders (DCC) in relation to exposures to textile industry dusts and chemicals. Several gene/environment investigations have also been conducted. We present the historical background leading to the research, and the logistical challenges that have emerged over time as political, social, and economic conditions in Shanghai have changed. These challenges include reduced access to workplaces, reduced worker participation rates, and governmentally imposed restrictions on transporting bio-specimens outside of China. Based on our experiences, we can offer some recommendations that occupational epidemiologists in high and low/middle income countries might consider to facilitate collaborative research: being cognizant of national and regional political, social, and economic policy changes; maintaining flexibility in research protocols and budgetary allocations during the course of study conduct; and, keeping lines of communication open throughout the research design and implementation.

Background In Mesoamerica CKDu(Chronic Kidney Disease of unknown cause) is epidemic among sugarcane workers and present in other workers. Excessive heat stress and workload are believed to contribute to onset and acceleration of CKDu. The Worker Health and Efficiency (WE) Program is the first evaluated intervention to address excessive heat stress and workload in sugarcane workers. We used the resulting press, political and industry attention to push for a wider agenda of worker protections. Objectives • Evaluate impact of intervention on patterns of heat illness/dehydration, kidney function, physical workload and productivity. • Demonstrate need for governments and industry to address CKDu and excessive heat stress in sugarcane- and other workers. Methods The WE intervention was piloted in two cohorts of workers, one inland and one coastal sugarcane cutters (totaling 117 individuals); thus, allowing assessment of the intervention via self-controls. Concurrently, outreach to industries and governments was conducted to exchange information. Using press and myriad contacts, private and public policy began to rapidly change. Results Pilot data analysis demonstrated a decrease in heat-related illness, improved hydration, and possibly a stabilisation in kidney function. Marked increase in productivity was also observed. The results drove policy discussions and measurable change in several companies, and the U.S. and Costa Rican Governments. Conclusion An evidenced-based dialogue between sugar industry farmers, millers, buyers, and governments was created. There are several challenges that remain, and navigating the path to where we are holds valuable lessons for those doing similar work.

There are direct and indirect health and performance detriments associated with occupational heat stress. This presentation will review methods and tools that can be used to examine physiological responses to occupational heat stress and highlight future directions for practice and research. Technological advancements have opened new opportunities for the capture and monitoring of physiological responses and metrics, particularly in the field. Continued validation of new technologies is necessary to benchmark the reliability and validity of field-based measures and methods. Measures of body temperature, metabolic workload, hydration status and psychophysiological responses can yield important information as to the strain induced from working in a hot environment. While there are a range of measurement techniques and methods to measure or estimate physiological responses, there are limitations that must be considered. These include the sensitivity, reliability and practicality of proposed measures. For example, gastro-intestinal temperature measures via a telemetric pill allows for direct, wireless, non-invasive measurement of deep internal temperature. However, water ingestion can influence telemetric pill readings while it remains in the stomach and the expense of such a system makes it prohibitive to use in large cohorts. Continued validation of new technologies is necessary to benchmark the reliability and validity of field-based measures and methods with the ultimate goal being to better quantify exposure-response and exposure-effect relationships for workers’ health, wellbeing and productivity. Importantly, more comprehensive assessments of the heat strain experienced by different populations would aid the interpretation of climate change impact on worker´s health at a local and global level.

Climate changes will markedly affect working people as increased heat and extreme weather may directly affect health and indirectly via reduced food access and spread of vector-borne diseases among outdoor workers. The effects will primarily affect low income people in tropical and sub-tropical areas, but occupational health authorities in all countries need to consider the emerging challenges. A recent EU project (www.HEAT-SHIELD.eu) is dedicated to improving heat resilience in workers, and NIOSH/USA recently (2016) published new guidelines. Considering the theme Eliminating Occupational Disease , a widespread occupational health threat from climate change will be excessive heat exposure causing ” workplace heat related illnesses ”. This is already a major problem in large parts of the world. A number of aspects of the occupational health challenges will be presented during this Mini-Symposium. Translating research into action involves broadening existing research/analysis to produce improved ”heat exposure evaluation” and ”occupational health impact assessment” related to climate change. Research needs to identify remediable conditions and solutions/interventions. This requires a major increase in occupational epidemiology studies (including intervention studies), focusing on hot parts of the world. The detrimental health and economic impacts should encourage global and national policies to address climate change mitigation. The Mini-Symposium will consider how to address these needs, and encourage networking among scientists in different fields for future studies. It also aims to engage young scientists in a field which has been overlooked in climate change impact analysis. The HEAT-SHIELD project welcomes cooperation in specific studies and sharing of methodologies.

SALTRA, IRET, IMM Program on Work, Environment and Health in Central America Programa de Trabajo, Ambiente y Salud en Centroamérica The First International Research Workshop on Mesoamerican Nephropathy (MeN) met in Costa Rica in November 2012 to discuss how to establish the extent and degree of MeN, examine relevant causal hypotheses, and focus efforts to control or eliminate the disease burden. MeN describes a devastating epidemic of chronic kidney disease of unknown origin predominantly observed among young male sugarcane cutters. The cause of MeN remains uncertain; however, the strongest hypothesis pursued to date is repeated episodes of occupational heat stress and water and solute loss, probably in combination with other potential risk factor(s), such as nonsteroidal anti-inflammatory drug and other nephrotoxic medication use, inorganic arsenic, leptospirosis, or pesticides. At the research workshop, clinical and epidemiologic case definitions were proposed in order to facilitate both public health and research efforts. Recommendations emanating from the workshop included measuring workload, heat, and water and solute loss among workers; quantifying nephrotoxic agents in drinking water and food; using biomarkers of early kidney injury to explore potential causes of MeN; and characterizing social and working conditions together with methods for valid data collection of exposures and personal risk factors. Advantages and disadvantages of different population study designs were detailed. To elucidate the etiology of MeN, multicountry studies with prospective cohort design, preferably integrating an ecosystem health approach, were considered the most promising. In addition, genetic, experimental, and mechanistic methods and designs were addressed, specifically the need for kidney biopsy analysis, studies in animal models, advances in biomarkers, genetic and epigenetic studies, a common registry and repository of biological and demographic data and/or specimens, and other areas of potential chronic kidney disease experimental research. Finally, in order to improve international collaboration on MeN, workshop participants agreed to establish a research consortium to link these Mesoamerican efforts to other efforts worldwide. El Primer Taller Internacional de Investigación sobre Nefropatía Mesoamericana (MeN) se reunió en Costa Rica en noviembre de 2012 para discutir cómo establecer la extensión y el grado de MeN, examinar hipótesis causales relevantes y enfocar los esfuerzos para controlar o eliminar la carga de la enfermedad. MeN describe una devastadora epidemia de enfermedad renal crónica de origen desconocido que se observa predominantemente entre los hombres jóvenes cortadores de caña de azúcar. La causa de MeN sigue siendo incierta; sin embargo, la hipótesis más fuerte perseguida hasta la fecha son los episodios repetidos de estrés por calor ocupacional y pérdida de agua y solutos, probablemente en combinación con otros factores de riesgo potenciales, como el uso de medicamentos antiinflamatorios no esteroideos y otros medicamentos nefrotóxicos, arsénico inorgánico, leptospirosis o pesticidas. En el taller de investigación, se propusieron definiciones de casos clínicos y epidemiológicos con el fin de facilitar tanto la salud pública como los esfuerzos de investigación. Las recomendaciones que surgieron del taller incluyeron medir la carga de trabajo, el calor y la pérdida de agua y solutos entre los trabajadores; cuantificación de agentes nefrotóxicos en agua potable y alimentos; el uso de biomarcadores de lesión renal temprana para explorar las posibles causas de MeN; y caracterizar las condiciones sociales y laborales junto con métodos para la recopilación de datos válidos de exposiciones y factores de riesgo personales. Se detallaron las ventajas y desventajas de los diferentes diseños de estudios de población. Para dilucidar la etiología de MeN, los estudios multinacionales con diseño de cohortes prospectivo, preferiblemente integrando un enfoque de salud ecosistémica, se consideraron los más prometedores. Además, se abordaron métodos y diseños genéticos, experimentales y mecanicistas, específicamente la necesidad de análisis de biopsias renales, estudios en modelos animales, avances en biomarcadores, estudios genéticos y epigenéticos, un registro y repositorio común de datos biológicos y demográficos y / o especímenes y otras áreas de investigación experimental potencial de enfermedad renal crónica. Finalmente, con el fin de mejorar la colaboración internacional sobre MeN, los participantes del taller acordaron establecer un consorcio de investigación para vincular estos esfuerzos mesoamericanos con otros esfuerzos en todo el mundo. O Primeiro Workshop Internacional de Pesquisa sobre Nefropatia Mesoamericana (MeN) se reuniu na Costa Rica em novembro de 2012 para discutir como estabelecer a extensão e o grau de MeN, examinar hipóteses causais relevantes e concentrar esforços para controlar ou eliminar a carga da doença. MeN descreve uma epidemia devastadora de doença renal crônica de origem desconhecida observada predominantemente entre jovens cortadores de cana do sexo masculino. A causa do MeN permanece incerta; no entanto, a hipótese mais forte perseguida até o momento são episódios repetidos de estresse calórico ocupacional e perda de água e soluto, provavelmente em combinação com outro (s) fator (es) de risco potencial (s), como o uso de antiinflamatórios não esteróides e outros medicamentos nefrotóxicos, arsênico inorgânico, leptospirose , ou pesticidas. No workshop de pesquisa, definições de casos clínicos e epidemiológicos foram propostas a fim de facilitar os esforços de saúde pública e de pesquisa. As recomendações emanadas da oficina incluíram a medição da carga de trabalho, calor e perda de água e soluto entre os trabalhadores; quantificar agentes nefrotóxicos em água potável e alimentos; usando biomarcadores de lesão renal precoce para explorar causas potenciais de MeN; e caracterizar as condições sociais e de trabalho juntamente com métodos para coleta de dados válidos de exposições e fatores de risco pessoais. Vantagens e desvantagens de diferentes desenhos de estudo populacional foram detalhadas. Para elucidar a etiologia do MeN, estudos multinacionais com desenho de coorte prospectivo, preferencialmente integrando uma abordagem de saúde do ecossistema, foram considerados os mais promissores. Além disso, métodos e designs genéticos, experimentais e mecanísticos foram abordados, especificamente a necessidade de análise de biópsia renal, estudos em modelos animais, avanços em biomarcadores, estudos genéticos e epigenéticos, um registro comum e repositório de dados biológicos e demográficos e / ou espécimes e outras áreas de pesquisa experimental em potencial para doença renal crônica. Finalmente, a fim de melhorar a colaboração internacional no MeN, os participantes do workshop concordaram em estabelecer um consórcio de pesquisa para vincular esses esforços mesoamericanos a outros esforços em todo o mundo. Universidad Nacional, Costa Rica Karolinska Institutet, Sweden Lund University, Sweden Umeå University, Sweden University of Massachusetts Lowell, United States Instituto Regional de Estudios en Sustancias Tóxicas

The epidemic of chronic kidney disease of unknown etiology in Mesoamerica : a call for interdisciplinary research and action

To examine barriers community health centers (CHCs) face in using workers' compensation insurance (WC).Leadership of CHCs in Massachusetts.We used purposeful snowball sampling of CHC leaders for in-depth exploration of reimbursement policies and practices, experiences with WC, and decisions about using WC. We quantified the prevalence of perceived barriers to using WC through a mail survey of all CHCs in Massachusetts.Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated.Few CHCs formally discourage use of WC, but underutilization emerged as a major issue: "We see an awful lot of work-related injury, and I would say that most of it doesn't go through workers' comp." Barriers include lack of familiarity with WC, uncertainty about work-relatedness, and reliance on patients to identify work-relatedness of their conditions. Reimbursement delays and denials lead patients and CHCs to absorb costs of services.Follow-up studies should fully characterize barriers to CHC use of WC and experiences in other states to guide system changes in CHCs and WC agencies. Education should target CHC staff and workers about WC.