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High-power impulse magnetron sputtering (HiPIMS) plus kick is a physical vapor deposition method that employs bipolar microsecond-scale voltage pulsing to precisely control the ion energy during sputter deposition. HiPIMS plus kick for AlN deposition is difficult since nitride deposition is challenged by low surface diffusion and high susceptibility to ion damage. In this current study, a systematic examination of the process parameters of HiPIMS plus kick was conducted. Under optimized main negative pulsing conditions, this study documented that a 25 V positive kick biasing for AlN deposition is ideal for optimizing a high quality film, as shown by X-ray diffraction and transmission electron microscopy as well as optimal thermal conductivity while increasing high speed deposition (25 nm/min) and obtaining ultrasmooth surfaces (rms roughness = 0.5 nm). HiPIMS plus kick was employed to deposit a single-texture 1 μm AlN film with a 7.4° rocking curve, indicating well oriented grains, which correlated with high thermal conductivity (121 W/m·K). The data are consistent with the optimal kick voltage enabling enhanced surface diffusion due to ion-substrate collisions without damaging the AlN grains.

Introduction: Although the association between gout and cardiovascular disease (CVD) has been extensively studied, scarce data are available for the Black population. We aimed to assess the association between gout and CVD in a predominantly Black urban population with gout., Methods: A cross-sectional analysis was performed between a gout cohort and an age-/sex-matched control group. Clinical parameters and 2D echocardiograms were reviewed for the patients with gout and heart failure (HF). The primary outcome studied includes the prevalence and strength of association between gout and CVD. Secondary outcomes studied includes strength of association of gout and HF categorized by ejection fraction, mortality, and HF readmissions., Results: Four hundred seventy-one patients with gout had a mean age of 63.7 ± 0.5 years; 89% were Black, 63% were men, and mean body mass index was 31.3 ± 0.4 kg/m 2 . Hypertension, diabetes mellitus, and dyslipidemia were present in 89%, 46%, and 52%, respectively. Compared with controls, patients with gout had significantly higher rates of angina, arrhythmia, coronary artery disease/stents, myocardial infarction, coronary artery bypass graft surgery, cerebrovascular accident, and peripheral vascular disease. The adjusted odds ratio for CVD was 2.9 (95% confidence interval, 1.9-4.5; p < 0.001). Gout patients had a higher prevalence of HF with 45% (n = 212) compared with controls with 9.4% (n = 44). Adjusted odds ratio for HF risk was 7.1 (95% confidence interval, 4.7-10.6; p < 0.01)., Conclusions: Gout in a predominantly Black population confers 3 times the CVD risk and 7 times HF-specific risk compared with age- and sex-matched cohort. Further research is needed to confirm our findings and to develop interventions to reduce morbidity associated with gout., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The aim of this study is to gain insight into the clinical experiences and perceptions that pediatric oncology experts, conventional healthcare providers, and complementary and alternative medicine (CAM) providers in Norway, Canada, Germany, the Netherlands, and the United States have with the use of supportive care, including CAM among children and adolescents with cancer., Methods: A qualitative study was conducted using semi-structured in-depth interviews (n = 22) with healthcare providers with clinical experience working with CAM and/or other supportive care among children and adolescents with cancer from five different countries. Participants were recruited through professional associations and personal networks. Systematic content analysis was used to delineate the main themes. The analysis resulted in three themes and six subthemes., Results: Most participants had over 10 years of professional practice. They mostly treated children and adolescents with leukemia who suffered from adverse effects of cancer treatment, such as nausea and poor appetite. Their priorities were to identify the parents' treatment goals and help the children with their daily complaints. Some modalities frequently used were acupuncture, massage, music, and play therapy. Parents received information about supplements and diets in line with their treatment philosophies. They received education from the providers to mitigate symptoms and improve the well-being of the child., Conclusions: Clinical experiences of pediatric oncology experts, conventional health care providers, and CAM providers give an understanding of how supportive care modalities, including CAM, are perceived in the field and how they can be implemented as adaptational tools to manage adverse effects and to improve the quality of life of children diagnosed with cancer and the families., (© 2023. The Author(s).)

Introduction: Although more than 300 000 children and adolescents worldwide are diagnosed with cancer yearly, little research has been conducted investigating how healthcare providers consider risk and patient safety connected with supportive care (including complementary and alternative medicine [CAM]) in this age group. This study aimed to explore how different healthcare providers perceive and evaluate risk when patients combine supportive care and conventional medicine in clinical practice and how they communicate and inform parents about the use of these modalities., Materials and Methods: In-depth semi-structured interviews were conducted with 22 healthcare providers with expertise in treating pediatric oncology patients from 5 countries. Systematic content analysis was conducted using Nvivo 1.61., Results: The analysis resulted in 3 themes and 8 subthemes. Generally, participants were cautious about implementing unproven new modalities or therapies when recommending supporting care modalities to parents of children and adolescents with cancer. The most important criterion when recommending a modality was evidence for safety based on a risk/benefit evaluation. Negative interactions with conventional medicine were avoided by using the half-life of a drug approach (the time it takes for the amount of a drug's active substance in the body to reduce by half). For patients with severe symptoms, less invasive modalities were used (ear seeds instead of ear needling). To enhance safety, participants practiced open and egalitarian communication with parents., Conclusion: Healthcare providers reported using a variety of approaches to achieve a safe practice when parents wanted to combine supportive care and conventional cancer treatment. They emphasized that these modalities should be foremost safe and not become an extra burden for the patients. Providers highlighted patient-centered care to meet the individual's specific health needs and desired health outcomes. A lack of national and regional standardized training programs for supportive care in pediatric oncology was considered a hazard to patient safety.

Background: The increasing number of patients surviving cancer leads to more people experiencing late and long term-effects from the disease and its treatment. Fatigue, sleep disorders, early menopause, pain, and nerve damage are commonly reported. Methods helping people to recover after cancer treatment are therefore essential. The aims of this study were threefold; (1) to determine the level of cancer patients suffering from late and long-term effects of cancer diagnosis and treatment in Norway, (2) explore complementary and alternative medicine (CAM) modalities used for managing these adversities, and (3) describe self-perceived benefits and harms of the CAM interventions., Methods: The study was conducted in cooperation with the Norwegian Cancer Society (NCS) and consisted of an online cross-sectional study among members of the NCS user panel with present or previous cancer (n = 706). The study was carried out in September/October 2021 using a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). A total of 315 women and 153 men agreed to participate, resulting in a response rate of 67%., Results: Most of the participants (83%) suffered from late and long-term effects of cancer treatment; mostly fatigue (59.2%), sleep disorder (41.5%), hot flashes (39.2%), nerve damage (polyneuropathy, 38.0%), and pain (36.6%) with a mean number of 5.1 different late and long-term effects. Late and long-term effects were positively associated with younger age and college/university education. Nearly half of the participants experiencing late and long-term effects (43%) reported having used CAM to treat these complaints. Most frequently used were self-help practices (26%) such as relaxation therapy (19%), yoga (14%) and meditation (13%), but also visits to CAM providers were reported by 22%. Herbal- and other natural remedies to treat late and long-term effects were used by 13%. A high percentage of CAM users reported self-perceived improvements of their symptoms (86% for self-help practices, 90% for visits to CAM providers). Few experienced adverse effects of the CAM treatment., Conclusion: A large proportion of cancer patients suffered from a wide range of late and long-term effects of cancer diagnosis and treatment, and they use CAM to treat these complaints to a rather high degree. Relaxation therapy, yoga, meditation, massage, and acupuncture were the most frequently used therapies regardless of complaint. The therapies used are generally considered to be both safe and beneficial for the respective complaint, indicating that the participants seem to be well informed about the choices they make., (© 2022. The Author(s).)

Background: Dealing with the symptom burden of cancer diagnosis and treatment has led parents to seek different self-management strategies including Alternative and Complementary Medicine (CAM). The aim of this study was to perform a systematic review and meta-analysis about the use and effect of CAM modalities to treat adverse effects of conventional cancer treatment among children and young adults., Methods: Six scientific research databases were used to identify randomized controlled trials (RCTs) from 1990 to September 2020. Included studies investigated the use of CAM to treat cancer treatment related adverse effects in children and young adults compared to controls., Results: Twenty RCTs comprising 1,069 participants were included in this review. The included studies investigated acupuncture, mind-body therapies, supplements, and vitamins for chemotherapy-induced nausea and vomiting (CINV), oral mucositis, and anxiety among children and young adults who underwent conventional cancer treatment. Seven studies (315 participants) were included in the meta-analysis. The overall effect of CAM (including acupuncture and hypnosis only) on chemotherapy-induced nausea and/or vomiting and controls was statistically significant with a standard mean difference of -0.54, 95% CI [-0.77, -0.31] I 2  = 0% (p < 0.00001). There was a significant difference between acupuncture and controls (n = 5) for intensity and/or episodes of CINV with an SMD -0.59, 95% CI [-0.85, -0.33] (p < 0.00001). No significant difference was found between hypnosis and controls (n = 2) for severity or episodes of CINV with an SMD -0.41, 95% CI [-1.09, 0.27] I 2  = 41% (p = 0.19)., Conclusion: Current evidence from this meta-analysis of randomized controlled trials shows that CAM, including acupuncture and hypnosis only, is effective in reducing chemotherapy-induced nausea and vomiting in children and young adults. More rigorous trials and long-term effects should be investigated if acupuncture and hypnosis are to be recommended for clinical use., (© 2022. The Author(s).)

This study describes the quality of drinking water sampled over 2 years (2018 and 2019) from 20 ASADAS (Spanish acronym for Administrative Associations for Water and Sewer Systems) in Costa Rica. The analysis included Rotavirus (RV), somatic coliphages, fecal coliforms, and Escherichia coli. The ASADAS were categorized into three regions as temperate rainy (region 1), tropical rainy (region 2), and tropical rainy and dry (region 3) according to biogeographic classification. The concentrations of fecal coliforms and E. coli were higher in samples from surface water sources from the ASADAS in region 3 compared to regions 1 and 2. RV-positive samples (24/296) were detected in drinking-water samples from regions 2 and 3 during dry and transition seasons, with higher concentrations more frequently in the dry season. In addition, somatic coliphages were detected in samples from the three regions, with higher concentrations in region 2. Furthermore, a statistically significant relationship was found between somatic coliphages and diarrheal cases, classified as outbreaks or alerts in the region. Thus, the results confirmed that somatic coliphages are a good indicator of the presence of diarrhea cases in a specific region.

Background: Complementary and Alternative Medicine (CAM) is widely used around the world to treat adverse effects derived from cancer treatment among children and young adults. Parents often seek CAM to restore and maintain the child's physical and emotional condition during and after cancer treatment., Objectives: The objectives of this review were (i) to identify literature that investigates CAM use for treating adverse effects of conventional cancer treatment, (ii) to investigate the safety of the included CAM modalities, and (iii) to evaluate the quality of included studies., Methods: Five scientific research databases were used to identify observational, quasi-experimental, and qualitative studies from January 1990 to May 2021. Included studies investigated the use of CAM to treat adverse effects of cancer treatment in childhood cancer., Results: Fifteen studies were included in this review. Ten quasi-experimental, 3 observational studies (longitudinal/prospective), 2 qualitative studies, and 1 study with a quasi-experimental and qualitative arm were identified. Less than half (n = 6; 40%) of the studies included reported adverse effects for the CAM modality being studied. Among the studies that reported adverse effects, they were mostly considered as direct risk, as 13% reported mainly bleeding and bruising upon acupuncture treatment, and dizziness with yoga treatment. All adverse effects were assessed as minor and transient. CAM modalities identified for treating adverse effects of cancer treatment were alternative medical systems, manipulative and body-based therapies, biologically-based therapies, and mind-body therapies. CAM modalities were used to alleviate anxiety, pain, toxicity, prevent trauma, and improve health-related quality of life, functional mobility, and physical activity levels. All studies assessed scored 70% or above according to the Joanna Briggs Institute critical appraisal for study quality checklists., Conclusion: Most of the studies (58.3%) included in this review did not report adverse effects from CAM modalities used to treat adverse effects of cancer treatment in children and young adults. This lack of safety information is of concern because parents need to know whether the modality represents an extra burden or harm to the child. To improve awareness about safety in the field, a universal and uniform reporting system for adverse effects in CAM research is needed.

Background: Genomic knowledge is becoming increasingly relevant to health care. Development of linguistically and culturally appropriate educational resources for Latino adults with limited education and English skills is needed., Objectives: The effectiveness of a telenovela was analyzed and lessons learned provided., Methods: The team developed a telenovela to convey key genomics concepts and delivered it to 100 Latino farmworkers and nonfarmworkers in North Carolina. Participants completed a pretest measuring genomic knowledge and self-efficacy, viewed the telenovela, then completed a post-test. Twenty-four participants repeated the post-test 6 months later. Changes in genomic knowledge and self-efficacy were calculated., Results: Overall, genomic knowledge and self-efficacy increased significantly after viewing the telenovela. Responses to two items indicated that the emphasis on epigenetics overshadowed other genomic mechanisms. Six-month follow-up results were not significantly different from the pretest., Conclusions: Increased attention to graphic design principles, presentation across multiple sessions, and supplemental activities may increase telenovelas' impact.

It is important to understand genetics within the context of health. This paper assesses (a) genetic knowledge among Mexican-born farmworker and non-farmworker adults; (b) their interpersonal and device sources of genetic knowledge; and (c) the association between their genetic knowledge and the sources of this genetic knowledge.Interviews were conducted with Mexican-born farmworkers (100) and non-farmworkers (100) in North Carolina. Participants answered 15 questions to assess genetic knowledge, and sources from which they had seen or heard about genes and genetics.Results show limited knowledge of genetics, with farmworkers and non-farmworkers providing a similar level of correct responses (6.6 versus 7.3), but with farmworkers providing more incorrect responses (4.0 versus 2.7). Important sources of genetic information for farmworkers were promotoras (47%), compared to teachers (49%) for non-farmworkers.This study demonstrates a need for increased dissemination of genetic information to Mexican-origin farmworkers and non-farmworkers., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

Children as young as ten-years-old can legally work as hired farm labor in the United States. In North Carolina, many hired children are part of the Latinx farmworker community. Agriculture is a hazardous industry, and child workers experience high rates of injury, illness, and mortality. As part of a community-based participatory research study, we draw from thirty in-depth interviews with Latinx child farmworkers aged ten to seventeen to describe their experiences of personal and observed workplace injury and close calls. Nearly all child workers had experienced or observed some form of injury, with several reporting close calls that could have resulted in severe injury or fatality. Overall, children reported a reactive approach to injury prevention and normalized pain as part of the job. Highlighting Latinx child farmworkers' structural "vulnerability, this analysis contextualizes understanding of workplace injury among this largely hidden population. We offer policy recommendations to protect and support these vulnerable workers.

Background: Although children 10-17 years can be hired to work in agriculture, little research has addressed possible musculoskeletal injuries. Children may be at particular risk for these injuries because of the repetitive and load bearing nature of work tasks. Existing research relies on child workers to self-report musculoskeletal injuries., Methods: In 2017, 202 Latinx child farmworkers ages 10-17 employed across North Carolina completed survey interviews. In 2018, 145 of these children (94 [64.8%] current farmworkers) completed a physical examination and second interview. The examination obtained findings for upper and lower extremity as well as back injuries., Results: Positive indicators for musculoskeletal symptoms were few in either current or former child farmworkers. The knee was most common site for positive indicators with 15.4% of children having at least one. Combining all anatomical sites, 29.0% of children had at least one positive indicator, with no significant difference between current and former farmworkers. Overall, boys had significantly more indicators of knee injuries than girls (21.3% vs. 4.1%), indicators of ankle injuries were found only in the youngest workers (9.5% of children 11-13 years), and significantly fewer current farmworkers had indicators of lower back injuries than former farmworkers (6.4% vs. 17.7%)., Conclusions: Expectations of injuries come from previous studies using child farmworker self-reports, adult farmworker injury rates, and sports medicine pediatric findings. Hired child farmworkers may not perform activities as repetitious and load-bearing as children in sports training or adult farmworkers. Additional research using physical examination is needed to confirm these findings., (© 2021 Wiley Periodicals LLC.)

COVID-19 has revealed social and health inequities in the United States. Structural inequalities have increased the likelihood of immigrants contracting COVID-19, by being essential workers and through poverty that forces this population to continue working. Rural and urban immigrant families may face different concerns. Using a telephone survey in May 2020 of 105 Latinx families in an existing study, quantitative and qualitative data were gathered on work and household economics, childcare and education, healthcare, and community climate. Analyses show that, although rural and urban groups experienced substantial economic effects, impacts were more acute for urban families. Rural workers reported fewer workplace protective measures for COVID-19. For both groups, fear and worry, particularly about finances and children, dominated reports of their situations with numerous reports of experiencing stress and anxiety. The experience of the pandemic is interpreted as an example of contextual vulnerability of a population already experiencing structural violence through social injustice. Policy implications are highlighted.

We examine the educational experience of Latinx hired child farmworkers in North Carolina, using a social justice framework. Qualitative ( n  = 30) and quantitative ( n  = 202) data collected among children ten to seventeen years of age revealed elevated rates of grade retention and dropout status. Children reported disruption to their schooling caused by international and interstate migration and intrastate movement. Few worked during school time; nevertheless, children reported missed participation in educational enrichment opportunities and little integration into school life. Schools often failed to accommodate language difficulties and problems caused by migration, and an atmosphere of racism prevailed. Educational programs for children in farmworker families were established during the 1960s. However, they do not meet the needs of hired child farmworkers. Policies to reduce child employment in agriculture and to meet their educational needs are necessary to ensure the education needed for future health and well-being. We discuss the applied implications of findings.

(1) Background: The COVID-19 pandemic poses substantial threats to Latinx farmworkers and other immigrants in food production and processing. Classified as essential, such workers cannot shelter at home. Therefore, knowledge and preventive behaviors are important to reduce COVID-19 spread in the community. (2) Methods: Respondents for 67 families with at least one farmworker (FWF) and 38 comparable families with no farmworkers (nonFWF) in North Carolina completed a telephone survey in May 2020. The survey queried knowledge of COVID-19, perceptions of its severity, self-efficacy, and preventive behaviors. Detailed data were collected to document household members' social interaction and use of face coverings. (3) Results: Knowledge of COVID-19 and prevention methods was high in both groups, as was its perceived severity. NonFWF had higher self-efficacy for preventing infection. Both groups claimed to practice preventive behaviors, though FWF emphasized social avoidance and nonFWF emphasized personal hygiene. Detailed social interactions showed high rates of inter-personal contact at home, at work, and in the community with more mask use in nonFWF than FWF. (4) Conclusions: Despite high levels of knowledge and perceived severity for COVID-19, these immigrant families were engaged in frequent interpersonal contact that could expose community members and themselves to COVID-19.

Children as young as ten are legally hired for farm work. In North Carolina, many of these hired children are Latinx; they often work long hours during hot and humid summer conditions. Heat-related illness occurs along a continuum of severity ranging from heat cramps and rashes to heat exhaustion and heat stroke, which can be fatal. The literature on the negative health effects of occupational heat exposure is growing; however, few studies have examined this exposure and health outcomes among child agricultural workers. To understand Latinx child farmworkers' experiences of working in heat, we conducted in-depth interviews (n = 30). To estimate the prevalence of heat-related illness symptoms and associated factors, we conducted survey interviews (n = 165). Heat-related illness is common among these child farmworkers. While children often understand the dangers of working in heat, work organization often prevents their taking precautions. Formal workplace protections to prevent heat-related illness are limited.

(1) Background: Early life exposure to neurotoxic chemicals can have later impacts on child health. Most research designs must assume that current exposure is similar to past. Life history calendar methods can help to provide data on early life exposure. (2) Methods: Life history calendars were completed by mothers of 8-year-old children from Latinx farmworker and non-farmworker families ( n = 73 and 65, respectively). Measures were created of months exposure through living adjacent to farm fields and having household members who worked in jobs exposing them to toxic chemicals. Data were divided into time periods of in utero, early childhood (birth-35 months) and later childhood (36-96 months). Cluster analysis compared the measures for children from farmworker and non-farmworker parents. (3) Results: Although, as a group, children from farmworker families have greater lifetime months of probable exposure to pesticides than children in non-farmworker families, cluster analysis reveals groups of children who do not follow that pattern. (4) Conclusions: The life history calendar is a technique for obtaining data on early life toxic chemical exposure that may help assign children to proper exposure groups. Conducting secondary analyses using such information can help to clarify the association of exposures to health outcomes.

Background: US government child labor policies allow children as young as age 10 to be hired as workers on farms not operated by family members. Children may face substantial health risks in an industry known for high worker morbidity and mortality rates, due to high demands for productivity, and low control and little support because of the organization of the workplace. This paper examines how child farmworkers in North Carolina experience their work situation., Methods: In-depth interviews conducted in 2016 with 30 Latinx child farmworkers, ages 10 to 17, were analyzed using concepts from the demand-control-support model. All had worked as either migrant or seasonal hired farmworkers within the past year., Results: Children reported planting, cultivating, and harvesting crops including fruits, vegetables, and tobacco. The crew leader supervisory system, piece-rate pay, and coworker pressure produced significant demands to work quickly and take risks including lifting heavy loads, operating mechanical equipment, and working in excessive heat. Children had little control over work to counter demands they experienced; and they labored in a state of fear of firing, wage theft, and other sanctions. Support was variable, with younger children more likely to experience family and coworker support than older children., Conclusions: The high demands with limited control and, for some, little support, that these children experience place them at risk and show the possibility of injury and exploitation. Future research should systematically document the occupational injury and illness of hired child farmworkers, and consider whether changes in labor policy are warranted., (© 2019 Wiley Periodicals, Inc.)

Background: Children as young as 10 years of age can be hired to work on farms. Many of these hired child farmworkers are Latinx. Although these children experience high rates of injury, little research has addressed work-safety perceptions among hired Latinx child farmworkers., Methods: For this qualitative study, we conducted in-depth interviews in North Carolina in 2016 with 30 Latinx child farmworkers, ages 10 to 17. Our analysis used the work-safety culture conceptual framework to delineate their perceptions of the psychological, behavioral, and situational elements of safety culture., Results: The child farmworkers describe a weak work-safety culture. Psychologically, they understand that their parents want them to be safe, but they observe that safety is important to only a fraction of their supervisors and coworkers. Behaviorally, they recognize many of the hazards they confront while working, but it is not clear how well they use this knowledge to mitigate these hazards or to change their behaviors to avoid these hazards. Situationally, several children note that the only safety training they receive is the imperative to "be careful." Most receive little formal training, much of the training they receive is informally provided by family members and coworkers rather than supervisors, and their training is geared more toward how to complete a task than how to complete the task safely., Conclusions: Child farmworkers perceive that work-safety culture is of limited importance in agriculture. Regulations are needed that improve work-safety culture in agriculture, especially for those vulnerable due to minority age., (© 2019 Wiley Periodicals, Inc.)

Latino farmworkers are exposed to a number of carcinogens in the workplace. Cancer survival rates for Latinos are below average. This paper describes Mexican immigrant farmworkers' knowledge of colorectal, breast, and testicular cancer, and compares farmworkers' cancer knowledge to that of other Mexican immigrants. Survey interviews for this study were conducted with 100 farmworkers and 100 non-farmworkers in 2015 in North Carolina as part of an ongoing community-based participatory research project. We found low to moderate levels of knowledge about colorectal, breast, and testicular cancer among farmworkers. Compared to non-farmworkers, farmworkers had similar levels of knowledge about breast and testicular cancer, but slightly lower knowledge about colorectal cancer (p = 0.0087). Few studies have used quantitative methods to assess farmworkers' knowledge of specific types of cancer. Our results demonstrate a need for increased dissemination of existing cancer education programs and further research to develop additional educational tools.

The human papilloma virus (HPV) vaccine is an effective but underused cancer prevention tool. This study assessed knowledge of HPV and HPV vaccine initiation among Mexican-born farmworkers in North Carolina. Interviewer-administered questionnaires were conducted with 100 Latino farmworkers and 100 nonfarmworker Latino North Carolina residents in 2015 as part of an ongoing community-based participatory research project. Farmworkers had low levels of knowledge about HPV and the HPV vaccine. They had a similar amount of HPV and HPV vaccine knowledge compared to nonfarmworkers. Farmworkers and nonfarmworkers learned about the HPV vaccine from different sources. Adolescent children of farmworkers and nonfarmworkers had low HPV vaccine initiation. However, for children living in the United States with farmworker parents, vaccine initiation was high. To prevent HPV-related cancers and improve health equity, interventions are needed in order to increase HPV education and vaccine initiation among children of Mexican-born farmworkers and nonfarmworkers. Public health programs should look for partners outside the traditional health care setting to reach underserved populations. Other key strategies include promoting catch-up vaccines, improving patient-provider communication, and providing case management services.

Mexican immigrants have a rich history of traditional healers. This analysis describes the conditions for which Mexican immigrants seek treatment from sobadores, and delineates factors that influence seeking treatment from a sobador or a biomedical doctor. This systematic qualitative analysis uses interview data collected with 24 adult Mexican immigrants to North Carolina who had been treated by a sobador in the previous 2 years. Immigrants are engaged in medical pluralism, seeking care from sobadores and biomedical doctors based on the complaint and patient's age. Using a hierarchy of resort, adults seek treatment from sobadores for musculoskeletal pain not involving a fracture. Doctors are first consulted when treating children; sobadores are consulted if doctors do not provide culturally appropriate treatment. Mexican immigrants seek care that addresses their culturally determined health concerns. The need to improve access to culturally competent biomedical health care for vulnerable immigrant populations continues.

This article compares detections and concentrations of specific organophosphate (OP), bis-dithiocarbamate, and pyrethroid pesticide urinary metabolites among Latino male farmworkers and nonfarmworkers in North Carolina. Data are from interviews and urine samples collected in 2012 and 2013. Farmworkers and nonfarmworkers frequently had detections for OP and pyrethroid pesticide urinary metabolites. Detection of bis-dithiocarbamate urinary metabolites was less frequent, but substantial among the nonfarmworkers. The concentrations of organophosphate, bis-dithiocarbamate, and pyrethroid pesticide urinary metabolites were high for farmworkers and nonfarmworkers compared to National Health and Nutrition Examination Survey results. Pesticide urinary metabolite detection was not associated with occupation in nonfarmworkers. Research for reducing pesticide exposure among farmworkers remains important; research is also needed to determine pesticide exposure pathways among Latino nonfarmworkers.

Objectives: This paper compares detections and concentrations of pesticide urinary metabolites for Latina farmworkers and nonfarmworkers in North Carolina., Methods: Thirty-one farmworkers and 55 nonfarmworkers provided urine samples in 2012 and 2013. Urine samples were analyzed for detections and concentrations of organophosphate insecticide, bis-dithiocarbamate fungicide, and pyrethroid insecticide urinary metabolites., Results: Detections for several organophosphate and pyrethroid pesticide urinary metabolites were present for substantial proportions of the farmworkers and nonfarmworkers. Concentrations for several of these metabolites were high. Farmworkers and nonfarmworkers were similar in detections and concentrations for the pesticide urinary metabolites included in this analysis., Conclusions: Participant pesticide exposure increases health risks for them and their children. Research needs to document pesticide exposure, its health effects, and ways to reduce it. Current information justifies policy development to reduce pesticide exposure in all communities.

Latino immigrants to the New Settlement area of the southeastern United States face structural and cultural obstacles to accessing the conventional health care system, and come from areas with long traditions of medical treatments from healers without professional training or licensure. Little is known about the use of such healers in New Settlement areas. This study focuses on sobadores, healers who use manipulative therapy. Goals were to describe sobadores practicing in North Carolina, including their background, conditions treated, and their understanding of the pathophysiology of their patients' conditions and how their treatments work. The paper also describes who sobadores treat and sobadores' understanding of where their treatment fits into patients' pursuit of relief from symptoms. This focused ethnography draws from in-depth, semi-structured interviews conducted with six sobadores from Mexico practicing in North Carolina. These sobadores appear to meet both structural and cultural needs for healthcare in the immigrant Latino population.

Agriculture in the United States employs youth ages ten and older in work environments with high pesticide levels. Younger children in rural areas may also be affected by indirect pesticide exposures. The long-term effects of pesticides on health and development are difficult to assess and poorly understood. Yet, epidemiologic studies suggest associations with cancer as well as cognitive deficits. We report a practical and cost-effective approach to assess environmental pesticide exposures and their biological consequences in children. Our approach combines silicone wristband personal samplers and DNA damage quantification from hair follicles, and was tested as part of a community-based participatory research (CBPR) project involving ten Latino children from farmworker households in North Carolina. Our study documents high acceptance among Latino children and their caregivers of these noninvasive sampling methods. The personal samplers detected organophosphates, organochlorines, and pyrethroids in the majority of the participants (70%, 90%, 80%, respectively). Pesticides were detected in all participant samplers, with an average of 6.2±2.4 detections/participant sampler. DNA damage in epithelial cells from the sheath and bulb of plucked hairs follicles was quantified by immunostaining 53BP1-labled DNA repair foci. This method is sensitive, as shown by dose response analyses to γ radiations where the lowest dose tested (0.1Gy) led to significant increased 53BP1 foci density. Immunolabeling of DNA repair foci has significant advantages over the comet assay in that specific regions of the follicles can be analyzed. In this cohort of child participants, significant association was found between the number of pesticide detections and DNA damage in the papilla region of the hairs. We anticipate that this monitoring approach of bioavailable pesticides and genotoxicity will enhance our knowledge of the biological effects of pesticides to guide education programs and safety policies., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Using scientific results to inform policy that improves health and well-being of vulnerable community members is essential to community-based participatory research (CBPR)., Objectives: We describe "policy briefs," a mechanism developed to apply the results of CBPR projects with migrant and seasonal farmworkers to policy changes., Lessons Learned: Policy briefs are two-page summaries of published research that address a single policy issue using language and graphics to make the science accessible to diverse audiences. Policy brief topics are selected by community advocates, based on collaborative research, and address a specific policy or regulation. Development is an iterative process of discussion with community representatives. Briefs have been used to provide information to advocates, state and national policymakers, and the public., Conclusions: Disseminating CBPR results to address policy is needed. Collaborating with community partners to produce policy briefs ensures that information about concerns and struggles reflects their priorities.

Background: This analysis documents detections and concentrations of the six dialkylphosphate (DAP) urinary metabolite of organophosphorus (OP) pesticides among North Carolina Latino migrant farmworkers, with comparison to non-farmworker Latino immigrants., Methods: Participants provided up to four urine samples during the 2012 and 2013 agricultural seasons. Composite urine samples for each year were analyzed., Results: DAP urinary metabolite detections were similar in farmworkers and non-farmworker; for example, for 2012, 75.4% of farmworkers and 67.4% of non-farmworkers and, for 2013, 89.3% of farmworkers and 89.7% of non-farmworkers had dimethylthiophosphate detections. DAP geometric mean concentrations were high; for example, dimethylphosphate concentrations among farmworkers were 11.39 μg/g creatinine for 2012 and 4.49 μg/g creatinine for 2013, while they were 10.49 μg/g creatinine for 2012 and 1.97 μg/g creatinine for 2013 for non-farmworkers CONCLUSIONS:: Research to reduce pesticide exposure among Latino farmworkers and non-farmworkers is needed., Competing Interests: Statement: Thomas A. Arcury, PhD, reports that in the 36 months prior to submission of this paper that he had financial relationships for consultation with Meharry Medical College (Nashville, TN), Marshfield Clinic (Marshfield, WI), and PDA, Inc. (Raleigh, NC). Paul J. Laurienti. MD, PhD, reports no conflicts of interest. Haiying Chen, MD, PhD, reports no conflicts of interest. Timothy D. Howard, PhD, reports no conflicts of interest. Dana Boyd Barr, PhD, reports no conflicts of interest. Dana C. Mora, MPH, reports no conflicts of interest. Phillip Summers, MPH, reports no conflicts of interest. Sara A. Quandt, PhD, reports no conflicts of interest.

Objectives: This analysis provides a description of the manual-therapy elements of sobadores practicing in North Carolina, using videotapes of patient treatment sessions., Design: Three sobadores allowed the video recording of eight patient treatment sessions (one each for two sobadores, six for the third sobador). Each of the recordings was reviewed by an experienced chiropractor who recorded the frequencies of seven defined manual-therapy elements: (1) treatment time; (2) patient position on treatment surface; (3) patient body part contacted by the sobador; (4) sobador examination methods; (5) primary treatment processes; (6) sobador body part area referencing patient; and (7) adjunctive treatment processes., Results: The range of treatment time of 9-30 min was similar to the treatment spectra that combine techniques used by conventional massage and manipulative practitioners. The patient positions on the treatment surface were not extraordinary, given the wide variety of treatment processes used, and indicated the sobadores treat patients in multiple positions. The patient body part contacted by the sobadores indicated that they were treating each of the major parts of the musculoskeletal system. Basic palpation dominated the sobadores' examination methods. The sobadores' primary treatment processes included significant variety, but rubbing was the dominant practice. The hands were the sobador body area that most often made contact with the patient. They all used lubricants., Conclusions: Sobadores' methods are similar to those of other manual-therapy practitioners. Additional study of video-recorded sobador practices is needed. Video-recorded practice of other traditional and conventional manual therapies for comparative analysis will help delineate the specific similarities and differences among the manual therapies., Competing Interests: Author Disclosure Statement No competing financial interests exist.

Objectives: Immigrant workers frequently take jobs that are physically demanding, provide low wages, and result in injuries (e.g., poultry production and processing). Through a qualitative approach, this paper elicits poultry workers' evaluations of their jobs and set them in the larger context of their lives., Methods: Semi-structured interviews were conducted with 65 poultry workers in western North Carolina. Workers were asked to discuss job characteristics, physical and psychological impacts of their employment, and perceived health risks., Results: Immigrant workers valued the stability, benefits, upward mobility, and pay offered. They disliked the physical demands, the potential perceived effects of the job on their health, and the interactions with bosses and peers., Conclusions: Workers' willingness to endure dirty, dangerous, and demanding (3-D) conditions of poultry must be understood in the context of other employment options, structural violence, and their focus on immediate family needs that positive aspects of these jobs can fulfill. Am. J. Ind. Med. 59:877-886, 2016. © 2016 Wiley Periodicals, Inc., Competing Interests: None of the authors have conflicts of interest to disclose., (© 2016 Wiley Periodicals, Inc.)

Introduction: The association between musculoskeletal injuries and carpal tunnel syndrome (CTS) has not been investigated in a large, population-based study., Methods: Latino manual laborers were recruited as part of a study of work-related health conditions. Each had a clinical examination, completed a hand diagram, and had nerve conduction studies., Results: A total of 512 individuals completed all testing. An association was found between rotator cuff syndrome and CTS, with an adjusted odds ratio of 2.25 (P = 0.01) for the right arm, 2.08 (P = 0.03) for the left arm, and 1.84 (P = 0.03) for all individuals. Associations between epicondylitis and CTS did not reach statistical significance., Conclusions: Individuals with rotator cuff syndrome have a higher prevalence of CTS. Further investigations will be needed to examine for causation and to determine if 1 condition typically occurs first and leads to the other. Muscle Nerve 54: 31-35, 2016., (© 2015 Wiley Periodicals, Inc.)

This paper evaluates the variability in the prevalence of epicondylitis, rotator cuff syndrome, low back pain, and lower extremity pathology among immigrant Latino farmworkers and non-farmworkers. Data were collected from a study among 272 farmworkers and non-farmworkers. Participants were recruited in eastern and central North Carolina. A physical examination was conducted by trained physicians. Prevalence of musculoskeletal disorders (MSDs) among Latino manual workers is high compared with other workers in similar occupations. Non-farmworkers (49%) had a higher prevalence of MSDs than farmworkers (35%). Epicondylitis (20.2%) and rotator cuff syndrome (19.1%) were most prevalent. Age was found to be significant among those who had epicondylitis (adjusted odds ratio [AOR] = 1.04) and lower extremity pathology (AOR = 1.07). Latino immigrant manual workers have high prevalence of MSDs. Further studies are needed to identify possible factors that make these populations more vulnerable to MSDs.

This analysis uses a longitudinal design to examine the associations of work organization and health outcomes among Latino manual workers. Participants included 247 Latino workers who completed baseline and 1-year follow-up interviews and clinical examinations. Health outcome measures were epicondylitis, rotator cuff syndrome, back pain, and depressive symptoms. Independent measures were measures of job demand, job control, and job support. Workers commonly experienced rotator cuff syndrome (6.5%), back pain (8.9%), and depressive symptoms (11.2%); fewer experienced epicondylitis (2.4%). Psychological demand was associated with rotator cuff syndrome; awkward position and decision latitude were associated with back pain. Decreased skill variety but increased decision latitude was associated with elevated depressive symptoms. Work context factors are important for health outcomes among vulnerable workers. Further research is needed to expand upon this work, particularly cultural perspectives on job support.

This analysis examines the associations of housing conditions with mental health among migrant farmworkers. Data are from a 2010 cross-sectional study conducted in 16 North Carolina counties. Interviews and housing inspections were completed with 371 farmworkers in 186 camps. Mental health measures included depression (Center for Epidemiologic Studies Depression Scale, CES-D), anxiety (Personality Assessment Inventory, PAI), and alcohol misuse (Alcohol Use Disorders Identification Test, AUDIT-C). Housing measures were number of people per sleeping room, perceived security of self and belongings, having a key to dwelling's door, having bedroom storage, toilet privacy issues, and number of housing regulation violations. Sixty (16.7%) participants had substantial depressive symptoms (CES-D ≥10), 31 (8.8%) had substantial anxiety (PAI ≥27), and 185 (50.1%) had the potential for alcohol misuse (AUDIT-C ≥4). Those with 5+ persons sleeping per room were more likely to have a depression score ≥10 (31.5% vs. 13-14%, P = .01) and an anxiety scores ≥27 (19.6% vs. 5-9%, P = .02). Those who did not feel they or their belongings were secure were more likely to have a depression score ≥10 (19.4% vs. 9.1%, P = .01). Those without a key were more likely to have an anxiety score ≥27 (11.5% vs. 5.1%, P = .04). Those with no bedroom storage were more likely to have a depression score ≥10 (28.9% vs. 14.9%, P = .03). This article suggests links between poor housing and farmworkers' mental health. These results inform regulations surrounding farmworker housing and inform health care providers on how to prevent and treat poor mental health among migrant farmworkers.

Farmworkers in the United States experience high rates of injury and illness but have limited access to conventional health care. Farmworkers are often from countries that have active traditional healers, so understanding the use of traditional healers among farmworkers is important. This pilot study (1) describes the use of traditional healers among farmworkers and (2) compares the use of traditional healers by farmworkers with other Latino immigrants. Interviews were conducted in 2015 with 100 Mexican farmworkers (80 men, 20 women) and 100 Mexican immigrant non-farmworkers (50 men, 50 women) in North Carolina. Most farmworkers (78%) had H-2A visas. More farmworkers (64%) than non-farmworkers (41%) had ever used traditional healers. Among farmworkers, 21% (vs. 11% of non-farmworkers) had used curanderos, 54% (vs. 32%) sobadores, 43% (vs. 21%) hueseros, 11% (vs. 13%) yerberos, and 4% (vs. 6%) espiritualistas. More farmworkers had used a traditional healer in the past year (16% vs. 8%), but fewer had used this healer in the United States (4% vs. 8%). Among all participants, males (58.5%) more than females (41.4%) (P = .0214), and returning to Mexico annually (64.1%) more than who do not (45.1%) (P = .0086) had ever used any traditional healer. This pilot study indicates the need for further research that documents the use of traditional healers by Latino farmworkers with diverse visa statuses, from countries in addition to Mexico, and in other regions in the United States. This research should also delineate the specific illnesses and injuries for which Latino farmworkers use traditional healers.

The nature of poultry processing puts workers at risk for developing neurological injuries, particularly carpal tunnel syndrome (CTS). Many poultry processing workers are Latino immigrants. This qualitative analysis uses an explanatory models of illness (EMs) framework to describe immigrant Latino poultry processing workers' (Guatemalan and Mexican) beliefs of CTS. Understanding these workers' CTS EMs provides a foundation for recommendations to reduce the risk factors for this occupational injury. In-depth interviews were completed with 15 poultry processing workers diagnosed with CTS. Systematic qualitative analysis was used to delineate beliefs about causes, symptoms, physiology, treatments, quality-of-life and health implications of CTS. Participants' EMs largely reflect current biomedical understanding of CTS. These EMs are similar for Guatemalan and Mexican workers. Beliefs about causes include factors in the work environment (e.g., repetition, cold) and individual physical weakness. Treatments include over-the-counter medicine, as well as traditional remedies. Most know the future impact of CTS will include chronic pain. These workers know what causes CTS and that curing it would require quitting their jobs, but feel that they must endure CTS to support their families. Latino poultry processing workers, whether Guatemalan or Mexican, have a fairly complete understanding of what causes CTS, how to treat it, and what they must do to cure it. However, situational factors force them to endure CTS. Policy changes are needed to change the structure of work in poultry processing, particularly line speed and break frequency, if the prevalence of CTS is to be reduced.

Background: This analysis describes work safety climate, personal protective equipment (PPE) use, and injuries among Latino residential roofers, and examines the associations of work safety climate with PPE use and injuries., Methods: Eighty-nine North Carolina residential roofers completed a baseline interview and daily logs about perceptions and use of PPE, occurrence of injuries in last 12 months, and work safety climate., Results: The mean work safety climate score was 26.5 (SD = 5.6). In the baseline interview, participants reported that the majority of employers provided PPE and that they used it most or all of the time; daily log data indicated that PPE was used for half or fewer of hours worked. 39.9% reported any injury in the last 12 months. Work safety climate was significantly correlated with the provision and use of most types of PPE, and was inversely associated with injury., Conclusions: Supervisors promoting safety may increase the PPE use and decrease injuries., (© 2014 Wiley Periodicals, Inc.)

This analysis was conducted to evaluate the prevalence of airway obstruction among Latino poultry processing workers. Data were collected from 279 poultry processing workers and 222 other manual laborers via spirometry and interviewer-administered questionnaires. Participants employed in poultry processing reported the activities they perform at work. Participants with forced expiratory volume in 1 second (FEV1) or FEV1/forced expiratory volume (FVC) below the lower limits of normal were categorized as having airway obstruction. Airway obstruction was identified in 13% of poultry processing workers and 12% of the comparison population. Among poultry processing workers, the highest prevalence of airway obstruction (21%) occurred among workers deboning chickens (prevalence ratio: 1.75; 95% confidence interval: 0.97, 3.15). These findings identify variations in the prevalence of airway obstruction across categories of work activities.

Objectives: We sought to describe work organization attributes for employed immigrant Latinas and determine associations of work organization with physical health, mental health, and health-related quality of life., Methods: We conducted a cross-sectional survey with 319 employed Latinas in western North Carolina (2009-2011). Measures included job demands (heavy load, awkward posture, psychological demand), decision latitude (skill variety, job control), support (supervisor control, safety climate), musculoskeletal symptoms, mental health (depressive symptoms), and mental (MCS) and physical component score (PCS) health-related quality of life., Results: Three fifths reported musculoskeletal symptoms. Mean scores for depression, MCS, and PCS were 6.2 (SE = 0.2), 38.3 (SE = 0.5), and 42.8 (SE = 0.3), respectively. Greater job demands (heavy load, awkward posture, greater psychological demand) were associated with more musculoskeletal and depressive symptoms and worse MCS. Less decision latitude (lower skill variety, job control) was associated with more musculoskeletal and depressive symptoms. Greater support (supervisor's power and safety climate) was associated with fewer depressive symptoms and better MCS., Conclusions: Work organization should be considered to improve occupational health of vulnerable women workers. Additional research should delineate the links between work organization and health among vulnerable workers.

Immigrant Latinos frequently experience social isolation in their receiving communities. This paper investigates the prevalence of social isolation among immigrant workers in a new settlement area and delineates the association between social isolation and physical and mental health outcomes. Interviews were conducted in Spanish with immigrant Latino manual workers (N = 743) in western North Carolina. The CES-D and the SF-12 questionnaires assessed health outcomes. A social isolation scale was used to assess degree of social isolation. Nearly 1 in 5 workers (19.5 %) reported the highest level of social isolation. Social isolation was associated with higher depressive symptoms and poorer physical and mental health, related to quality of life. Social isolation is a common experience among immigrant Latinos that may have negative implications for physical and mental health. Community outreach efforts to minimize experiences of isolation may be useful in protecting immigrant physical and mental health.

Introduction: The aim of this study was to determine whether there is an association between flexor digitorum and lumbrical muscle intrusion into the carpal tunnel and carpal tunnel syndrome (CTS)., Methods: Five hundred thirteen manual laborers (1026 wrists) were evaluated with ultrasound to determine whether those with CTS had more muscle intrusion into the carpal tunnel than those without CTS. One hundred ninety of the participants without CTS at baseline (363 wrists) were followed over 1 year to determine whether muscle intrusion at baseline predicted the development of CTS., Results: Participants with CTS had more muscle within the carpal tunnel with the wrist in the neutral (P=0.026) and flexed (P=0.018) positions than those without CTS. Baseline muscle intrusion did not predict development of CTS at 1 year., Conclusions: Muscle intrusion into the carpal tunnel is associated with CTS, but muscle intrusion alone does not predict the development of CTS over the course of a year., (© 2014 Wiley Periodicals, Inc.)

Objectives: Latino immigrant workers experience elevated rates of skin disease that result from their working and living conditions. Working in manual occupations exposes workers to a variety of challenges, including occlusive shoes, vigorous physical activity, and wet conditions. These challenges predispose workers to fungal infection. The objectives of this article are to examine the comorbidity of tinea pedis and onychomycosis and to identify possible risk factors among Latino immigrant poultry and nonpoultry workers in western North Carolina., Methods: Data were obtained from a cross-sectional study conducted between June 2009 and November 2010 in rural western North Carolina among 518 manual Latino immigrant workers to assess their occupational injuries. Participants completed a face-to-face interview and a dermatologic examination., Results: Nearly one-third of the participants (32%) were diagnosed as having onychomycosis and more than one-third (37.8%) were diagnosed as having tinea pedis. There was a greater prevalence of tinea pedis in men than women (71.3% vs 28.7%, respectively). Of the 518 participants, 121 (23.5%) had both conditions. Participants who reported the use of occlusive shoes as "always" or "most of the time" had a higher prevalence of comorbid onychomycosis and tinea pedis than the rest of the group., Conclusions: Comorbidity of tinea pedis and onychomycosis is common among immigrant Latino men and women who perform manual labor. Further studies confirming the presence and type of dermatophyte should be conducted.

Background: Manual labor employment occurs in environments with exposures likely to impact skin-related quality of life (SRQOL)., Objectives: The objectives of this paper are to (1) document the dimensions of SRQOL, (2) examine its association with skin symptoms, and (3) identify the predictors of SRQOL in Latino manual workers., Methods: A population-based survey of 733 Latino manual workers obtained Dermatology Life Quality Index (DLQI) and skin symptoms in the prior year., Results: Two-thirds of workers were employed in production. Skin symptoms in prior year were reported by 23%. Impaired SRQOL was reported by 23%. In multivariate analyses, reduced SRQOL was associated with age, occupation, childhood indigenous language use, and experience of skin symptoms in the prior year., Conclusions: Despite overall high SRQOL exposures in some immigrant occupational groups produce reduce SRQOL. This rural, immigrant population faces significant obstacles to obtaining dermatological care; efforts are needed to improve their SRQOL., (© 2013 Wiley Periodicals, Inc.)

Background: This analysis examines the associations of work organization attributes among Latino women in manual occupations with musculoskeletal and neurological injuries., Methods: Participants included 234 women in western North Carolina. Outcome measures included epicondylitis, rotator cuff syndrome, back pain, and carpal tunnel syndrome. Independent measures included indicators of job demand, job control, and job support, as well as personal characteristics., Results: Latina workers commonly experienced epicondylitis, rotator cuff syndrome, back pain, and CTS. Awkward posture and decision latitude were associated with epicondylitis. Rotator cuff syndrome was associated with awkward posture and psychological demand. Awkward posture and psychological demand, and decreased skill variety and job control were related to CTS., Conclusions: Work organization factors are potentially important for musculoskeletal and neurological injury among vulnerable workers. Research is required to understand the associations of work and health outcomes of these women. Policy initiatives need to consider how work organization affects health., (© 2014 Wiley Periodicals, Inc.)

Objective: To determine the incidence of carpal tunnel syndrome (CTS) over 1 year in Latino poultry processing workers., Methods: Symptoms and nerve conduction studies were used to identify Latino poultry processing workers (106 wrists) and Latinos in other manual labor occupations (257 wrists) that did not have CTS at baseline, and these individuals were then evaluated in the same manner 1 year later., Results: Based on wrists, the 1-year incidence of CTS was higher in poultry processing workers than non-poultry manual workers (19.8% vs. 11.7%, P = 0.022). Poultry workers had a higher odds (1.89; P = 0.089) of developing CTS over 1 year compared to non-poultry manual workers., Discussion: Latino poultry processing workers have an incidence of CTS that is possibly higher than Latinos in other manual labor positions. Latino poultry workers' high absolute and relative risk of CTS likely results from the repetitive and strenuous nature of poultry processing work., (© 2013 Wiley Periodicals, Inc.)

Between-employer differences in working conditions may lead to variable injury rates. The objective of this paper is to assess the difference in the prevalence of epicondylitis, rotator cuff syndrome, and low back pain among immigrant Latino poultry workers at plants of three different employers. Data were collected from a cross-sectional study among 286 poultry processing workers. Community-based sampling was used to recruit participants in western North Carolina. Rotator cuff syndrome (26.7%) and low back pain (27.9%) were more prevalent among employees of one specific employer. Multivariate analysis showed significant associations of low back pain and rotator cuff syndrome with age, task performed in the processing line, and employer. Employer is a major predictor of musculoskeletal disorders and pain. Line speed and work pace may account for these differences and provide an opportunity for regulation and intervention to protect the health of workers.

Background: Immigrant Latino workers represent an expanding workforce in rural areas of the USA, where their employment is concentrated in occupations such as poultry processing that entail chemical, infectious, and mechanical skin exposures. Occupation-related skin illnesses in this vulnerable population are not well characterized., Objectives: This study was designed to describe the prevalences of skin diseases among immigrant Latino poultry processors and other manual workers in North Carolina., Methods: Community-based sampling was used to recruit 742 immigrant Latino workers, 518 of whom underwent a physical examination supervised by a board-certified dermatologist. The presence or absence of skin disease on the face, neck, arms, hands, and feet was recorded., Results: Workers ranged in age from 18 years to 68 years. Slightly over half of the sample were male (52.6%). Poultry workers represented 55.8% of the study sample. Infectious skin diseases were the most common diagnosis, present in 52.3% of workers. Inflammatory skin diseases were present in 28.2% and pigmentary disorders in 21.8% of workers. The most common skin conditions were tinea pedis (37.6%), onychomycosis (31.9%), scars (13.7%), acne (11.8%), and melasma (9.3%). Age, sex, first language, and work as a poultry processor accounted in part for the prevalence of these diseases., Conclusions: Several skin diseases are highly prevalent in immigrant Latino workers and may relate to work environment. These may impair the quality of life of these workers and predispose them to further illness., (© 2013 The International Society of Dermatology.)