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Méndez-Rivero F, Matilla-Santander N, Gunn V, Wegman DH, Hernando-Rodriguez JC, Kvart S, Julià M, Kreshpaj B, Bodin T, Hemmingsson T, Muntaner C, Padrosa E, Almroth M. Can psychosocial risk factors mediate the association between precarious employment and mental health problems in Sweden? Results from a register-based study. Scand J Work Environ Health 2024; 50:268-278. [PMID: 38522097 DOI: 10.5271/sjweh.4151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVES The aim of this study was to examine the mediating effect of the psychosocial work environment on the association between precarious employment (PE) and increased risk of common mental disorders (CMD), substance use disorders and suicide attempts. METHODS This longitudinal register-study was based on the working population of Sweden, aged 25-60 years in 2005 (N=2 552 589). Mediation analyses based on a decomposition of counterfactual effects were used to estimate the indirect effect of psychosocial risk factors (PRF) (mediators, measured in 2005) on the association between PE (exposure, measured in 2005) and the first diagnosis of CMD, substance use disorders, and suicide attempts occurring over 2006-2017. RESULTS The decomposition of effects showed that the indirect effect of the PRF is practically null for the three outcomes considered, among both sexes. PE increased the odds of being diagnosed with CMD, substance use disorders, and suicide attempts, among both men and women. After adjusting for PE, low job control increased the odds of all three outcomes among both sexes, while high job demands decreased the odds of CMD among women. High job strain increased the odds of CMD and suicide attempts among men, while passive job increased the odds of all three outcomes among women. CONCLUSION The results of this study did not provide evidence for the hypothesis that psychosocial risks could be the pathways linking precarious employment with workers` mental health. Future studies in different social contexts and labour markets are needed.
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Affiliation(s)
- Fabrizio Méndez-Rivero
- GREDS (Research Group on Health Inequalities, Environment, and Employment Conditions Network), Universitat Pompeu Fabra, 25-27 Ramon Trias Fargas Street, Ciutadella Campus, Mercè Rodoreda Building, 08005 Barcelona, Spain. [E-mail: ]
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Hansson E, Jakobsson K, Glaser J, Wesseling C, Chavarria D, Lucas RAI, Prince H, Wegman DH. Impact of heat and a rest-shade-hydration intervention program on productivity of piece-paid industrial agricultural workers at risk of chronic kidney disease of nontraditional origin. Ann Work Expo Health 2024; 68:366-375. [PMID: 38367206 PMCID: PMC11033565 DOI: 10.1093/annweh/wxae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVES Assess the impact of environmental heat and a rest-shade-hydration (RSH) intervention against heat stress on productivity of piece-paid Mesoamerican sugarcane cutters. These workers are at a high risk of chronic kidney disease of non-traditional origin (CKDnt), from the severe heat stress they experience due to heavy work under hot conditions. RSH interventions in these populations improve kidney health outcomes, but their impact on productivity has yet to be examined. METHODS We accessed routine productivity data from seed (SC, N = 749) and burned (BCC, N = 535) sugarcane cutters observed over five harvest seasons with increasing RSH intervention at a large Nicaraguan sugarcane mill. Hourly field-site wet-bulb globe temperature (WBGT) was recorded by mill staff and summarized as a daily mean. Mixed linear regression was used to model daily productivity, adjusting for age (18-29, 30-44, and >45 years), sex, WBGT (<28, 28-29, 29-30, 30-31, and >31 °C) on the same and preceding day, harvest season (2017-18 to 2021-22), month, and acclimatization status (<1, 1-2, and >2 weeks). RESULTS There was an inverse dose-response relationship between SC productivity and WBGT on the same and preceding days, decreasing by approximately 3%/°C WBGT. Productivity increased during the study period, i.e. coinciding with RSH scale-up, by approximately 19% in SC and 9% in BCC. CONCLUSION Agricultural worker productivity was expected lower on hotter days, strengthening the interest in all stakeholders to mitigate increasing global temperatures and their impact. Despite decreasing the total time allocated for work each day, an RSH intervention appears to result in increased productivity and no apparent loss in productivity.
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Affiliation(s)
- Erik Hansson
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 413 90 Gothenburg, Sweden
| | - Kristina Jakobsson
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 413 90 Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, 413 90 Gothenburg, Sweden
| | - Jason Glaser
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
| | - Catharina Wesseling
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Box 210, 171 77 Stockholm, Sweden
| | - Denis Chavarria
- Occupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Km. 119 Carretera León-Chinandega, Chichigalpa, Nicaragua
| | - Rebekah A I Lucas
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Heath Prince
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- LBJ School of Public Affairs, University of Texas at Austin, 2315 Red River St, Austin, TX 78712,United States
| | - David H Wegman
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- University of Massachusetts Lowell, 1 University Avenue, Lowell, 01854 MA, United States
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Hansson E, Jakobsson K, Glaser JR, Wesseling C, Chavarría D, Lucas RAI, Wegman DH. Association Between Acute Kidney Injury Hospital Visits and Environmental Heat Stress at a Nicaraguan Sugarcane Plantation. Workplace Health Saf 2024; 72:131-142. [PMID: 38591368 PMCID: PMC11055406 DOI: 10.1177/21650799241235410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Mesoamerican sugarcane cutters are at a high risk of chronic kidney disease of non-traditional origin, a disease likely linked to heat-related acute kidney injury (AKI). Studies in general populations have described a positive association between high environmental temperatures and clinically assessed kidney outcomes, but there are no studies in occupational settings. METHOD We accessed routine records of clinically diagnosed AKI (AKI-CD) and wet bulb globe temperatures (WBGT) at a large Nicaraguan sugarcane plantation and modeled the relationship between these using negative binomial regression. A rest-shade-hydration intervention was gradually enhanced during the study period, and efforts were made to increase the referral of workers with suspected AKI to healthcare. RESULTS Each 1°C WBGT was associated with an 18% (95% confidence interval [CI]: [4, 33%]) higher AKI-CD rate on the same day and a 14% (95% CI [-5, 37%]) higher rate over a week. AKI-CD rates and severity, and time between symptoms onset and diagnosis decreased during the study period, that is, with increasing rest-shade-hydration intervention. Symptoms and biochemical signs of systemic inflammation were common among AKI-CD cases. DISCUSSION Occupational heat stress, resulting from heavy work in environmental heat, was associated with a higher rate of clinically diagnosed AKI in a population at risk of CKDnt. Promoting rest-shade-hydration may have contributed to reducing AKI rates during the study period. Occupational health and safety personnel have key roles to play in enforcing rest, shade, and hydration practices, referring workers with suspected AKI to healthcare as well as collecting and analyzing the data needed to support workplace heat stress interventions.
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Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, District of Columbia, USA
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Jakobsson
- La Isla Network, Washington, District of Columbia, USA
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Catharina Wesseling
- La Isla Network, Washington, District of Columbia, USA
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Denis Chavarría
- Occupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Chichigalpa, Nicaragua
| | - Rebekah A. I. Lucas
- La Isla Network, Washington, District of Columbia, USA
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - David H. Wegman
- La Isla Network, Washington, District of Columbia, USA
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Matilla-Santander N, Matthews AA, Gunn V, Muntaner C, Kreshpaj B, Wegman DH, Sánchez-Martínez N, Hernando-Rodriguez JC, Albin M, Balogh R, Davis L, Bodin T. Causal effect of shifting from precarious to standard employment on all-cause mortality in Sweden: an emulation of a target trial. J Epidemiol Community Health 2023; 77:736-743. [PMID: 37620008 PMCID: PMC10579471 DOI: 10.1136/jech-2023-220734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND We aimed at estimating the causal effect of switching from precarious to standard employment on the 6-year and 12-year risk of all-cause mortality among workers aged 20-55 years in Sweden. METHODS We emulated a series of 12 target trials starting every year between 2005 and 2016 using Swedish register data (n=251 273). We classified precariously employed individuals using a multidimensional approach at baseline as (1) remaining in precarious employment (PE) (73.8%) and (2) shifting to standard employment (26.2%). All-cause mortality was measured from 2006 to 2017. We pooled data for all 12 emulated trials and used covariate-adjusted pooled logistic regression to estimate intention-to-treat and per-protocol effects via risk ratios (RRs) and standardised risk curves (the parametric g-formula). RESULTS Shifting from precarious to standard employment decreases the 12-year risk of death by 20% on the relative scale (RR: 0.82, 95% CI: 0.73; 0.93), regardless of what happens after the initial shift. However, we estimated a 12-year risk reduction of 30% on the relative scale for workers shifting from precarious to standard employment and staying within this employment category for the full 12 years (RR: 0.71, 95% CI: 0.54; 0.95). CONCLUSIONS This study finds that shifting from low to higher-quality employment conditions (ie, stable employment, sufficient income levels and high coverage by collective agreements) decreases the risk of death. Remaining in PE increases the risk of premature mortality. Our results emphasise the necessity of ensuring decent work for the entire working population to accomplish the 2030 Agenda for Sustainable Development.
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Affiliation(s)
| | - Anthony A Matthews
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Virginia Gunn
- Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- School of Nursing, Cape Breton University, Sydney, New South Wales, Canada
| | - Carles Muntaner
- Bllomberg Faculty of Nursing, Division of Social and Behavioural Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Bertina Kreshpaj
- Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - David H Wegman
- Public Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Néstor Sánchez-Martínez
- Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
- Public Health, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Maria Albin
- Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - Rebeka Balogh
- Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
- Institute for Employment Research, University of Warwick, Coventry, UK
| | | | - Theo Bodin
- Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
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Alahmad B, Al-Hemoud A, Al-Bouwarthan M, Khraishah H, Kamel M, Akrouf Q, Wegman DH, Bernstein AS, Koutrakis P. Extreme heat and work injuries in Kuwait's hot summers. Occup Environ Med 2023; 80:347-352. [PMID: 37068948 DOI: 10.1136/oemed-2022-108697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/27/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Hot, 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. METHODS We 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. RESULTS During 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). CONCLUSION We 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.
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Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, Kuwait City, Kuwait
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ali Al-Hemoud
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Safat, Kuwait
| | - Mohammed Al-Bouwarthan
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mohamed Kamel
- Occupational Health Administration, Ministry of Health, Kuwait City, Kuwait
| | - Qassem Akrouf
- Occupational Health Administration, Ministry of Health, Kuwait City, Kuwait
| | - David H Wegman
- Environmental Health Department, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
- La Isla Network, District of Columbia, Washington, DC, USA
| | - Aaron S Bernstein
- Center for Climate, Health and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard University, Cambridge, Massachusetts, USA
| | - Petros Koutrakis
- Environmental Health Department, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Kreshpaj B, Wegman DH, Burstrom B, Davis L, Hemmingsson T, Håkansta C, Jonsson J, Johansson G, Kjellberg K, Sanchez Martinez N, Matilla-Santander N, Orellana C, Bodin T. Precarious employment and occupational injuries in Sweden between 2006 and 2014: a register-based study. Occup Environ Med 2023; 80:179-185. [PMID: 36585247 PMCID: PMC10086457 DOI: 10.1136/oemed-2022-108604] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Precarious 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 risk OBJECTIVE: To investigate if PE is a risk factor for OIs in Sweden. METHODS This 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. RESULTS Precarious workers were at lower risk of OIs as compared with non-precarious workers among both males and females (OR <1) also when applying weights for under-reporting and adjusting for time at risk (part-time work). Male agencies workers had a higher risk of OIs (OR 1.19, 95% CI 1.15 to 1.23), as did male and female workers in multiple jobs/sectors (OR 1.25, 95% CI 1.23 to 1.28 and OR 1.10, 95% CI 1.07 to 1.13 respectively), and female workers in the low-income groups (OR 1.11, 95% CI 1.09 to 1.12). Low coverage of collective bargaining agreements was associated with a lower risk of OIs for both men and women (OR 0.30, 95% CI 0.29 to 0.31 and OR 0.26, 95% CI 0.24 to 0.27, respectively). CONCLUSIONS While 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.
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Affiliation(s)
- Bertina Kreshpaj
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden .,Section of Epidemiology, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - David H Wegman
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Bo Burstrom
- Department of Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Letitia Davis
- Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Tomas Hemmingsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carin Håkansta
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Working Life Science, Karlstad University, Karlstad, Sweden
| | - Johanna Jonsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gun Johansson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Stockholms Lans Landsting, Stockholm, Sweden
| | - Katarina Kjellberg
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Stockholms Lans Landsting, Stockholm, Sweden
| | - Nestor Sanchez Martinez
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nuria Matilla-Santander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Orellana
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Stockholms Lans Landsting, Stockholm, Sweden
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Smyth B, Glaser J, Butler-Dawson J, Nanayakkara N, Wegman DH, Anand S, Levin A, Correa Rotter R, Eckardt KU, Fire A, Friedman D, Herath C, Jha V, Wijewickrama E, Yang CW, Bajpai D, Pippias M, Ulasi I, Nangaku M. Challenges and opportunities in interventions for chronic kidney disease of unknown origin (CKDu): report from the International Society of Nephrology Consortium of Collaborators on CKDu. Kidney Int 2023; 103:6-12. [PMID: 36603985 DOI: 10.1016/j.kint.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Brendan Smyth
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia; Department of Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia
| | - Jason Glaser
- La Isla Network, Washington, District of Columbia, USA
| | - Jaime Butler-Dawson
- Center for Health, Work, and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - David H Wegman
- La Isla Network, Washington, District of Columbia, USA; Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, California, USA.
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Lucas RAI, Skinner BD, Arias-Monge E, Jakobsson K, Wesseling C, Weiss I, Poveda S, Cerda-Granados FI, Glaser J, Hansson E, Wegman DH. Targeting workload to ameliorate risk of heat stress in industrial sugarcane workers. Scand J Work Environ Health 2023; 49:43-52. [PMID: 36209512 PMCID: PMC10549916 DOI: 10.5271/sjweh.4057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of this study was to quantify the physiological workload of manual laborers in industrial sugarcane and assess the effect of receiving a rest, shade, and hydration intervention to reduce heat stress exposure risk. METHODS In an observational study, physiological workload was evaluated for burned cane cutters (BCC), seed cutters (SC) and drip irrigation repair workers (DIRW) using heart rate (HR) recorded continuously (Polar®) across a work shift. Workers' percentage of maximal HR (%HRmax), time spent in different HR zones, and estimated core temperature (ECTemp) were calculated. The effect of increasing rest across two harvests was evaluated for BCC and SC. RESULTS A total of 162 workers participated in this study [52 BCC (all male), 71 SC (13 female) and 39 DIRW (16 female)]. Average %HRmax across a work shift was similar between BCC and SC (BCC: 58%, SC: 59%), but lower in DIRW (51%). BCC and SC spent similar proportions of work shifts at hard/very hard intensities (BCC: 13%, SC: 15%), versus DIRW who worked mostly at light (46%) or light-moderate (39%) intensities. SC maximum ECTemp reached 38.2°C, BCC 38.1°C; while DIRW only reached 37.7°C. Females performed at a higher %HRmax than males across work shifts (SC 64% versus 58%; DIRW 55% versus 49%). An additional rest period was associated with a lower average %HRmax across a work shift in BCC. CONCLUSION In this setting, BCC and SC both undertake very physiologically demanding work. Females maintained a higher workload than male co-workers. Regulated rest periods each hour, with water and shade access, appears to reduce physiological workload/strain.
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Affiliation(s)
- Rebekah A I Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
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Matilla-Santander N, Matthews AA, Gunn V, Muntaner C, Kreshpaj B, Wegman DH, Jonsson J, Bodin T, Consortium PPWR. The causal effect of switching from precarious to standard employment on mortality in Sweden. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Precarious employment (PE) is a well-known social determinant of health and health inequalities, yet the effect of PE on mortality has not been explored sufficiently and high-quality longitudinal studies are lacking. When studying this effect, several methodological factors must be considered, one of them being the immortal time bias or prevalent user bias. A framework that helps us overcome these biases is the target trial. Therefore, the aim of this study is to estimate the causal effect of switching from precarious to standard employment (SE) on the 12-year risk of all-cause mortality among precariously employed workers aged 20-55 in Sweden.
Methods
We emulated the target trial as a series of 11 target trials (starting at any year between 2005 and 2016), such that each individual may participate in multiple trials using Swedish register data (N = 251274). We classified individuals as: a) workers that at baseline (start) move from PE to SE and then followed while in SE or b) continuation of PE over follow-up. All-cause mortality was measured from 2006 to 2017. We pooled data for all 11 emulated trials and used pooled logistic regression to estimate intention-to-treat effects via hazard ratios and standardized survival curves.
Results
The following results are preliminary. Individuals that continued on PE were 185,480 and those that initiated SE were 65,794. Over the 12-year follow-up, 1553 individuals died. The estimated observational analogue of the intention-to-treat 12-year survival difference for all cause-mortality between workers that continued on PE and those that initiated SE was of -0.2%, and the HR:0.82, 95%CI:0.72-0.94.
Conclusions
The following conclusions are preliminary. According to our results, we find indication that shifting from PE to SE decreased the risk of death. Our study highlights the crucial role of decent employment conditions for health.
Key messages
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Affiliation(s)
| | - AA Matthews
- Unit of Epidemiology, Karolinska Institutet , Stockholm, Sweden
| | - V Gunn
- Unit of Occupational Medicine, Karolinska Institutet , Stockholm, Sweden
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute , Toronto, Canada
| | - C Muntaner
- Division of Social and Behavioral Sciences, University of Toronto , Toronto, Canada
| | - B Kreshpaj
- Unit of Occupational Medicine, Karolinska Institutet , Stockholm, Sweden
| | - DH Wegman
- University of Massachusetts Lowell , Lowell, USA
| | - J Jonsson
- Unit of Occupational Medicine, Karolinska Institutet , Stockholm, Sweden
| | - T Bodin
- Unit of Occupational Medicine, Karolinska Institutet , Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm Region , Stockholm, Sweden
| | - PPWR Consortium
- Unit of Occupational Medicine, Karolinska Institutet , Stockholm, Sweden
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Hansson E, Wegman DH, Wesseling C, Glaser J, Schlader ZJ, Wijkström J, Jakobsson K. Markers of kidney tubular and interstitial injury and function among sugarcane workers with cross-harvest serum creatinine elevation. Occup Environ Med 2022; 79:396-402. [PMID: 34972693 PMCID: PMC9120403 DOI: 10.1136/oemed-2021-107989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/08/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Serum 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). METHODS Urine 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). RESULTS Urine MCP-1 (p for differential cross-harvest trend <0.001), KIM-1 (p=0.002), calbindin (p=0.02), GST-π (p=0.04), albumin (p=0.001) and FEK (p<0.001) increased in cases, whereas blood haemoglobin (p<0.001) and serum erythropoietin (p<0.001) decreased. CONCLUSION Several 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.
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Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, DC, USA
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - David H Wegman
- La Isla Network, Washington, DC, USA
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Catharina Wesseling
- La Isla Network, Washington, DC, USA
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Zachary J Schlader
- Department of Kinesiology, Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Jakobsson
- La Isla Network, Washington, DC, USA
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Matilla-Santander N, Muntaner C, Kreshpaj B, Gunn V, Jonsson J, Kokkinen L, Selander J, Baron SL, Orellana C, Östergren PO, Hemmingsson T, Wegman DH, Bodin T. Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study. Lancet Reg Health Eur 2022; 15:100314. [PMID: 35169764 PMCID: PMC8829810 DOI: 10.1016/j.lanepe.2022.100314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke. METHODS This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family. FINDINGS Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women. INTERPRETATION The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time. FUNDING The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.
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Affiliation(s)
- Nuria Matilla-Santander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Corresponding author. Unit of Occupational Medicine, Karolinska Institutet, Solnavägen 4, 113 65 Stockholm.
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing and Division of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bertina Kreshpaj
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Virginia Gunn
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto & MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Johanna Jonsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jenny Selander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sherry L Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York City, USA
| | - Cecilia Orellana
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Tomas Hemmingsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Sweden
| | | | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
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12
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Glaser J, Wegman DH, Arias-Monge E, Pacheco-Zenteno F, Prince H, Chavarria D, Martinez-Cuadra WJ, Jakobsson K, Hansson E, Lucas RAI, Weiss I, Wesseling C. Workplace Intervention for Heat Stress: Essential Elements of Design, Implementation, and Assessment. Int J Environ Res Public Health 2022; 19:ijerph19073779. [PMID: 35409463 PMCID: PMC8998134 DOI: 10.3390/ijerph19073779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Jason Glaser
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- Correspondence: (J.G.); (D.H.W.); Tel.: +1-(347)-585-7465 (J.G.); +1-(617)-921-1506 (D.H.W.)
| | - David H. Wegman
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- University of Massachusetts Lowell, Lowell, MA 01854, USA
- Correspondence: (J.G.); (D.H.W.); Tel.: +1-(347)-585-7465 (J.G.); +1-(617)-921-1506 (D.H.W.)
| | - Esteban Arias-Monge
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- Unidad de Gestión Ambiental y Seguridad Laboral, Instituto Tecnológico de Costa Rica, 15th Street, 14th Avenue, Cartago 159-7050, Costa Rica
| | - Felipe Pacheco-Zenteno
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Göteborg, Sweden;
| | - Heath Prince
- Ray Marshall Center, LBJ School of Public Affairs, University of Texas at Austin, 3001 Lake Austin Blvd., Ste. 3.200, Austin, TX 78703, USA;
| | - Denis Chavarria
- Occupational Health, Ingenio San Antonio, Chinandega 26100, Nicaragua;
| | - William Jose Martinez-Cuadra
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
| | - Kristina Jakobsson
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Göteborg, Sweden;
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, 405 30 Göteborg, Sweden
| | - Erik Hansson
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Göteborg, Sweden;
| | - Rebekah A. I. Lucas
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Ilana Weiss
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
| | - Catharina Wesseling
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, 113 65 Stockholm, Sweden
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13
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Wegman DH, Neupane D, Sharma S, Glaser J. Dying for sport. Occup Environ Med 2021; 79:73-74. [PMID: 34876499 DOI: 10.1136/oemed-2021-107978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/13/2021] [Indexed: 11/04/2022]
Affiliation(s)
- David H Wegman
- University of Massachusetts Lowell, Lowell, Massachusetts, USA .,La Isla Network, Washington, DC, USA
| | - Dinesh Neupane
- La Isla Network, Washington, DC, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shailendra Sharma
- La Isla Network, Washington, DC, USA.,Nephrology, Sparrow Health System, Lansing, Michigan, USA
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14
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Kreshpaj B, Bodin T, Wegman DH, Matilla-Santander N, Burstrom B, Kjellberg K, Davis L, Hemmingsson T, Jonsson J, Håkansta C, Orellana C. Under-reporting of non-fatal occupational injuries among precarious and non-precarious workers in Sweden. Occup Environ Med 2021; 79:3-9. [PMID: 34544894 PMCID: PMC8685629 DOI: 10.1136/oemed-2021-107856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022]
Abstract
Background Under-reporting of occupational injuries (OIs) among precariously employed workers in Sweden challenges effective surveillance of OIs and targeted preventive measures. Objective To estimate the magnitude of under-reporting of OIs among precarious and non-precarious workers in Sweden in 2013. Methods Capture–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. Results Under-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. Conclusions This 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.
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Affiliation(s)
- Bertina Kreshpaj
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Stockholm, Sweden
| | - David H Wegman
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Nuria Matilla-Santander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bo Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Kjellberg
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Stockholm, Sweden
| | | | - Tomas Hemmingsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Johanna Jonsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carin Håkansta
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Working Life Science, Karlstad University, Karlstad, Sweden
| | - Cecilia Orellana
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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15
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Jonsson J, Muntaner C, Bodin T, Alderling M, Rebeka R, Burström B, Davis L, Gunn V, Hemmingsson T, Julià M, Kjellberg K, Kreshpaj B, Orellana C, Padrosa E, Wegman DH, Matilla-Santander N. Low-quality employment trajectories and risk of common mental disorders, substance use disorders and suicide attempt: a longitudinal study of the Swedish workforce. Scand J Work Environ Health 2021; 47:509-520. [PMID: 34397098 PMCID: PMC8504160 DOI: 10.5271/sjweh.3978] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Johanna Jonsson
- Unit of Occupational Medicine, The Institute of Environmental Medicine (IMM), Karolinska Institutet, Solnavägen 4, 113 65, Stockholm, Sweden.
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16
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Gunn V, Håkansta C, Vignola E, Matilla-Santander N, Kreshpaj B, Wegman DH, Hogstedt C, Ahonen EQ, Muntaner C, Baron S, Bodin T. Initiatives addressing precarious employment and its effects on workers' health and well-being: a protocol for a systematic review. Syst Rev 2021; 10:195. [PMID: 34193280 PMCID: PMC8244669 DOI: 10.1186/s13643-021-01728-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Precarious 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. METHODS The 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. DISCUSSION We 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 REGISTRATION PROSPERO CRD42020187544 .
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Affiliation(s)
- Virginia Gunn
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm Region, Sweden.
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
| | - Carin Håkansta
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm Region, Sweden
- Working Life Science, Karlstad University, Karlstad, Sweden
| | - Emilia Vignola
- CUNY Graduate School of Public Health & Health Policy, New York, USA
| | - Nuria Matilla-Santander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm Region, Sweden
| | - Bertina Kreshpaj
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm Region, Sweden
| | | | - Christer Hogstedt
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm Region, Sweden
| | - Emily Q Ahonen
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, USA
| | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm Region, Sweden
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17
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Chapman CL, Hess HW, Lucas RAI, Glaser J, Saran R, Bragg-Gresham J, Wegman DH, Hansson E, Minson CT, Schlader ZJ. Occupational heat exposure and the risk of chronic kidney disease of nontraditional origin in the United States. Am J Physiol Regul Integr Comp Physiol 2021; 321:R141-R151. [PMID: 34161738 DOI: 10.1152/ajpregu.00103.2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
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.
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Affiliation(s)
| | - Hayden W Hess
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Rebekah A I Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jason Glaser
- La Isla Network, Washington, D.C.,Responsible Business Center at Birkbeck, University of London, London, United Kingdom
| | - Rajiv Saran
- Division of Nephrology and the Kidney Epidemiology and Cost Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Bragg-Gresham
- Division of Nephrology and the Kidney Epidemiology and Cost Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David H Wegman
- Department of Epidemiology, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Erik Hansson
- La Isla Network, Washington, D.C.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Zachary J Schlader
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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18
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Orellana C, Kreshpaj B, Burstrom B, Davis L, Frumento P, Hemmingsson T, Johansson G, Kjellberg K, Wegman DH, Bodin T. Organisational factors and under-reporting of occupational injuries in Sweden: a population-based study using capture-recapture methodology. Occup Environ Med 2021; 78:745-752. [PMID: 33790030 PMCID: PMC8458053 DOI: 10.1136/oemed-2020-107257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/13/2021] [Accepted: 02/25/2021] [Indexed: 11/04/2022]
Abstract
Objective To estimate the magnitude of under-reporting of non-fatal occupational injuries (OIs) by different organisational factors in Sweden for the year 2013. Methods Capture–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. Results There 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. Conclusions Results 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.
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Affiliation(s)
- Cecilia Orellana
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bertina Kreshpaj
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bo Burstrom
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | | | - Paolo Frumento
- Department of Political Sciences, Università di Pisa, Pisa, Italy
| | - Tomas Hemmingsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Stockholm, Sweden
| | - Gun Johansson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - Katarina Kjellberg
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - David H Wegman
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
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19
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Al-Bouwarthan M, Quinn MM, Kriebel D, Wegman DH. A Field Evaluation of Construction Workers' Activity, Hydration Status, and Heat Strain in the Extreme Summer Heat of Saudi Arabia. Ann Work Expo Health 2021; 64:522-535. [PMID: 32219304 DOI: 10.1093/annweh/wxaa029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/25/2020] [Accepted: 02/29/2020] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Mohammed Al-Bouwarthan
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Margaret M Quinn
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - David Kriebel
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - David H Wegman
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,La Isla Network, Ada, MI, USA
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20
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Matilla-Santander N, Ahonen E, Albin M, Baron S, Bolíbar M, Bosmans K, Burström B, Cuervo I, Davis L, Gunn V, Håkansta C, Hemmingsson T, Hogstedt C, Jonsson J, Julià M, Kjellberg K, Kreshpaj B, Lewchuk W, Muntaner C, O'Campo P, Orellana C, Östergren PO, Padrosa E, Ruiz ME, Vanroelen C, Vignola E, Vives A, Wegman DH, Bodin T. COVID-19 and Precarious Employment: Consequences of the Evolving Crisis. Int J Health Serv 2021; 51:226-228. [PMID: 33430684 PMCID: PMC8114423 DOI: 10.1177/0020731420986694] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Nuria Matilla-Santander
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden
| | - Emily Ahonen
- Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, 10668Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Maria Albin
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, 2009City University of New York, New York City, USA
| | - Mireia Bolíbar
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Science, 16770Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Kim Bosmans
- Interface Demography, Department of Sociology, 70493Vrije Universiteit Brussel, Brussels, Belgium
| | - Bo Burström
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Sweden
| | - Isabel Cuervo
- Barry Commoner Center for Health and the Environment, Queens College, 2009City University of New York, New York City, USA
| | - Letitia Davis
- Barry Commoner Center for Health and the Environment, Queens College, 2009City University of New York, New York City, USA
| | - Virginia Gunn
- Lawrence S. Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, 70379University of Toronto, Toronto, Canada
| | - Carin Håkansta
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden.,Department of Working Life Science, Karlstad University, Sweden
| | - Tomas Hemmingsson
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Sweden
| | - Christer Hogstedt
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden
| | - Johanna Jonsson
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden
| | - Mireia Julià
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Science, 16770Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Katarina Kjellberg
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden
| | - Bertina Kreshpaj
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden
| | - Wayne Lewchuk
- School of Labour Studies, McMaster University, Hamilton, Ontario, Canada
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, 70379University of Toronto, Toronto, Canada
| | - Patricia O'Campo
- Lawrence S. Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, 70379University of Toronto, Toronto, Canada
| | - Cecilia Orellana
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, 5193Lund University, Sweden
| | - Eva Padrosa
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Science, 16770Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Marisol E Ruiz
- Department of Public Health, 28033Pontificia Universidad Católica de Chile, Santiago de Chile
| | - Christophe Vanroelen
- Interface Demography, Department of Sociology, 70493Vrije Universiteit Brussel, Brussels, Belgium
| | - Emilia Vignola
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, USA
| | - Alejandra Vives
- Department of Public Health, Pontificia Universidad Católica de Chile, CEDEUS, Santiago de Chile
| | | | - Theo Bodin
- Unit of Occupational Medicine, The Institute of Environmental Medicine, 27106Karolinska Institutet, Stockholm, Sweden
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21
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Hansson E, Glaser J, Jakobsson K, Weiss I, Wesseling C, Lucas RAI, Wei JLK, Ekström U, Wijkström J, Bodin T, Johnson RJ, Wegman DH. Pathophysiological Mechanisms by which Heat Stress Potentially Induces Kidney Inflammation and Chronic Kidney Disease in Sugarcane Workers. Nutrients 2020; 12:E1639. [PMID: 32498242 PMCID: PMC7352879 DOI: 10.3390/nu12061639] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. METHODS Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from >800 sugarcane cutters followed across harvest and review the CKDnt literature to assess empirical support of the theoretical framework. RESULTS Inflammation (CRP elevation and fever) and hyperuricemia was tightly linked to kidney injury. Rehydrating with sugary liquids and NSAID intake increased the risk of kidney injury, whereas electrolyte solution consumption was protective. Hypokalemia and hypomagnesemia were associated with kidney injury. DISCUSSION Heat stress, muscle injury, reduced renal blood flow and fructose metabolism may induce kidney inflammation, the successful resolution of which may be impaired by daily repeating pro-inflammatory triggers. We outline further descriptive, experimental and intervention studies addressing the factors identified in this study.
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Affiliation(s)
- Erik Hansson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Jason Glaser
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, 405 30 Gothenburg, Sweden
| | - Ilana Weiss
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Catarina Wesseling
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Rebekah A. I. Lucas
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, 142 Edgbaston Park Rd, Birmingham B15 2TT, UK
| | - Jason Lee Kai Wei
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, 2 Medical Drive, MD9, National University of Singapore, Singapore 117593, Singapore;
- Global Asia Institute, National University of Singapore, 10 Lower Kent Ridge Rd, Singapore 119076, Singapore
- N.1 Institute for Health, National University of Singapore, 28 Medical Dr, Singapore 117456, Singapore
| | - Ulf Ekström
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, 221 85 Lund, Sweden
| | - Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science Intervention and Technology, Karolinska Institutet, 141 86 Stockholm, Sweden;
| | - Theo Bodin
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA;
| | - David H. Wegman
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA 01845, USA
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22
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Al-Bouwarthan M, Quinn MM, Kriebel D, Wegman DH. Risk of Kidney Injury among Construction Workers Exposed to Heat Stress: A Longitudinal Study from Saudi Arabia. Int J Environ Res Public Health 2020; 17:ijerph17113775. [PMID: 32466510 PMCID: PMC7312975 DOI: 10.3390/ijerph17113775] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
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 ≥ 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.
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Affiliation(s)
- Mohammed Al-Bouwarthan
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, 61 Wilder Street, Lowell, MA 01854, USA; (M.M.Q.); (D.K.); (D.H.W.)
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
- Correspondence:
| | - Margaret M. Quinn
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, 61 Wilder Street, Lowell, MA 01854, USA; (M.M.Q.); (D.K.); (D.H.W.)
| | - David Kriebel
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, 61 Wilder Street, Lowell, MA 01854, USA; (M.M.Q.); (D.K.); (D.H.W.)
| | - David H. Wegman
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, 61 Wilder Street, Lowell, MA 01854, USA; (M.M.Q.); (D.K.); (D.H.W.)
- La Isla Network, P.O. Box 816, Ada, MI 49301, USA
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23
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Glaser J, Hansson E, Weiss I, Wesseling C, Jakobsson K, Ekström U, Apelqvist J, Lucas R, Arias Monge E, Peraza S, Hogstedt C, Wegman DH. Preventing kidney injury among sugarcane workers: promising evidence from enhanced workplace interventions. Occup Environ Med 2020; 77:527-534. [PMID: 32404530 PMCID: PMC7402461 DOI: 10.1136/oemed-2020-106406] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/22/2020] [Accepted: 04/05/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To 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. METHODS Based 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. RESULTS In 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. CONCLUSION Kidney 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.
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Affiliation(s)
- Jason Glaser
- La Isla Network, Washington, District of Columbia, USA.,London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Erik Hansson
- La Isla Network, Washington, District of Columbia, USA .,Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Ilana Weiss
- La Isla Network, Washington, District of Columbia, USA
| | - Catharina Wesseling
- La Isla Network, Washington, District of Columbia, USA.,Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Jakobsson
- Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Ulf Ekström
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lunds Universitet, Lund, Sweden
| | - Jenny Apelqvist
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lunds Universitet, Lund, Sweden
| | - Rebekah Lucas
- La Isla Network, Washington, District of Columbia, USA.,School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Esteban Arias Monge
- La Isla Network, Washington, District of Columbia, USA.,Instituto Tecnologico de Costa Rica, Cartago, Costa Rica
| | - Sandra Peraza
- La Isla Network, Washington, District of Columbia, USA.,Facultad de Quimica y Farmacia, Universidad de El Salvador, San Salvador, El Salvador
| | - Christer Hogstedt
- La Isla Network, Washington, District of Columbia, USA.,Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David H Wegman
- La Isla Network, Washington, District of Columbia, USA.,University of Massachusetts Lowell, Lowell, Massachusetts, USA
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24
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Al-Bouwarthan M, Quinn MM, Kriebel D, Wegman DH. Assessment of Heat Stress Exposure among Construction Workers in the Hot Desert Climate of Saudi Arabia. Ann Work Expo Health 2020; 63:505-520. [PMID: 31051037 PMCID: PMC6527521 DOI: 10.1093/annweh/wxz033] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/23/2019] [Accepted: 04/09/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives Excessive 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. Methods Worksite 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. Results Construction 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. Conclusion The 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.
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Affiliation(s)
- Mohammed Al-Bouwarthan
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Margaret M Quinn
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - David Kriebel
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - David H Wegman
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
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25
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Hansson E, Glaser J, Weiss I, Ekström U, Apelqvist J, Hogstedt C, Peraza S, Lucas R, Jakobsson K, Wesseling C, Wegman DH. Workload and cross-harvest kidney injury in a Nicaraguan sugarcane worker cohort. Occup Environ Med 2020; 76:818-826. [PMID: 31611303 PMCID: PMC6839725 DOI: 10.1136/oemed-2019-105986] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/20/2019] [Accepted: 09/18/2019] [Indexed: 12/29/2022]
Abstract
Objectives To 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. Methods Biological 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. Results Mean 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. Conclusions Workers 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.
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Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, District of Columbia, USA.,School of Public Health, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Jason Glaser
- La Isla Network, Washington, District of Columbia, USA .,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ilana Weiss
- La Isla Network, Washington, District of Columbia, USA
| | - Ulf Ekström
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University Faculty of Medicine, Lund, Sweden
| | - Jenny Apelqvist
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University Faculty of Medicine, Lund, Sweden
| | - Christer Hogstedt
- La Isla Network, Washington, District of Columbia, USA.,Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sandra Peraza
- La Isla Network, Washington, District of Columbia, USA.,Facultad de Quimica y Farmacia, Universidad de El Salvador, San Salvador, El Salvador.,Programa SALTRA/ES, San Salvador, El Salvador
| | - Rebekah Lucas
- La Isla Network, Washington, District of Columbia, USA.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Kristina Jakobsson
- La Isla Network, Washington, District of Columbia, USA.,School of Public Health, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Catharina Wesseling
- La Isla Network, Washington, District of Columbia, USA.,Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - David H Wegman
- La Isla Network, Washington, District of Columbia, USA.,University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Wesseling C, Glaser J, Rodríguez-Guzmán J, Weiss I, Lucas R, Peraza S, da Silva AS, Hansson E, Johnson RJ, Hogstedt C, Wegman DH, Jakobsson K. Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress. Rev Panam Salud Publica 2020; 44:e15. [PMID: 31998376 PMCID: PMC6984407 DOI: 10.26633/rpsp.2020.15] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/09/2020] [Indexed: 12/30/2022] Open
Abstract
The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.
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Affiliation(s)
- Catharina Wesseling
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - Jason Glaser
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Julieta Rodríguez-Guzmán
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Ilana Weiss
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Rebekah Lucas
- University of BirminghamUniversity of BirminghamBirminghamUnited KingdomUniversity of Birmingham, Birmingham, United Kingdom
| | - Sandra Peraza
- University of El SalvadorUniversity of El SalvadorSan SalvadorEl SalvadorUniversity of El Salvador, San Salvador, El Salvador
| | - Agnes Soares da Silva
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Erik Hansson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
| | - Richard J. Johnson
- University of Colorado at DenverUniversity of Colorado at DenverAuroraUnited States of AmericaUniversity of Colorado at Denver, Aurora, United States of America
| | - Christer Hogstedt
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - David H. Wegman
- University of Massachusetts LowellUniversity of Massachusetts LowellLowellUnited States of AmericaUniversity of Massachusetts Lowell, Lowell, United States of America
| | - Kristina Jakobsson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
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Kreshpaj B, Orellana C, Burström B, Davis L, Hemmingsson T, Johansson G, Kjellberg K, Jonsson J, Wegman DH, Bodin T. What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies. Scand J Work Environ Health 2020; 46:235-247. [PMID: 31901944 DOI: 10.5271/sjweh.3875] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The lack of a common definition for precarious employment (PE) severely hampers the comparison of studies within and between countries, consequently reducing the applicability of research findings. We carried out a systematic review to summarize how PE has been conceptualized and implemented in research and identify the construct's dimensions in order to facilitate guidance on its operationalization. Methods According to PRISMA guidelines, we searched Web of Science and Scopus for publications with variations of PE in the title or abstract. The search returned 1225 unique entries, which were screened for eligibility. Exclusion criteria were (i) language other than English, (ii) lack of a definition for PE, and (iii) non-original research. A total of 63 full-text articles were included and qualitative thematic-analysis was performed in order to identify dimensions of PE. Results We identified several theory-based definitions of PE developed by previous researchers. Most definitions and operationalizations were either an accommodation to available data or the direct result of qualitative studies identifying themes of PE. The thematic-analysis of the selected articles resulted in a multidimensional construct including the following three dimensions: employment insecurity, income inadequacy, and lack of rights and protection. Conclusions Despite a growing number of studies on PE, most fail to clearly define the concept, severely restricting the advancement of the research of PE as a social determinant of health. Our combined theoretical and empirical review suggests that a common multidimensional definition could be developed and deployed in different labor market contexts using a variety of methodological approaches.
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Affiliation(s)
- Bertina Kreshpaj
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Sweden.
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Ekström U, Apelqvist J, Hansson E, Bodin T, Wegman DH, Abrahamson M, Jakobsson K. Insufficient mixing of thawed serum samples leading to erroneous results - experience from a field study and use of a correction procedure. Scand J Clin Lab Invest 2019; 80:99-105. [PMID: 31847598 DOI: 10.1080/00365513.2019.1700425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Ulf Ekström
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, Lund, Sweden.,La Isla Network, Washington, DC, USA
| | - Jenny Apelqvist
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, Lund, Sweden
| | - Erik Hansson
- La Isla Network, Washington, DC, USA.,School of Public Health and Community Medicine, Unit of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David H Wegman
- La Isla Network, Washington, DC, USA.,University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Magnus Abrahamson
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, Lund, Sweden
| | - Kristina Jakobsson
- La Isla Network, Washington, DC, USA.,Sahlgrenska University Hospital, Gothenburg, Sweden
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Anand S, Caplin B, Gonzalez-Quiroz M, Schensul SL, Bhalla V, Parada X, Nanayakkara N, Fire A, Levin A, Friedman DJ, Aguilar-Gonzalez A, Abbot K, Abeysekara T, Amann K, Anand S, Ashuntantang G, Bhalla V, Brooks D, Caplin B, Chavarria D, Christoph D, Rotter RC, De Broe M, De Silva PMC, Dominguez J, Eckardt KU, Fader D, Finkelstein F, Fire A, Fischer R, Friedman D, Ganguli A, Garcia Trabinho RA, Glaser J, Gonzalez Quiroz MA, Fischer R, Haider L(L, Harris D, Herath C, Herrera R, Hradsky A, Hoy W, Jakobsson K, Jayasinghe S, Jaysummana C, Jha V, Johnson R, Kambham N, Karanasema N, Kaze F, Kimmel P, Koritzinsky E, Langham R, Le Bellego L, Levin A, Levin N, Lyuckx V, Madero M, Martin E, Malik C, Moist L, Moxey-Mims M, Nanayakkara N, Narva A, Nerbass F, O'Donoghue D, Orantes C, Parada X, Pearce N, Ratnayake C, Roy-Chaudhury P, Ruggiero A, Sanchez-Lozada LG, Saran R, Schensul S, Segantini L, Seksek I, Sheikh-Hamad D, Star R, Strani L, Vlahos P, Wegman DH, Weiss I, Wijewickrama E, Wijkstrom J, Wise P, Wright E, Yang CW, Yeates K. Epidemiology, molecular, and genetic methodologies to evaluate causes of CKDu around the world: report of the Working Group from the ISN International Consortium of Collaborators on CKDu. Kidney Int 2019; 96:1254-1260. [DOI: 10.1016/j.kint.2019.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/30/2022]
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30
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Wegman DH. Air Pollution. Environ Epidemiol 2019. [DOI: 10.1201/9780429263361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Wegman DH, Davis L. New Horizons for Occupational Health Surveillance. Am J Public Health 2018; 108:e3. [PMID: 30089017 DOI: 10.2105/ajph.2018.304578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- David H Wegman
- David H. Wegman is with the University of Massachusetts Lowell. Letitia Davis is with the Massachusetts Department of Public Health, Boston
| | - Letitia Davis
- David H. Wegman is with the University of Massachusetts Lowell. Letitia Davis is with the Massachusetts Department of Public Health, Boston
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Wegman DH, Apelqvist J, Bottai M, Ekström U, García-Trabanino R, Glaser J, Hogstedt C, Jakobsson K, Jarquín E, Lucas RAI, Weiss I, Wesseling C, Bodin T. Intervention to diminish dehydration and kidney damage among sugarcane workers. Scand J Work Environ Health 2017; 44:16-24. [PMID: 28691728 DOI: 10.5271/sjweh.3659] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- David H Wegman
- University of Massachusetts Lowell, 7 Camden Place, Cambridge, MA 02138, USA.
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García-Trabanino R, Jakobsson K, Guzmán Quilo C, Brooks DR, Crowe J, Barnoya J, Madero M, González Quiroz M, Wesseling C, Wegman DH, Correa-Rotter R. In reply to: "Should we consider renaming 'Mesoamerican Nephropathy' as Nephropathy of Unknown Cause in Agricultural Labourers (NUCAL)?". Occup Environ Med 2016; 73:802-803. [PMID: 27566784 DOI: 10.1136/oemed-2016-104005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/10/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Ramón García-Trabanino
- Centro de Hemodiálisis, San Salvador, El Salvador Emergency Social Fund for Health of Tierra Blanca, Tierra Blanca, El Salvador
| | - Kristina Jakobsson
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | | | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Crowe
- Regional Institute for Studies on Toxic Substances (IRET), Program on Health, Work and Environment (SALTRA), Universidad Nacional, Heredia, Costa Rica
| | - Joaquín Barnoya
- Research Department, Cardiovascular Surgery Unit, Guatemala, Guatemala Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico city, Mexico
| | - Marvin González Quiroz
- Research Center on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Catharina Wesseling
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - David H Wegman
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico city, Mexico
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Azaroff LS, Lax MB, Levenstein C, Wegman DH. Wounding the Messenger: The New Economy Makes Occupational Health Indicators Too Good to Be True. Int J Health Serv 2016; 34:271-303. [PMID: 15242159 DOI: 10.2190/4h2x-xd53-gk0j-91nq] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The U.S. Bureau of Labor Statistics and workers' compensation insurers reported dramatic drops in rates of occupational injuries and illnesses during the 1990s. The authors argue that far-reaching changes in the 1980s and 1990s, including the rise of precarious employment, falling wages and opportunities, and the creation of a super-vulnerable population of immigrant workers, probably helped create this apparent trend by preventing employees from reporting some injuries and illnesses. Changes in the health care system, including loss of access to health care for growing numbers of workers and increased obstacles to the use of workers' compensation, compounded these effects by preventing the diagnosis and documentation of some occupational injuries and illnesses. Researchers should examine these forces more closely to better understand trends in occupational health.
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Affiliation(s)
- Lenore S Azaroff
- Department of Work Environment, University of Massachusetts Lowell, 01854, USA.
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Bodin T, García-Trabanino R, Weiss I, Jarquín E, Glaser J, Jakobsson K, Lucas RAI, Wesseling C, Hogstedt C, Wegman DH. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1. Occup Environ Med 2016; 73:409-16. [PMID: 27073211 PMCID: PMC4893112 DOI: 10.1136/oemed-2016-103555] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/24/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic heat stress and dehydration from strenuous work in hot environments is considered an essential component of the epidemic of chronic kidney disease in Central America. OBJECTIVE (1) To assess feasibility of providing an intervention modelled on OSHA's Water.Rest.Shade programme (WRS) during sugarcane cutting and (2) to prevent heat stress and dehydration without decreasing productivity. METHODS Midway through the 6-month harvest, the intervention introduced WRS practices. A 60-person cutting group was provided water supplied in individual backpacks, mobile shaded rest areas and scheduled rest periods. Ergonomically improved machetes and efficiency strategies were also implemented. Health data (anthropometric, blood, urine, questionnaires) were collected preharvest, preintervention, mid-intervention and at the end of harvest. A subsample participated in focus group discussions. Daily wet bulb globe temperatures (WBGT) were recorded. The employer provided individual production records. RESULTS Over the harvest WBGT was >26°C from 9:00 onwards reaching average maximum of 29.3±1.7°C, around 13:00. Postintervention self-reported water consumption increased 25%. Symptoms associated with heat stress and with dehydration decreased. Individual daily production increased from 5.1 to a high of 7.3 tons/person/day postintervention. This increase was greater than in other cutting groups at the company. Focus groups reported a positive perception of components of the WRS, and the new machete and cutting programmes. CONCLUSIONS A WRS intervention is feasible in sugarcane fields, and appears to markedly reduce the impact of the heat stress conditions for the workforce. With proper attention to work practices, production can be maintained with less impact on worker health.
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Affiliation(s)
- T Bodin
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - R García-Trabanino
- Association of Nephrology and Hypertension of El Salvador, San Salvador, El Salvador
| | - I Weiss
- La Isla Foundation, Ada, Michigan, USA
| | - E Jarquín
- Agency for Development and Agricultural Health (AGDYSA), San Salvador, El Salvador
| | - J Glaser
- La Isla Foundation, Ada, Michigan, USA
| | - K Jakobsson
- Department of Public Health and Community Medicine, Gothenburg University, Gothenburg, Sweden
| | - R A I Lucas
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - C Wesseling
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - C Hogstedt
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - D H Wegman
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Wesseling C, García-Trabanino R, Wegman DH. Mesoamerican Nephropathy: Do Novel Biomarkers of Kidney Damage Have a Role to Play? Am J Kidney Dis 2016; 67:173-5. [PMID: 26802327 DOI: 10.1053/j.ajkd.2015.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 01/30/2023]
Affiliation(s)
| | | | - David H Wegman
- University of Massachusetts Lowell, Lowell, Massachusetts
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Dropkin J, Kim H, Punnett L, Wegman DH, Warren N, Buchholz B. Effect of an office ergonomic randomised controlled trial among workers with neck and upper extremity pain. Occup Environ Med 2014; 72:6-14. [PMID: 25227570 DOI: 10.1136/oemed-2014-102160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Office computer workers are at increased risk for neck/upper extremity (UE) musculoskeletal pain. METHODS A seven-month office ergonomic intervention study evaluated the effect of two engineering controls plus training on neck/UE pain and mechanical exposures in 113 computer workers, including a 3-month follow-up period. Participants were randomised into an intervention group, who received a keyboard/mouse tray (KBT), touch pad (TP) for the non-dominant hand and keyboard shortcuts, and a control group who received keyboard shortcuts. Participants continued to have available a mouse at the dominant hand. Outcomes were pain severity, computer rapid upper limb assessment (RULA), and hand activity level. Prevalence ratios (PRs) evaluated intervention effects using dichotomised pain and exposure scores. RESULTS In the intervention group, the dominnt proximal UE pain PR=0.9, 95% CI 0.7 to 1.2 and the dominant distal UE PR=0.8, 95% CI 0.5 to 1.3, postintervention. The non-dominant proximal UE pain PR=1.0, 95% CI 0.8 to 1.4, while the non-dominant distal UE PR=1.2, 95% CI 0.6 to 2.2, postintervention. Decreases in non-neutral postures were found in two RULA elements (non-dominant UE PR=0.9, 95% CI 0.8 to 0.9 and full non-dominant RULA PR=0.8, 95% CI 0.8 to 0.9) of the intervention group. Hand activity increased on the non-dominant side (PR=1.4, 95% CI 1.2 to 1.6) in this group. CONCLUSIONS While the intervention reduced non-neutral postures in the non-dominant UE, it increased hand activity in the distal region of this extremity. To achieve lower hand activity, a KBT and TP used in the non-dominant hand may not be the best devices to use.
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Affiliation(s)
- Jonathan Dropkin
- Department of Population Health, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, USA
| | - Hyun Kim
- Department of Population Health, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, USA
| | - Laura Punnett
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - David H Wegman
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Nicholas Warren
- Ergonomic Technology Center, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Bryan Buchholz
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Affiliation(s)
- David H Wegman
- Department of Work Environment, University of Massachusetts Lowell, 1 University Avenue, Lowell, Massachusetts, USA
| | - Christer Hogstedt
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Affiliation(s)
- Catharina Wesseling
- Catharina Wesseling and Jennifer Crowe are with the Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica. Christer Hogstedt is with the Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden. Kristina Jakobsson is with the Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden. Rebekah Lucas is with the Hothaps Program, Umeå International School of Public Health, Umeå University, Umeå, Sweden. David H. Wegman is with Work Environment, University of Massachusetts, Lowell
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Wesseling C, Crowe J, Hogstedt C, Jakobsson K, Lucas R, Wegman DH. Resolving the enigma of the mesoamerican nephropathy: a research workshop summary. Am J Kidney Dis 2013; 63:396-404. [PMID: 24140367 DOI: 10.1053/j.ajkd.2013.08.014] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/05/2013] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Catharina Wesseling
- Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica.
| | - Jennifer Crowe
- Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Christer Hogstedt
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm
| | - Kristina Jakobsson
- Department of Occupational and Environmental Medicine, Lund University, Lund
| | - Rebekah Lucas
- Hothaps Program, Umeå International School of Public Health, Umeå University, Umeå, Sweden
| | - David H Wegman
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA
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Marucci-Wellman H, Wegman DH, Leamon TB, Binh TTT, Diep NB, Kriebel D. Work-related injury surveillance in Vietnam: a national reporting system model. Am J Public Health 2013; 103:1989-96. [PMID: 24028255 DOI: 10.2105/ajph.2013.301304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Developing nations bear a substantial portion of the global burden of injury. Public health surveillance models in developing countries should recognize injury risks for all levels of society and all causes and should incorporate various groups of workers and industries, including subsistence agriculture. However, many developing nations do not have an injury registration system; current data collection methods result in gross national undercounts of injuries, failing to distinguish injuries that occur during work. In 2006, we established an active surveillance system in Vietnam's Xuan Tien commune and investigated potential methods for surveillance of work-related injuries. On the basis of our findings, we recommend a national model for work-related injury surveillance in Vietnam that builds on the existing health surveillance system.
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Affiliation(s)
- Helen Marucci-Wellman
- Helen Marucci-Wellman is with the Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, MA, and the School of Health and Environment, University of Massachusetts, Lowell. David H. Wegman, Tom B. Leamon, and David Kriebel are with the School of Health and Environment, University of Massachusetts, Lowell. Tom B. Leamon is also with the Harvard School of Public Health, Boston, MA. Ta Thi Tuyet Binh and Nguyen Bich Diep are with the National Institute for Occupational and Environmental Health, Hanoi, Vietnam
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43
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Wesseling C, Crowe J, Hogstedt C, Jakobsson K, Lucas R, Wegman DH. The epidemic of chronic kidney disease of unknown etiology in Mesoamerica: a call for interdisciplinary research and action. Am J Public Health 2013; 103:1927-30. [PMID: 24028232 DOI: 10.2105/ajph.2013.301594] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Catharina Wesseling
- Catharina Wesseling and Jennifer Crowe are with the Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica. Christer Hogstedt is with the Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden. Kristina Jakobsson is with the Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden. Rebekah Lucas is with the Hothaps Program, Umeå International School of Public Health, Umeå University, Umeå, Sweden. David H. Wegman is with Work Environment, University of Massachusetts, Lowell
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Meucci RD, Fassa AG, Paniz VM, Silva MC, Wegman DH. Increase of chronic low back pain prevalence in a medium-sized city of southern Brazil. BMC Musculoskelet Disord 2013; 14:155. [PMID: 23634830 PMCID: PMC3651714 DOI: 10.1186/1471-2474-14-155] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 04/23/2013] [Indexed: 11/16/2022] Open
Abstract
Background Chronic low back pain (CLBP) is a highly disabling morbidity with high social, economic and individual effects. Demographic, occupational and behavioral changes that took place in Brazil over the last decade are related with an increasing burden of chronic conditions. Despite these changes, comparison studies on CLBP prevalence and associated factors, over time are scarce in the literature in general, and unknown in Brazil. The present study compared the CLBP prevalence in a medium sized city in Brazil between the years 2002 and 2010 and examined factors associated with prevalence in 2010. Methods Two cross-sectional studies with similar methodology were conducted in a medium-sized city in southern Brazil, in 2002 and 2010. 3182 individuals were interviewed in the first study and 2732 in the second one, all adults aged twenty years or more. Those who reported pain for seven weeks or more in the last three months in the lumbar region where considered cases of CLBP. Results The CLBP prevalence increased from 4.2% to 9.6% in 8 years. In most of the studied subgroups the CLBP prevalence has at least doubled and the increase was even larger among younger individuals with more years of education and higher economic status. Conclusions Increase in CLBP prevalence is worrisome because it is a condition responsible for substantial social impact, besides being an important source of demand for health services.
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Affiliation(s)
- Rodrigo D Meucci
- Post-Graduate Program in Epidemiology-Social Medicine Department, Federal University of Pelotas, Pelotas, Brazil.
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Azaroff LS, Davis LK, Naparstek R, Hashimoto D, Laing JR, Wegman DH. Barriers to use of workers' compensation for patient care at Massachusetts community health centers. Health Serv Res 2013; 48:1375-92. [PMID: 23445431 DOI: 10.1111/1475-6773.12045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To examine barriers community health centers (CHCs) face in using workers' compensation insurance (WC). DATA SOURCES/STUDY SETTING Leadership of CHCs in Massachusetts. STUDY DESIGN 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. DATA COLLECTION/EXTRACTION METHODS Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated. PRINCIPAL FINDINGS 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. CONCLUSION 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.
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Affiliation(s)
- Lenore S Azaroff
- Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA 02108, USA.
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Aguilar Madrid G, Beaudry M, Bell W, Bowes D, Brophy J, Burdorf A, Carlsten C, Castleman B, Chaturvedi S, Conti ME, Corra L, Corrêa Filho HR, Cranor CF, Cullen E, Dalvie A, Dickson RC, Digon A, Egilman D, Eisner Falvo C, Fischer E, Frank AL, Frank E, Gee D, Giannasi F, Goldstein BD, Greenberg M, Guidotti TL, Harris WA, Hindry M, Houlson A, Hu H, Huff J, Infante PF, Thambyappa J, Juarez Perez CA, Jeebhay MF, Joshi TK, Keith M, Keyserlingk JR, Khatter K, King D, Kodeih N, Kristensen J, Kulsomboon V, Landrigan PJ, Lee CW, Leigh J, Lemen RA, Lippman A, London L, Matzopoulos R, McCulloch J, McDiarmid MA, Mehrdad R, Mirabelli D, Moshammer H, Notebaert É, Nycz Z, Oberta AF, O'Connor J, O'Neill R, Orris P, Ozonoff D, Paek D, Rickard C, Rodriguez EJ, Sass J, Sentes KE, Simpson IM, Soffritti M, Soskolne CL, Sparling SP, Spiegel J, Takahashi K, Takaro TK, Terracini B, Thébaud-Mony A, Trosic I, Turcotte F, Vakil C, Van Der Walt A, Waterman YRK, Watterson A, Wegman DH, Welch LS, Weiss SH, Winston R, Yassi A. Statement in response to asbestos industry efforts to prevent a ban on asbestos in Pakistan: chrysotile asbestos use is not safe and must be banned. Arch Environ Occup Health 2013; 68:243-249. [PMID: 23697697 DOI: 10.1080/19338244.2013.780807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Abstract
Adolescent employment is commonly valued in the United States for its ability to promote youths’ positive psychosocial development. Empirical research, however, suggests the extent to which youth reap such benefits from work is largely a function of work’s quality. This study investigated adolescent work quality by examining the extent to which characteristics associated with positive or negative psychosocial outcomes are found in the jobs adolescents hold today. Our findings from surveys and interviews with working youth show that contemporary adolescent jobs provide at least moderate levels of the characteristics that promote positive psychosocial outcomes and some of those that promote negative outcomes. Adolescent jobs have the greatest capacity to encourage positive psychosocial development by providing opportunities for youth to be helpful and, to a lesser extent, to be around supportive others and to learn new things. Improvements in other areas of work quality are needed to maximize work’s potential to contribute positively to adolescent psychosocial development.
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Affiliation(s)
- Kimberly J. Rauscher
- Department of Occupational and Environmental Health Sciences, West Virginia University School of Public Health, WVU Injury Control Research Center, Morgantown, WV, USA
| | - David H. Wegman
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA, USA
| | - John Wooding
- Department of Political Science, University of Massachusetts Lowell, Lowell, MA, USA
| | - Letitia Davis
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Rozelinda Junkin
- West Virginia University, Injury Control Research Center, Morgantown, WV, USA
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Levy BS, Wegman DH. Commentary: public health and preventive medicine: proposing a transformed context for medical education and medical care. Acad Med 2012; 87:837-839. [PMID: 22735558 DOI: 10.1097/acm.0b013e3182583ae9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Because medical students and residents receive inadequate education and training in public health and preventive medicine, they will miss many opportunities, as they practice medicine, to improve the health of individual patients and populations. Although there is an ongoing need to expand the number and improve the specialist training of public health and preventive medicine residents, all medical students and residents should enter practice with substantive knowledge and practical skills in public health and preventive medicine. This knowledge and these skills will make them more effective in such areas as enabling patients to make lifestyle changes, identifying and reducing occupational and environmental risk factors, and empowering patients to manage their chronic health conditions. The authors propose a paradigm shift to establish public health and preventive medicine as the context for medical education and medical care.
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Affiliation(s)
- Barry S Levy
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 01770, USA.
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Wegman DH, Wagner GR. Swimming Upstream. Am J Public Health 2012; 102:1053. [DOI: 10.2105/ajph.2012.300826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- David H. Wegman
- Department of Work Environment University of Massachusetts Lowell
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50
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Marucci-Wellman H, Leamon TB, Binh TTT, Diep NB, Wegman DH, Kriebel D. The burden of occupational injury: a 1-year prospective study in Xuan Tien Commune, Viet Nam. Am J Ind Med 2012; 55:205-16. [PMID: 22161813 DOI: 10.1002/ajim.21039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Developing nations carry a substantial portion of the global burden of injury, but without reliable injury surveillance, there is no way to characterize or prioritize the causes of work-related injury for prevention. METHODS Injury data from 52 treatment sites in the Xuan Tien Commune, Vietnam with over 10,000 inhabitants were collected between January 1 and December 31, 2006. Injured residents were interviewed to determine work-relatedness, relevant causes, disability, and burden. RESULTS Five hundred four work-related injuries were reported from formal treatment sites (incidence rate of 87 per 1,000 FTE) with a mean lost work day of 11 days. Four thousand five hundred seventy-four lost work day equivalents were estimated based on actual days lost to recover plus work days lost earning income to pay for medical costs, accumulating a total direct burden to the community of 8,641 lost work day equivalents. Almost half of that burden was caused by work in manufacturing. First aid boxes placed in 40 manufacturing enterprises yielded the 2nd highest reporting source. CONCLUSION This study demonstrated the feasibility and value at the local level to build an active injury surveillance system which could have a large impact on preventing the burden of injuries in workplaces in Vietnam.
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