Assessing the role of social determinants of health in health disparities: The need for data on work

BACKGROUND

Work is a key social determinant of health. Without the collection of work-related information in public health data systems, the role of social determinants in creating and reinforcing health disparities cannot be fully assessed.

METHODS

The Centers for Disease Control and Prevention (CDC) maintains or supports a number of public health surveillance and health monitoring systems, including surveys, case-based disease and exposure systems, vital status records, and administrative data systems. We evaluated a convenience sample of these systems for inclusion of information in three work-related domains: employment status, industry and occupation, and working conditions.

RESULTS

While 12 of 39 data systems were identified as collecting work-related data, this information was often minimal (e.g., only employment status), restricted to a subset of respondents, or only gathered periodically. Information on working conditions was particularly sparse.

CONCLUSION

Historically, the limited and inconsistent collection of work-related information in public health data systems has hindered understanding of the role work plays in health disparities. Current CDC data modernization efforts present opportunities to enhance the identification and mitigation of health disparities by prioritizing inclusion of an expanded set of work-related data elements.

Occupational Safety and Health Equity Impacts of Artificial Intelligence: A Scoping Review

Artificial intelligence (AI) has the potential to either reduce or exacerbate occupational safety and health (OSH) inequities in the workplace, and its impact will be mediated by numerous factors. This paper anticipates challenges to ensuring that the OSH benefits of technological advances are equitably distributed among social groups, industries, job arrangements, and geographical regions. A scoping review was completed to summarize the recent literature on AI's role in promoting OSH equity. The scoping review was designed around three concepts: artificial intelligence, OSH, and health equity. Scoping results revealed 113 articles relevant for inclusion. The ways in which AI presents barriers and facilitators to OSH equity are outlined along with priority focus areas and best practices in reducing OSH disparities and knowledge gaps. The scoping review uncovered priority focus areas. In conclusion, AI's role in OSH equity is vastly understudied. An urgent need exists for multidisciplinary research that addresses where and how AI is being adopted and evaluated and how its use is affecting OSH across industries, wage categories, and sociodemographic groups. OSH professionals can play a significant role in identifying strategies that ensure the benefits of AI in promoting workforce health and wellbeing are equitably distributed.

Mixed messages and COVID-19 prevention: Why information isn't always enough to protect meat processing workers

Introduction

The objective of this project was to investigate U.S. meat and poultry processing workers' knowledge of COVID-19, perceived ability to protect themselves from infection, and perspectives on COVID-19 vaccines to inform COVID-19 prevention efforts within this linguistically, racially, and ethnically diverse workforce.

Methods

Qualitative semi-structured in-depth interviews were conducted with Mexican, Central American, Congolese refugee, and Black or African American meat/poultry processing workers from Mississippi, Minnesota, Virginia, and Kentucky (N=40). Data were collected from December 5, 2020, to January 28, 2021. Interview audio was transcribed, and rapid qualitative data analysis was used to analyze transcripts.

Results

Most participants expressed receiving mixed messages about COVID-19 protection measures: they were told how to protect themselves (n=38), but workplace policies (such as lack of paid sick leave) often undermined their efforts. Participants who were asked about COVID-19 vaccines (n=31) were aware there were one or more vaccines available to protect them from COVID-19; one-third were eager to get vaccinated.

Conclusions

Community-based efforts may consider supplementing large scale unified information campaigns in order to prevent mixed messages, address worker needs to accurately gauge the threat of illness to their families and communities and empower them to prevent infection.

Mobile Health and Wellness Project: A binational collaboration of frontline health services to the Latino population in the United States in times of COVID-19

Hardly reached communities in the United States greatly benefit from collective efforts and partnerships from Community Based Organizations, Health Institutions and Government Agencies, yet the effort to engage in this collaborative effort is minimal and funding to support these projects is lacking. The COVID-19 Pandemic exacerbated on a national scale what many vulnerable communities experience regularly; difficult access to basic medical care, information and support. In an effort to directly engage with community organizations and curb the infection rate of the COVID-19 virus within vulnerable communities, the US Centers for Disease Control and Prevention (CDC) launched its first targeted effort to partner directly with community based organizations. This article will highlight the first pilot year of activities and key results of COVID-19 education and vaccination efforts by the Mobile Health and Wellness project. This is a fleet of 11 Mobile Health Vehicles managed by the Mexico Section US-Mexico Border Health Commission in partnership with Alianza Americas, Latino Commission on AIDS, and the CDC, targeting Latino, Immigrant and rural communities across the US.

Occupational Safety and Health with Technological Developments in Livestock Farms: A Literature Review

In recent decades, there have been considerable technological developments in the agriculture sector to automate manual processes for many factors, including increased production demand and in response to labor shortages/costs. We conducted a review of the literature to summarize the key advances from installing emerging technology and studies on robotics and automation to improve agricultural practices. The main objective of this review was to survey the scientific literature to identify the uses of these new technologies in agricultural practices focusing on new or reduced occupational safety risks affecting agriculture workers. We screened 3248 articles with the following criteria: (1) relevance of the title and abstract with occupational safety and health; (2) agriculture technologies/applications that were available in the United States; (3) written in English; and (4) published 2015-2020. We found 624 articles on crops and harvesting and 80 articles on livestock farming related to robotics and automated systems. Within livestock farming, most (78%) articles identified were related to dairy farms, and 56% of the articles indicated these farms were using robotics routinely. However, our review revealed gaps in how the technology has been evaluated to show the benefits or potential hazards to the safety and well-being of livestock owners/operators and workers.

Working hours, sleep, and fatigue in the agriculture, forestry, and fishing sector: A scoping review

INTRODUCTION

Agriculture, forestry, and fishing industry (AgFF) workers often work extremely long hours during peak production seasons, resulting in sleep deprivation and fatigue. The National Occupational Research Agenda has classified fatigue as a "significant safety issue" and area of concern for many industry sectors, including AgFF. This review explores current research and practice in AgFF and proposes next steps.

METHODS

We conducted a scoping literature review to examine the extent and nature of research in this area. Article inclusion criteria included peer-reviewed journal articles written in English; published after 1989; covering AgFF workers in high-income countries; with data on working hours/schedules and sleep related to safety and health.

RESULTS

Limited research has addressed long hours and sleep deprivation among AgFF workers. We identified 8350 articles for title and abstract review. Among those, 407 underwent full-text review and 96 met all inclusion criteria (67% agriculture, 25% fishing/seafood processing, 8% forestry). The literature provided some evidence fatigue contributes to fatalities, injuries, and illnesses in AgFF. Older, new, young, foreign-born, and female workers, as well as those who work in small organizations or longer hours (40+) may be at higher risk for fatigue-related injury and illness. Few studies have developed or evaluated interventions to control risks.

DISCUSSION

Given that fatigue is a factor in injury and illness for this sector, future AgFF surveillance and research should increase efforts to capture fatigue and sleep data, directly investigate the role of long hours and nonstandard work schedules in the sector, and most importantly, create practical interventions to manage fatigue.

Preventing Suicidal Behavior Among American Indian and Alaska Native Adolescents and Young Adults

From 2009 to 2018, overall suicide rates in the United States increased by 20.3% and increased by 43.5% among non-Hispanic American Indian and Alaska Native (AI/AN) communities. Combining years 2009 through 2018, suicide rates per 100 000 population among non-Hispanic AI/AN adolescents and young adults aged 15 to 34 years were 2 to 4 times higher than those of adolescents and young adults of other races and ethnicities. An estimated 14% to 27% of non-Hispanic AI/AN adolescents attempted suicide during that time. The elevated rates of suicidal behavior among non-Hispanic AI/AN adolescents and young adults reflect inequities in the conditions that create health. In this topical review, we describe school-based educational efforts that are driven by local AI/AN communities, such as the American Indian Life Skills curriculum, that teach stress and coping skills and show promise in reducing suicidal ideation attempts and fatalities among AI/AN adolescents. Using a social-determinants-of-health lens, we review the availability and quality of employment as an important influencer of suicidal behavior, as well as the role of the workplace as an environment for suicide prevention in AI/AN communities. Working with tribal, state, local, and federal colleagues, the public health community can implement programs known to be effective and create additional comprehensive strategies to reduce inequities and ultimately reduce suicide rates.

Selective Enhancement of Swine Myocardium with a Novel Ultrasound Enhancing Agent During Transthoracic Echocardiography

Ultrasound enhancing agents are approved to delineate the endocardial border and opacify the left ventricle cavity (LVC). We present a nested phase change agent (NPCA) designed to enable selective myocardial enhancement without enhancing the LVC by employing a dual-activation mechanism dependent on sufficient ultrasound intensity and the microenvironment of the myocardium. Swine received bolus injections of NPCA while echocardiograms were collected and processed to determine background-subtracted acoustic intensities (AI) in the LVC and septal myocardium. At mechanical index (MI) ≥ 0.8, the NPCA enhanced the myocardium selectively (p < 0.001) while the LVC remained at baseline AI. A 5-mL bolus of NPCA enhanced swine myocardium and enhancement persisted for > 5 min at 1.4 MI, while hemodynamics and EKG remained normal. Our findings demonstrate that the NPCA enhances swine myocardium selectively without enhancing the LVC. The NPCA could have utility for functional and structural echocardiographic studies with clinical ultrasound using standard settings.

Health Equity and a Paradigm Shift in Occupational Safety and Health

Despite significant improvements in occupational safety and health (OSH) over the past 50 years, there remain persistent inequities in the burden of injuries and illnesses. In this commentary, the authors assert that addressing these inequities, along with challenges associated with the fundamental reorganization of work, will require a more holistic approach that accounts for the social contexts within which occupational injuries and illnesses occur. A biopsychosocial approach explores the dynamic, multidirectional interactions between biological phenomena, psychological factors, and social contexts, and can be a tool for both deeper understanding of the social determinants of health and advancing health equity. This commentary suggests that reducing inequities will require OSH to adopt the biopsychosocial paradigm. Practices in at least three key areas will need to adopt this shift. Research that explicitly examines occupational health inequities should do more to elucidate the effects of social arrangements and the interaction of work with other social determinants on work-related risks, exposures, and outcomes. OSH studies regardless of focus should incorporate inclusive methods for recruitment, data collection, and analysis to reflect societal diversity and account for differing experiences of social conditions. OSH researchers should work across disciplines to integrate work into the broader health equity research agenda.

Heart Attacks, Bloody Noses, and Other "Emotional Problems": Cultural and Conceptual Issues With the Spanish Translation of Self-Report Emotional Health Items

This article examines how respondents understood items in the Spanish versions of the Short-Form 36 (SF-36v2). Cognitive interviews of the SF-36 were conducted in 2 phases with 46 Spanish speakers living in the United States. Roughly one-third (17/46) of respondents had difficulty understanding the Role Emotional items upon their initial reading, and almost half (21/46) provided examples that were inconsistent with the intended meaning of the items. The findings of this study underscore the importance of conducting cognitive testing to ensure conceptual equivalence of any instrument regardless of how well validated it appears to be.

Public Health Impacts of Underemployment and Unemployment in the United States: Exploring Perceptions, Gaps and Opportunities

BACKGROUND

Unemployment, underemployment, and the quality of work are national occupational health risk factors that drive critical national problems; however, to date, there have been no systematic efforts to document the public health impact of this situation.

METHODS

An environmental scan was conducted to explore the root causes and health impacts of underemployment and unemployment and highlight multilevel perspectives and factors in the landscape of underemployment and unemployment.

METHODS

included a review of gray literature and research literature, followed by key informant interviews with nine organizational representatives in employment research and policy, workforce development, and industry to assess perceived needs and gaps in practice.

RESULTS

Evidence highlights the complex nature of underemployment and unemployment, with multiple macro-level underlying drivers, including the changing nature of work, a dynamic labor market, inadequate enforcement of labor protection standards, declining unions, wage depression, and weak political will interacting with multiple social determinants of health. Empirical literature on unemployment and physical, mental, and psychological well-being, substance abuse, depression in young adults, and suicides is quite extensive; however, there are limited data on the impacts of underemployment on worker health and well-being. Additionally, organizations do not routinely consider health outcomes as they relate to their work in workforce or policy development.

DISCUSSION AND CONCLUSIONS

Several gaps in data and research will need to be addressed in order to assess the full magnitude of the public health burden of underemployment and unemployment. Public health needs to champion a research and practice agenda in partnership with multisector stakeholders to illuminate the role of employment quality and status in closing the gap on health inequities, and to integrate workforce health and well-being into labor and economic development agendas across government agencies and industry.

Reaching "hard to reach" workers: Evaluating approaches to disseminate worker safety information via the Mexican consular network

Mexican immigrants suffer a disproportionately large number of work-related injuries and deaths given their share of the workforce. Barriers of language, culture, and mistrust are often cited as factors that complicate efforts to reach these workers with occupational safety and health (OSH) interventions. By partnering with the Mexican government and its consulate network in the United States, researchers from the National Institute for Occupational Safety and Health were able to assess the impact of four different information dissemination approaches (posters, passively distributed brochures, actively distributed brochures, and video kiosks) in Spanish in a five-phase study. Exit interviews conducted with Mexicans seeking consular services indicated that while nearly all respondents considered OSH to be of importance, significant differences in impact measures, such as noticing the materials and liking of content, were found when comparing the different approaches. Despite these differences, even the least effective approaches were noticed by large numbers of individuals and significantly increased their stated behavioral intentions regarding OSH. Considering all materials together, significantly more participants reported liking the materials (p < 0.001) than did not, learning something new (p < 0.01), trusting the information (p < 0.05), intending to seek out additional OSH information (p < 0.01), and intending to speak to their bosses about OSH (p < 0.05). These findings contribute to building an evidence base for moving research knowledge into practice, which is an essential, but often overlooked, element of occupational safety and health research, particularly among workers from underserved communities.

An Innovative United States-Mexico Community Outreach Initiative for Hispanic and Latino People in the United States: A Collaborative Public Health Network

Collaborative partnerships are a useful approach to improve health conditions of disadvantaged populations. The Ventanillas de Salud (VDS) ("Health Windows") and Mobile Health Units (MHUs) are a collaborative initiative of the Mexican government and US public health organizations that use mechanisms such as health fairs and mobile clinics to provide health information, screenings, preventive measures (eg, vaccines), and health services to Mexican people, other Hispanic people, and underserved populations (eg, American Indian/Alaska Native people, geographically isolated people, uninsured people) across the United States. From 2013 through 2019, the VDS served 10.5 million people (an average of 1.5 million people per year) at Mexican consulates in the United States, and MHUs served 115 461 people from 2016 through 2019. We describe 3 community outreach projects and their impact on improving the health of Hispanic people in the United States. The first project is an ongoing collaboration between VDS and the Centers for Disease Control and Prevention (CDC) to address occupational health inequities among Hispanic people. The second project was a collaboration between VDS and CDC to provide Hispanic people with information about Zika virus infection and health education. The third project is a collaboration between MHUs and the University of Arizona to provide basic health services to Hispanic communities in Pima and Maricopa counties, Arizona. The VDS/MHU model uses a collaborative approach that should be further assessed to better understand its impact on both the US-born and non-US-born Hispanic population and the public at large in locations where it is implemented.

Envisioning the future of work to safeguard the safety, health, and well-being of the workforce: A perspective from the CDC's National Institute for Occupational Safety and Health

The future of work embodies changes to the workplace, work, and workforce, which require additional occupational safety and health (OSH) stakeholder attention. Examples include workplace developments in organizational design, technological job displacement, and work arrangements; work advances in artificial intelligence, robotics, and technologies; and workforce changes in demographics, economic security, and skills. This paper presents the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health's Future of Work Initiative; suggests an integrated approach to address worker safety, health, and well-being; introduces priority topics and subtopics that confer a framework for upcoming future of work research directions and resultant practical applications; and discusses preliminary next steps. All future of work issues impact one another. Future of work transformations are contingent upon each of the standalone factors discussed in this paper and their combined effects. Occupational safety and health stakeholders are becoming more aware of the significance and necessity of these factors for the workplace, work, and workforce to flourish, merely survive, or disappear altogether as the future evolves. The future of work offers numerous opportunities, while also presenting critical but not clearly understood difficulties, exposures, and hazards. It is the responsibility of OSH researchers and other partners to understand the implications of future of work scenarios to translate effective interventions into practice for employers safeguarding the safety, health, and well-being of their workers.

Overlapping vulnerabilities in workers of the electronics recycling industry formal sector: A commentary

Vulnerabilities in workers performing electronics recycling (e-recycling) in the informal sector worldwide have been well documented. However, the growing e-recycling industry in the formal sector still brings many challenges to protect the health of workers and their environment. This commentary aims to draw attention to the overlooked vulnerabilities faced by the workers of the e-recycling industry formal sector in high-income countries and discuss the potential impact on health inequalities experienced by these workers. Expanding the definition of vulnerability, not limited to the biological susceptibility to chemical and physical exposures, the demographic characteristics of workers in the e-recycling formal sector often reveal social groups known to be disadvantaged regarding occupational exposures and health effects, including young workers, immigrant or ethnic minorities, and workers with mental or physical health issues or disabilities. Overlapping structural vulnerabilities of the e-recycling industry stem from its newness, its working conditions, its conditions of employment, and the sociodemographic characteristics of its workforce. This phenomenon in high-income countries is not restricted to the e-recycling industry alone. It is rather a symptom of more generalized macro socioeconomical phenomena. The present challenges are in line with the new gig and green economies and changes in the global market, and their consequences on the solid waste sector. Continued efforts to strengthen the inclusion of social aspects of health into the complex interaction of the structural vulnerabilities met by e-recycling workers will be essential to anticipate and prevent health issues in this essential but still emerging workforce.

A Voltage-Sensitive Ultrasound Enhancing Agent for Myocardial Perfusion Imaging in a Rat Model

Echocardiographers with specialized expertise sometimes perform myocardial perfusion imaging using U.S. Food and Drug Administration-approved microbubbles in an off-label capacity, correlating microbubble replenishment in the near field with blood flow through the myocardium. This study reports the in vivo clinical feasibility of a voltage-sensitive ultrasound enhancing agent (UEA) for myocardial perfusion imaging. Four UEAs were injected into Sprague-Dawley rats while ultrasound images were collected to quantify brightness in the left ventricular (LV) cavity, septal wall, and posterior wall in systole and diastole. Formulation IV, a phase change agent nested within a negatively charged phospholipid bilayer, increased the tissue-to-cavity ratio in both systole and diastole in the septal wall, 6 dB, and in the posterior wall, 5 dB, while leaving the LV cavity at baseline. This outcome improves the signal of the myocardium relative to the LV cavity and shows promise as a myocardial perfusion UEA.

An Ultrasound Enhancing Agent with Nonlinear Acoustic Activity that Depends on the Presence of an Electric Field

The nonlinear acoustic properties of microbubble ultrasound enhancing agents have allowed for the development of subharmonic, second harmonic, and contrast-pulse sequence ultrasound imaging modes, which enhance the quality, reduce the noise, and improve the diagnostic capabilities of clinical ultrasound. This study details acoustic scattering responses of perfluorobutane (PFB) microbubbles, an un-nested perfluoropentane (PFP) nanoemulsion, and two nested PFP nanoemulsions-one comprising a negatively charged phospholipid bilayer and another comprising a zwitterionic phospholipid bilayer-when excited at 1 or 2.25 MHz over a peak negative pressure range of 200 kPa to 4 MPa in the absence and presence of a 1-Hz, 1-V/cm electric field. The only sample that exhibited an increase in nonlinear activity in the presence of an electric field at both excitation frequencies was the negatively charged nested PFP nanoemulsion; the most pronounced effect was observed at an excitation of 2.25 MHz. Interestingly, the application of an electric field not only increased the nonlinear acoustic activity of the negatively charged nested PFP nanoemulsion but increased it beyond that seen when the nanoemulsion is un-nested and on the same scale as PFB microbubbles.

Eliminating Take-Home Exposures: Recognizing the Role of Occupational Health and Safety in Broader Community Health

Toxic contaminants inadvertently brought from the workplace to the home, known as take-home or paraoccupational exposures, have often been framed as a problem that arises due to unsanitary worker behavior. This review article conceptualizes take-home exposures as a public health hazard by (i) investigating the history of take-home contaminants and how they have been studied, (ii) arguing that an ecosocial view of the problem is essential for effective prevention, (iii) summarizing key structural vulnerabilities that lead populations to be at risk, and (iv) discussing future research and prevention effort needs. This article reframes take-home exposures as one of many chronic pathways that contributes to persistent health disparities among workers, their families, and communities. Including the role of work in community health will increase the comprehensiveness of prevention efforts for contaminants such as lead and pesticides that contribute to environmental disparities.

Work experiences of Latino building cleaners: An exploratory study

BACKGROUND

There are roughly 3.8 million cleaning workers in the United States. The cleaning workforce is largely composed of women, immigrants, and ethnic minorities who receive low wages and have low education levels. They are exposed to physical, chemical, biological, and psychosocial hazards.

METHODS

Qualitative methodology was used to investigate how Latino immigrants experience work as building cleaners. A grounded theory coding approach was used to analyze focus group data from 77 participants.

RESULTS

Three major themes were identified: economic vulnerability, psychosocial stressors, and health and safety effects. Although workers are aware of the safety hazards associated with their jobs, they believe their immigration status limits employment opportunities leading them to accept poor working conditions. They work through injuries and cope psychologically through minimizing negative health impacts and normalizing work-related injuries and illnesses.

CONCLUSIONS

The findings suggest that interventions for these workers should recognize the hostile organizational and psychosocial contexts within which immigrants often work.

Evaluation of toolbox safety training in construction: The impact of narratives

BACKGROUND

Construction is a dangerous industry with a large number of small businesses. Because they require minimal resources to deliver, toolbox talks may be an ideal training format for small construction contractors.

METHODS

Eight toolbox talks were developed, each with two versions. One version of each toolbox talk was standard and one version included a narrative and discussion questions. Participants were randomly assigned to receive the standard or the narrative version. Pre- and post-intervention surveys measured demographics, workplace safety climate, and knowledge. The post-intervention survey also measured training impact.

RESULTS

Including narratives with discussion questions significantly increased knowledge gain and led to increased training impact. Less experienced workers were more likely to gain knowledge and training impact compared to more experienced workers. There were no significant changes in workplace safety climate.

CONCLUSIONS

The results suggest that including a narrative and discussion questions increases toolbox talk effectiveness.

Exploring workplace TB interventions with foreign-born Latino workers

BACKGROUND

Persons born outside the United States are more likely to be diagnosed with tuberculosis disease (TB) than native-born individuals. Foreign-born Latinos at risk of TB may be difficult to reach with public health interventions due to cultural and institutional barriers. Workplaces employing large concentrations of foreign-born Latinos may be useful locations for TB interventions targeting this high-risk population.

METHOD

This study used a two-phase approach to investigate the feasibility of workplace TB interventions. The first phase investigated employer knowledge of TB and receptiveness to allowing TB interventions in their businesses through 5 structured interviews. The second phase investigated foreign-born workers' knowledge of TB and their receptiveness to receiving TB interventions in their places of employment through 12 focus groups stratified by gender and education.

RESULTS

Phase 1: Only 1 of the 5 employers interviewed had a high level of knowledge about TB, and three had no knowledge other than that TB was a disease that involved coughing. They were receptive to workplace TB interventions, but were concerned about lost productivity and customers finding out if an employee had TB. Phase 2: There was no observed differences in responses between gender and between the bottom two education groups, so the final analysis took place between a gender-combined lower education group and higher education group. The higher education group tended to have knowledge that was more accurate and to view TB as a disease associated with poverty. The lower education group tended to have more misconceptions about TB and more often expressed concern that their employers would not support worksite interventions.

CONCLUSIONS

The results from both phases indicate that more TB education is needed among both foreign-born Latino workers and their employers. Obstacles to implementing workplace TB interventions include knowledge, potential productivity loss, employer liability, and perceived customer response.

Differences in safety training among smaller and larger construction firms with non-native workers: Evidence of overlapping vulnerabilities

Collaborative efforts between the National Institute for Occupational Safety and Health (NIOSH) and the American Society of Safety Engineers (ASSE) led to a report focusing on overlapping occupational vulnerabilities, specifically small construction businesses employing young, non-native workers. Following the report, an online survey was conducted by ASSE with construction business representatives focusing on training experiences of non-native workers. Results were grouped by business size (50 or fewer employees or more than 50 employees). Smaller businesses were less likely to employ a supervisor who speaks the same language as immigrant workers (p < .001). Non-native workers in small businesses received fewer hours of both initial safety training (p = .005) and monthly ongoing safety training (p = .042). Immigrant workers in smaller businesses were less likely to receive every type of safety training identified in the survey (including pre-work safety orientation [p < .001], job-specific training [p < .001], OSHA 10-hour training [p = .001], and federal/state required training [p < .001]). The results highlight some of the challenges a vulnerable worker population faces in a small business, and can be used to better focus intervention efforts. Among businesses represented in this sample, there are deflcits in the amount, frequency, and format of workplace safety and health training provided to non-native workers in smaller construction businesses compared to those in larger businesses. The types of training conducted for non-native workers in small business were less likely to take into account the language and literacy issues faced by these workers. The findings suggest the need for a targeted approach in providing occupational safety and health training to non-native workers employed by smaller construction businesses.

Has the question of e-waste opened a Pandora's box? An overview of unpredictable issues and challenges

Despite regulatory efforts and position papers, electrical and electronic waste (e-waste) remains ill-managed as evidenced by the extremely low rates of proper e-waste recycling (e-recycling) worldwide, ongoing illegal shipments to developing countries and constantly reported human health issues and environmental pollution. The objectives of this review are, first, to expose the complexity of e-waste problems, and then to suggest possible upstream and downstream solutions. Exploring e-waste issues is akin to opening a Pandora's box. Thus, a review of prevailing e-waste management practices reveals complex and often intertwined gaps, issues and challenges. These include the absence of any consistent definition of e-waste to date, a prevalent toxic potential still involving already banned or restricted hazardous components such as heavy metals and persistent and bioaccumulative organic compounds, a relentless growth in e-waste volume fueled by planned obsolescence and unsustainable consumption, problematic e-recycling processes, a fragile formal e-recycling sector, sustained and more harmful informal e-recycling practices, and more convoluted and unpredictable patterns of illegal e-waste trade. A close examination of the e-waste legacy contamination reveals critical human health concerns, including significant occupational exposure during both formal and informal e-recycling, and persistent environmental contamination, particularly in some developing countries. However, newly detected e-waste contaminants as well as unexpected sources and environmental fates of contaminants are among the emerging issues that raise concerns. Moreover, scientific knowledge gaps remain regarding the complexity and magnitude of the e-waste legacy contamination, specifically, a comprehensive characterization of e-waste contaminants, information on the scale of legacy contamination in developing countries and on the potential environmental damage in developed countries, and a stronger body of evidence of adverse health effects specifically ascribed to e-waste contaminants. However, the knowledge accumulated to date is sufficient to raise awareness and concern among all stakeholders. Potential solutions to curb e-waste issues should be addressed comprehensively, by focusing on two fronts: upstream and downstream. Potential upstream solutions should focus on more rational and eco-oriented consumer habits in order to decrease e-waste quantities while fostering ethical and sustained commitments from manufacturers, which include a limited usage of hazardous compounds and an optimal increase in e-waste recyclability. At the downstream level, solutions should include suitable and pragmatic actions to progressively reduce the illegal e-waste trade particularly through international cooperation and coordination, better enforcement of domestic laws, and monitoring in both exporting and receiving countries, along with the supervised integration of the informal sector into the recycling system of developing countries and global expansion of formal e-waste collection and recycling activities. Downstream solutions should also introduce stronger reverse logistics, together with upgraded, more affordable, and eco-friendly and worker-friendly e-recycling technologies to ensure that benefits are derived fully and safely from the great economic potential of e-waste.

Promotion of alternative-sized personal protective equipment

INTRODUCTION

With more diversity in the workforce, companies are producing PPE such as hard hats, safety glasses, coveralls, foot protection, and safety harnesses for a larger range of body shapes and sizes. However, gray literature reports suggest that barriers exist to getting alternate sized PPE from the manufacturer to the workers who need it. The purpose of this study is to determine the extent to which alternative-sized PPE is marketed.

METHOD

A web-based review of seven major manufacturers of PPE was conducted to determine: (a) whether or not they offer alternative-sized products, (b) if these products are clearly labeled, and (c) if images used to display PPE are representative of a diverse workforce.

RESULTS

Of the seven PPE manufacturers investigated, six had at least one product that was marketed as gender and/or size alternatives however, alternative sizes were more common for larger body types. Alternative-sized products rarely included size charts, and the models used to display PPE were overwhelmingly white males of average size.

CONCLUSIONS

Despite the growing availability of alternative-sized PPE, it can be difficult to find these products, which suggests that they are rarely promoted or labeled as alternative-sized. Our study indicates that companies should expand their product lines and more aggressively market and promote these items. Guidance on how to properly fit their products would also be extremely helpful to the end-user.

PRACTICAL APPLICATIONS

Manufacturers could improve the availability of alternative-sized PPE and increase their promotion of these products on their websites and in their catalogs. Individual companies and safety professionals may assist in this process by demonstrating demand for alternative-sized PPE.

Tailoring Computer-Based Training for Latino Immigrant Workers: Pilot Test of the NIOSH Mouse Tutorial

An interactive tutorial on using a mouse for first-time computer users was developed as part of a training CD-ROM tailored for Latino immigrant workers in trenching and excavation. It was designed for Spanish-speaking users with varying levels of formal education. The tutorial was tested in focus groups with workers who had little or no previous experience using a computer. Findings revealed that while users with less than a fourth-grade education and/or low proficiency in Spanish had some difficulties with the tutorial, they still scored above 67 percent on the performance evaluation; participants with at least a fourth-grade education (the majority) completed it with minimal assistance and scored 80%-100% on the performance evaluation. Feedback from participant focus groups following the computer sessions supported these findings. The results of this study suggest that computer-based training may be able to be made accessible for low computer literacy Latino immigrant workers, if it is tailored to their needs.

Leveraging the Domain of Work to Improve Migrant Health

Work is a principal driver of current international migration, a primary social determinant of health, and a fundamental point of articulation between migrants and their host society. Efforts by international organizations to promote migrant health have traditionally focused on infectious diseases and access to healthcare, while international labor organizations have largely focused on issues of occupational health. The underutilization of the domain of work in addressing the health of migrants is truly a missed opportunity for influencing worker well-being and reducing societal economic burden. Understanding of the relationships among migration, work, and health would facilitate further integration of migrant health concerns into the policy agenda of governments and international agencies that work at the nexus of labor, health and development. The domain of work offers an opportunity to capitalize on the existing health and development infrastructure and leverage technical resources, programs and research to promote migrant health. It also provides the opportunity to advance migrant health through new and innovative approaches and partnerships.

Undocumented status as a social determinant of occupational safety and health: The workers' perspective

BACKGROUND

Undocumented immigration to the United States has grown dramatically over the past 25 years. This study explores undocumented status as a social determinant of occupational health by examining its perceived consequences on workplace safety of Latino immigrants.

METHODS

Guided by the Theory of Work Adjustment, qualitative analysis was conducted on transcripts from focus groups and individual interviews conducted with a convenience sample of Latino immigrant workers.

RESULTS

Participants reported that unauthorized status negatively impacted their safety at work and resulted in a degree of alienation that exceeded the specific proscriptions of the law. Participants overwhelming used a strategy of disengagement to cope with the challenges they face as undocumented immigrants.

CONCLUSION

This study describes the complex web of consequences resulting from undocumented status and its impact on occupational health. This study presents a framework connecting the daily work experiences of immigrants, the coping strategy of disengagement, and efforts to minimize the impact of structural violence.

Improving occupational safety and health among Mexican immigrant workers: a binational collaboration

Latino immigrants are 50% more likely than all workers in the United States to experience a fatal injury at work. Occupational safety and health (OSH) organizations often find that the approaches and networks they successfully use to promote OSH among U.S.-born workers are ineffective at reaching Latino immigrants. This article describes the collaboration between the National Institute for Occupational Safety and Health (NIOSH) and the Mexican Ministry of Foreign Affairs (Secretaría de Relaciones Exteriores) to promote OSH among Mexican immigrant workers. The Ministry of Foreign Affairs operates 50 consulates throughout the U.S. that provide four million discrete service contacts with Mexican citizens annually. The focus of this ongoing collaboration is to develop the internal capacity of Mexican institutions to promote OSH among Mexican immigrants while simultaneously developing NIOSH's internal capacity to create effective and sustainable initiatives to better document and reduce occupational health disparities for Mexican immigrants in the U.S.

Immigration, Work, and Health: A Literature Review of Immigration Between Mexico and the United States

Understanding the influence someone's job or career has on their health goes beyond the physical, emotional and social hazards, risks and conditions that they face at work. One's job or career also exerts a significant influence over other aspects of life that contribute or detract from their health and that of their family. Work is the major incentive for Latin American migration to the United States. Latino immigrants experience increasingly poorer outcomes for physical health and chronic diseases the longer they remain in the U.S. The strong link between work and immigration suggests that, for many Latin Americans, immigration can be understood as a career path which puts them, and their family members, in situations that can change their physical, emotional, and social health as a condition of their employment. Given the large number of Latin Americans who emigrate for work, it is essential that the unique physical, mental and social impacts of emigration are accounted for when working with clients impacted by emigration at the individual, family and community level as well as those social workers practicing at the system level. This paper is a literature review that explores the impact that emigrating for work has on the health of those that emigrate and their family members that stay behind.

Trench Safety-Using a Qualitative Approach to Understand Barriers and Develop Strategies to Improve Trenching Practices

Despite efforts to ensure workplace safety and health, injuries and fatalities related to trenching and excavation remain alarmingly high in the construction industry. Because properly installed trenching protective systems can potentially reduce the significant number of trenching fatalities, there is clearly a need to identify the barriers to the use of these systems and to develop strategies to ensure these systems are utilized consistently. The current study reports on the results of focus groups with construction workers and safety management personnel to better understand these barriers and to identify solutions. The results suggest several factors, from poor planning to pressures from experienced workers and supervisors, which present barriers to safe trenching practices. Based on the results, it is recommended that safety trainings incorporate unique messages for new workers, experienced workers and management in an effort to motivate each group to work safely as well as provide them with solutions to overcome the identified barriers.

Work Experiences of Latina Immigrants: A Qualitative Study

Almost half of the Latino immigrants working in the United States are women. However, studies concerning the work experiences of Latinas are almost absent in the literature. This article reports the findings from a qualitative study using eight focus groups (n = 53) of Latina immigrant workers. The focus group transcripts were analyzed using the grounded theory approach in which themes emerge from iterative readings of the transcripts by a group of investigators. This study identified themes related to excessive workload, familiar work/unfamiliar hazards, cultural tensions, lack of health care, pregnancy, sexual harassment, and family obligations/expectations. The responses of the Latina workers in this study clearly indicated that they live within a complex web of stressors, both as workers and as women. The increased economic opportunities that come with immigration to the United States are accompanied by many opportunities for exploitation, especially if they are undocumented. It is hoped that the findings of this study will raise awareness regarding these issues and spur further work in this area.

Applying the Theory of Work Adjustment to Latino Immigrant Workers: An Exploratory Study

Blustein mapped career decision making onto Maslow's model of motivation and personality and concluded that most models of career development assume opportunities and decision-making latitude that do not exist for many individuals from low income or otherwise disadvantaged backgrounds. Consequently, Blustein argued that these models may be of limited utility for such individuals. Blustein challenged researchers to reevaluate current career development approaches, particularly those assuming a static world of work, from a perspective allowing for changing circumstances and recognizing career choice can be limited by access to opportunities, personal obligations, and social barriers. This article represents an exploratory effort to determine if the theory of work adjustment (TWA) might meaningfully be used to describe the work experiences of Latino immigrant workers, a group living with severe constraints and having very limited employment opportunities. It is argued that there is significant conceptual convergence between Maslow's hierarchy of needs and the work reinforcers of TWA. The results of an exploratory, qualitative study with a sample of 10 Latino immigrants are also presented. These immigrants participated in key informant interviews concerning their work experiences both in the United States and in their home countries. The findings support Blustein's contention that such workers will be most focused on basic survival needs and suggest that TWA reinforcers are descriptive of important aspects of how Latino immigrant workers conceptualize their jobs.

Longitudinal study of effects of alcohol use and/or personal exercise on high density lipoprotein cholesterol in aging humans

Self-controlled alcohol use and/or personal physical exercise is generally believed to be advantageous in extending good health in aging humans. We investigated whether data collected over 31 years in the same subjects (369 men, 75 women) in our Longitudinal Aging Study of humans (1969-2000) showed strong relationship between alcohol and/or physical exercise with High Density Lipoprotein Cholesterol (HDLC). Women s HDLC interactions among age, diet, alcohol use and/or exercise were not found to be statistically significant in our study. Men, however, showed a strong positive statistical significance (p<or= 0.0001) among alcohol, personal physical exercise and HDLC.

Cardiovascular complications of weight reduction diets

Weight reduction diets may reduce the severity of risk factors for coronary heart disease such as diabetes mellitus, hypertension, and dyslipidemia. Several case reports and small studies of patients receiving starvation diets have reported hypotension and sudden cardiac death. Myofibrillar damage was documented in 1 case. Very-low-calorie diets are generally safe and well-tolerated. However, low QRS voltage, QT interval prolongation, and both nonsustained ventricular arrhythmias and sudden cardiac death have been described in subjects treated with such diets. Orthostatic hypotension may complicate very-low-calorie protein diets because of sodium depletion and depressed sympathetic nervous system activity. Bariatric surgery is associated with disproportionately high mortality rates in both the perioperative and postoperative periods.

Facile entry to the tetracyclic 5-7-6-3 tigliane ring system

[figure: see text] A tandem anionic 5-exo-dig cyclization/Claisen rearrangement sequence was used to effect a facile, "one-pot" conversion of an appropriately substituted 4-alkyn-1-ol to the tetracyclic carbon core structure of phorbol. The synthesis was conducted using readily available nonracemic starting materials to provide the target structure as a single enantiomer in high chemical yield.

Electromagnetic guidance for catheter-based transendocardial injection: a platform for intramyocardial angiogenesis therapy. Results in normal and ischemic porcine models

OBJECTIVES

To test the feasibility of myocardial angiogenic gene expression using a novel catheter-based transendocardial injection system.

BACKGROUND

Angiogenesis has been induced by direct injection of growth factors into ischemic myocardium during open-heart surgery. Catheter-based transendocardial injection of angiogenic factors may provide equivalent benefit without need of surgery.

METHODS

A new guidance system for intramyocardial therapy utilizes magnetic fields and catheter-tip sensors to locate a position in space and reconstruct three-dimensional left ventricular (LV) electromechanical maps without using fluoroscopy. A retractable 27G needle was coupled with the guidance system for LV transendocardial injection. In 12 pigs, the catheter was used to inject 0.1 ml of methylene-blue (MB) dye and 8 pigs had myocardial injections of adenoviral vector (1 x 10(10) particles per site) containing the LacZ transgene. Ten pigs underwent catheter-based transendocardial injection and six pigs were injected using transepicardial approach with the gene encoding adenovirus vascular endothelial growth factor-121 (Ad.VEGF121; 1 x 10(10) viral particles x 6 sites) and sacrificed at 24 h. Injection sites were identified with ultraviolet light by coinjection of fluorescent beads.

RESULTS

Overall, 138 of 152 attempted injection MB tracks (91%) were found after sacrifice. Tissue staining was 7.1+/-2.1 mm in depth and 2.3+/-1.8 mm in width. No animal had pericardial effusion or tamponade. In Ad.LacZ injected animals, gross pathology showed positive staining in injected zones, and histology confirmed positive myocyte staining. Adenovirus vascular endothelial growth factor-121 injected sites showed high levels of VEGF121 production that was of similar magnitude whether injected using the transendocardial (880.4+/-412.2 pg VEGF121/mg protein) or transepicardial (838.3+/-270 pg VEGF121/mg protein) delivery approach (p = 0.62).

CONCLUSIONS

Using this magnetic guidance catheter-based navigational system, transgenes can effectively be transfected into designated myocardial sites. Thus, if it is determined that direct intramyocardial injection of angiogenic factors enhances collateral function in patients, this less invasive catheter-based system offers a similar gene delivery efficiency and, thus, may have clear advantages compared with the surgically-based transepicardial injection approach.

Use of fluorescent microspheres to localize in vivo gene transfer injection sites

The potential for using gene therapy to treat a variety of disease states is growing rapidly. Many vector types and delivery systems have been developed that allow the optimization of protein production levels and kinetics for a given therapeutic gene product. In cases in which a transient, localized delivery of gene product is desired, any determination of the locale of transfected tissue by non-marker genes is problematic. We describe a technique by which the use of fluorescent microspheres can help in identifying potentially transfected tissue. Adenovirus containing the gene for beta-galactosidase (beta-gal) was mixed with fluorescent microspheres and injected into rat skeletal muscle and porcine myocardium. The injection sites could be visualized under ultraviolet light and correlated with beta-gal enzyme expression. This method is simple, inexpensive and generally useful for in vivo gene transfer experiments.

Butenolide endothelin antagonists with improved aqueous solubility

Continued development around our ETA-selective endothelin (ET) antagonist 1 (CI-1020) has led to the synthesis of analogues with improved aqueous solubility profiles. Poor solubility characteristics displayed by 1 required a complex buffered formulation in order to conduct iv studies. To overcome the use of specific iv formulations for preclinical studies on additional drug candidates, analogues with improved aqueous solubility were desired. Several analogues were synthesized with substitution patterns that allowed for the formation of either acid or base addition salts. These derivatives had dramatically improved aqueous solubility. In addition, these analogues retained equivalent or improved ETA receptor selectivity and antagonist potency, versus 1, both in vitro and in vivo. Compound 29, which contains as a substituent the sodium salt of a sulfonic acid, has an ETA IC50 = 0.38 nM, ETA selectivity of 4200-fold, and ETA functional activity of KB = 7.8, all of which are similar or superior to those of 1. Compound 29 also has vastly superior aqueous solubility and solubility duration, compared to 1. Furthermore, 29 after iv infusion displays improved activity to 1 in preventing acute hypoxia-induced pulmonary hypertension in rats with an ED50 = 0.3 microg/kg/h.

Dehydroepiandrosterone replacement in aging humans

Because so much medical and media attention has been drawn to the alleged benefits of dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS), it is important to evaluate the effects of replacement therapy objectively using double blind, cross-over, randomized research methodology. In this 9-month study, healthy older men (n = 39) received replacement dose DHEA. Lean body mass, blood hematology, chemistry and endocrine values, as well as urological and psychological data were measured. Data showed some mild and temporary, but significant, changes during oral use of 100 mg DHEA for 3 months compared with placebo taken for 3 months. Body composition did not change during the 6 months of treatment, nor did any urological parameters. Concomitant with the endocrine changes, some small but, significant, variations in blood values (blood urea nitrogen, creatinine, uric acid, alanine transaminase, cholesterol, high density lipoprotein, and potassium) were found. After cessation of DHEA and placebo, followed by 3 months of no treatment, all values previously found to be altered returned to entry baseline. Well publicized effects of the drug reported by others, such as a sense of well-being or improved sexual function, were not found in this study.

An approach to the development of food-based dietary guidelines for Ireland

The aim of the present study was to analyse the different food and nutrient intakes of the adult Irish population from the lowest and highest quartiles of intake for total fat (%energy) dietary fibre (g/MJ) and fruit and vegetables (g/day). Data on Irish adults (n = 715) from the Irish National Nutrition Survey conducted in 1989 were used for the analyses and showed that the average diet is low in dietary fibre, with fruit and vegetables being only half the recommended level of 400 g. Comparisons of people with low or high intakes (from lowest and highest quartiles) of total fat (%energy), dietary fibre (g/MJ) and fruit and vegetables (g/day) show patterns of food intake differing in both the percentage of consumers and in the mean intakes among consumers only. This analysis provides data which may be useful as a first step towards the development of food-based dietary guidelines for Ireland. In particular, the low intake of fruit and vegetables in the adult Irish population deserves special attention.

Avian osteoclast cells are stimulated to resorb calcified matrices by and possess receptors for leukotriene B4

Leukotriene B4 (LTB4) is elevated in inflammatory conditions and appears to be a potential mediator of inflammation. We have recently shown that this 5-lipoxygenase metabolite of arachidonic acid stimulates bone resorption in vitro and in vivo. In order to determine the mechanism whereby LTB4 causes bone resorption, avian osteoclasts were examined for the effects of LTB4 and for the presence of LTB4 receptors. Isolated avian osteoclast mononuclear precursor cells, which fuse in culture to form multinucleated cells, were chosen for receptor binding studies because this population is a morphologically similar source of osteoclasts, and large numbers of these cells can be obtained from egg-laying hens. Binding of LTB4 and activation would support the hypothesis of a direct effect of this compound on osteoclasts. LTB4 stimulated isolated avian osteoclasts to form resorption lacunae on calcified matrices and to increase their content of tartrate-resistant acid phosphatase (TRAP), a marker of activated osteoclasts. Receptor binding studies were performed at day 1, when the cells were mononuclear, at day 4, when mononuclear precursors were actively fusing, and at day 7, when fusion has slowed. Scatchard analysis of saturation binding data showed two classes of binding sites, a high- and low-affinity binding site with dissociation constants (KD) of 0.2-0.4 nM and 5. 6-24 nM. Association studies showed rapid binding of LTB4 to the cells within 10 minutes. These data show that LTB4 accelerates fusion and activates highly enriched populations of avian osteoclasts and that LTB4 receptors are present in this cell population.

Endothelin B receptors on human endothelial and smooth-muscle cells show equivalent binding pharmacology

We have described the pharmacologic profiles of endothelin B receptors in human endothelial cells and vascular and nonvascular smooth-muscle cells. First, by amplifying endothelin B receptor numbers through the use of phosphoramidon and intact cell-binding techniques, we demonstrated the presence of these receptors in human umbilical vein endothelial cells (100% endothelin B receptors), human aortic smooth-muscle cells (22% endothelin B, 78% endothelin A receptors), and human bronchial smooth-muscle cells (55% endothelin B, 45% endothelin A receptors) by using [125I]-endothelin-1 radioligand binding. The typical binding profiles of the endothelin B receptors were established through competition binding curve analysis with endothelin-1, endothelin-3, sarafotoxin 6c, and the endothelin A receptor-selective antagonist BQ-123. In the presence of BQ-123, a diverse group of antagonists, including PD 142893, BQ-788, SB 209670, and Ro 47-0203, were used to probe for binding differences indicative of multiple endothelin B-receptor subtypes. The results indicate a rank order of potency for the antagonists of BQ-788 > SB 209670 > PD 142893 > Ro 47-0203 for each cell line, and that between any of these human cell lines, measurements of [125I]-endothelin-1-binding antagonism for each of the four test compounds differed by less than twofold. Although this study cannot discount the possibility of more than one endothelin B-receptor subtype in humans, it does indicate that these tissues express receptors that show equivalent binding pharmacology.

The pursuit of thinness: a study of Dublin schoolgirls aged 15 y

Despite increasing trends in the prevalence of overweight and obesity, fatness phobia is common during female adolescence. This study has demonstrated a high level of dissatisfaction with body weight in a sample of Dublin schoolgirls aged 15 y. Of 420 subjects, 59% reported that they wanted to be slimmer and 68% had previously tried to lose weight. Contrary to expectations, overweight girls were not found to hold the monopoly on such dissatisfactions. Normal weight and even underweight girls also expressed a desire to be thinner and reported using unhealthy weight control practices including random avoidance of staple foods, fasting, smoking and purging, in their pursuit of the 'perfect' female figure. Obesity prevention programmes which target adolescent girls 'at risk' of overweight and obesity, must take cognizance of their profound fear of fatness, otherwise the use of harmful slimming strategies may be further increased as teenage girls frantically try to lose weight and to avoid the stigma associated with female fatness.