The Safe Home Care Intervention Study: Implementation Methods and Effectiveness Evaluation.

Home care (HC) aides experience numerous safety hazards in clients' homes; many hazards also put clients at risk. We hypothesized that safety coaching led by nurse managers (NMs) during their initial HC needs assessment could prompt clients to improve safety conditions in their homes. Following a 2-arm proof-of-concept intervention study design, intervention NMs used motivational interviewing (MI), facilitated by a safety handbook and video, to coach clients on home safety improvements. Control arm NMs performed intake assessments with no changes to usual practices. Intervention effectiveness was assessed by NMs and aides. Three HC agencies and two elder services contributed 35 intervention and 23 control homes. NMs coached 97% of clients and reported that 94% were engaged; 63% implemented improvements. NMs' and aides' assessments were consistent; homes with clients reported by NMs as resistant to safety changes had higher aides' hazard scores. Client coaching can be effective for improving HC safety.

A cohort study of retinal detachment among Swedish construction workers.

OBJECTIVE: Retinal detachment (RD) has been associated with exposure to heavy lifting. Many occupations within the construction industry are likely to involve lifting tasks. We investigated the association between occupational heavy lifting and rhegmatogenous RD in a retrospective cohort study of Swedish construction workers. METHODS: We studied Swedish construction workers who participated in an industry-wide health and safety program from 1971 to 1993. Individual occupation codes were linked to a job exposure matrix, assigning intensity of exposure to heavy lifting to each worker. The Swedish National Patient Register was used to identify cases of RD that occurred during follow-up through the end of 2012. We used Poisson regression modeling to calculate incidence rates of RD associated with heavy lifting, age and other covariates. A subcohort of those age ≤25 years at enrollment was studied to reduce bias from missing exposure information from work prior to enrollment. RESULTS: Of 256 241 construction workers, 17% were classified with high exposure to heavy lifting in their occupation. Within the cohort, 1588 cases of RD were identified. Average exposure intensity of heavy lifting was not associated with risk of RD. However, RD risk increased with increasing cumulative exposure to heavy lifting, both in the full cohort and subcohort of those who were ≤25 years old at entry into the construction-worker cohort. CONCLUSION: Construction workers' risk of RD appeared to increase with time spent exposed to heavy lifting.

Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification.

Objective: We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARCMonographs program. Methods: A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses. Results: Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I2) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14-2.20, 8%) for mesothelioma, 1.16 (1.08-1.26, 0%) for bladder cancer, 1.21 (1.12-1.32, 81%) for prostate cancer, 1.37 (1.03-1.82, 56%) for testicular cancer, 1.19 (1.07-1.32, 37%) for colon cancer, 1.36 (1.15-1.62, 83%) for melanoma, 1.12 (1.01-1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02-1.61, 40%) for thyroid cancer, and 1.09 (0.92-1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses. Conclusions: There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.

Targeting patients for early COVID-19 therapy; Pre-infection metabolic dysfunction, polycystic ovary syndrome and risk of severe disease in patients under 65: A Massachusetts community-based observational study.

INTRODUCTION: The demographics of those developing severe coronavirus disease (COVID-19) outcomes are shifting to younger patients. In an observational study utilizing electronic health records from a Massachusetts group medical practice, we identified 5025 patients with confirmed COVID-19 from March 1 to December 18, 2020. Of these, 3870 were under 65 years of age. We investigated the hypothesis that pre-infection metabolic or immunologic dysregulation including polycystic ovary syndrome (PCOS) increased risk of serious COVID-19 outcomes in patients under 65 years of age. MATERIALS AND METHODS: We compared those with COVID-19 related hospitalization or mortality to all other COVID-19 patients, using a case control approach. Using logistic regression and propensity score modeling, we evaluated risk of developing severe COVID-19 outcomes (hospitalization or death) in those with pre-infection comorbidities, metabolic risk factors, or PCOS. RESULTS: Overall, propensity score matched analyses demonstrated pre-infection elevated liver enzymes alanine aminotransferase (ALT) >40, aspartate aminotransferase (AST) >40 and blood glucose ≥215 mg/dL were associated with more severe COVID-19 outcomes, OR = 1.74 (95% CI 1.31, 2.31); OR = 1.98 (95% CI 1.52, 2.57), and OR = 1.55 (95% CI 1.08, 2.23) respectively. Elevated hemoglobin A1C or blood glucose levels were even stronger risk factors for severe COVID-19 outcomes among those aged < 65, OR = 2.31 (95% CI 1.14, 4.66) and OR = 2.42 (95% CI 1.29, 4.56), respectively. In logistic regression models, women aged < 65 with PCOS demonstrated more than a four-fold increased risk of severe COVID-19, OR 4.64 (95% CI 1.98, 10.88). CONCLUSION: Increased risk of severe COVID-19 outcomes in those < age 65 with pre-infection indicators of metabolic dysfunction heightens the importance of monitoring pre-infection indicators in younger patients for prevention and early treatment. The PCOS finding deserves further investigation. Meanwhile women who suffer from PCOS should be carefully evaluated and prioritized for earlier COVID-19 treatment and vaccination.

If Smoking Were Eliminated, Which US Counties Would Still Have High Rates of Smoking-Related Cancers?

OBJECTIVE: to characterize the county variability of the impact of smoking elimination on rates of smoking-related cancers and explore whether common environmental indices predicted which metropolitan counties would experience high rates of smoking-related cancers even after smoking was eliminated. METHODS: Surveillance, Epidemiology, and End Results Program (SEER) and Environmental Protection Agency (EPA) data were obtained. County level cancer rates for 257 metropolitan SEER counties, including the observed rates and those predicted after eliminating smoking, were derived via multilevel regression modeling and age standardized to the 2016 SEER population. Associations between the EPA's Environmental Quality Index (EQI) scores and "Low Benefit" counties (counties that remain above the top 20th percentile of post-smoking elimination incidence rates) were explored via logistic regression. RESULTS: Reductions in smoking-related cancer incidence ranged from 58.4 to 3.2%. The overall EQI (OR = 1.96, 95% CI [1.34, 2.86]) and the air quality index (OR = 5.99, 95% CI [3.20, 11.22]) scores predicted higher odds of being a "Low Benefit" county. CONCLUSIONS: Substantial inequities in the post-smoking elimination cancer rates were observed; air pollution appears to be a primary explanation for this. Cancer prevention in metropolitan counties with high levels of air pollution should prioritize pollution control at least as much as tobacco control.

MIND Diet and Cognitive Function in Puerto Rican Older Adults.

BACKGROUND: Healthy diets have been associated with better cognitive function. Socioeconomic factors including education, poverty, and job complexity may modify the relationship between diet and cognition. METHODS: We used adjusted linear mixed models to examine the association between long-term adherence to the Mediterranean-Dietary Approaches to Stop Hypertension - Intervention for Neurodegenerative Delay (MIND) diet and cognitive function over 8 years of follow-up in Puerto Rican adults residing in the Boston, MA area (aged 45-75 years at baseline). We also examined whether the MIND diet-cognition association was confounded or modified by socioeconomic measures. RESULTS: In both cross-sectional and longitudinal analyses the highest, versus lowest, MIND quintile was associated with better cognition function (ß = 0.093; 95% CI: 0.035, 0.152; p trend = .0019), but not with cognitive trajectory over 8 years. Education <=8th grade (ß = -0.339; 95% CI: 0.394, -0.286; p < .0001) and income-to-poverty ratio <120% (ß = -0.049; 95% CI: -0.092, -0.007; p = .024) were significantly associated with lower cognitive function, while higher job complexity (ß = 0.008; 95% CI: 0.006, 0.011; p < .0001) was associated with better cognition function. These variables acted as confounders, but not effect modifiers of the MIND-diet-cognitive function relationship. CONCLUSION: Adherence to the MIND diet was associated with better cognitive function at baseline and over 8 years of follow-up; however, MIND diet was not associated with 8-year cognitive trajectory. More studies are needed to better understand whether the MIND diet is protective against long-term cognitive decline.

Predicting COVID-19 Infected Individuals in a Defined Population from Wastewater RNA Data.

Wastewater surveillance of SARS-CoV-2 RNA has become an important tool for tracking the presence of the virus and serving as an early indicator for the onset of rapid transmission. Nevertheless, wastewater data are still not commonly used to predict the number of infected individuals in a sewershed. The main objective of this study was to calibrate a susceptible-exposed-infectious-recovered (SEIR) model using RNA copy rates in sewage (i.e., gene copies per liter times flow rate) and the number of SARS-CoV-2 saliva-test-positive infected individuals in a university student population that was subject to repeated weekly testing during the Spring 2021 semester. A strong correlation was observed between the RNA copy rates and the number of infected individuals. The parameter in the SEIR model that had the largest impact on calibration was the maximum shedding rate, resulting in a mean value of 7.72 log10 genome copies per gram of feces. Regressing the saliva-test-positive infected individuals on predictions from the SEIR model based on the RNA copy rates yielded a slope of 0.87 (SE=0.11), which is statistically consistent with a 1:1 relationship between the two. These findings demonstrate that wastewater surveillance of SARS-CoV-2 can be used to estimate the number of infected individuals in a sewershed.

COVID-19 wastewater epidemiology: a model to estimate infected populations.

BACKGROUND: Wastewater-based epidemiology provides an opportunity for near real-time, cost-effective monitoring of community-level transmission of SARS-CoV-2. Detection of SARS-CoV-2 RNA in wastewater can identify the presence of COVID-19 in the community, but methods for estimating the numbers of infected individuals on the basis of wastewater RNA concentrations are inadequate. METHODS: This is a wastewater-based epidemiology study using wastewater samples that were collected weekly or twice a week from three sewersheds in South Carolina, USA, between either May 27 or June 16, 2020, and Aug 25, 2020, and tested for SARS-CoV-2 RNA. We developed a susceptible-exposed-infectious-recovered (SEIR) model based on the mass rate of SARS-CoV-2 RNA in the wastewater to predict the number of infected individuals, and have also provided a simplified equation to predict this. Model predictions were compared with the number of confirmed cases identified by the Department of Health and Environmental Control, South Carolina, USA, for the same time period and geographical area. FINDINGS: We plotted the model predictions for the relationship between mass rate of virus release and numbers of infected individuals, and we validated this prediction on the basis of estimated prevalence from individual testing. A simplified equation to estimate the number of infected individuals fell within the 95% confidence limits of the model. The rate of unreported COVID-19 cases, as estimated by the model, was approximately 11 times that of confirmed cases (ie, ratio of estimated infections for every confirmed case of 10·9, 95% CI 4·2-17·5). This rate aligned well with an independent estimate of 15 infections for every confirmed case in the US state of South Carolina. INTERPRETATION: The SEIR model provides a robust method to estimate the total number of infected individuals in a sewershed on the basis of the mass rate of RNA copies released per day. This approach overcomes some of the limitations associated with individual testing campaigns and thereby provides an additional tool that can be used to inform policy decisions. FUNDING: Clemson University, USA.

Paracetamol use during pregnancy - a call for precautionary action.

Paracetamol (N-acetyl-p-aminophenol (APAP), otherwise known as acetaminophen) is the active ingredient in more than 600 medications used to relieve mild to moderate pain and reduce fever. APAP is widely used by pregnant women as governmental agencies, including the FDA and EMA, have long considered APAP appropriate for use during pregnancy when used as directed. However, increasing experimental and epidemiological research suggests that prenatal exposure to APAP might alter fetal development, which could increase the risks of some neurodevelopmental, reproductive and urogenital disorders. Here we summarize this evidence and call for precautionary action through a focused research effort and by increasing awareness among health professionals and pregnant women. APAP is an important medication and alternatives for treatment of high fever and severe pain are limited. We recommend that pregnant women should be cautioned at the beginning of pregnancy to: forego APAP unless its use is medically indicated; consult with a physician or pharmacist if they are uncertain whether use is indicated and before using on a long-term basis; and minimize exposure by using the lowest effective dose for the shortest possible time. We suggest specific actions to implement these recommendations. This Consensus Statement reflects our concerns and is currently supported by 91 scientists, clinicians and public health professionals from across the globe.

Commercial Fishing as an Occupational Determinant of Opioid Overdoses and Deaths of Despair in Two Massachusetts Fishing Ports, 2000-2014.

The opioid epidemic has had disproportionate effects across various sectors of the population, differentially impacting various occupations. Commercial fishing has among the highest rates of occupational fatalities in the United States. This study used death certificate data from two Massachusetts fishing ports to calculate proportionate mortality ratios of fatal opioid overdose as a cause of death in commercial fishing. Statistically significant proportionate mortality ratios revealed that commercial fishermen were greater than four times more likely to die from opioid poisoning than nonfishermen living in the same fishing ports. These important quantitative findings suggest opioid overdoses, and deaths to diseases of despair in general, deserve further study in prevention, particularly among those employed in commercial fishing.

Effects of precarious work on symptomatology of anxiety and depression in Chilean workers, a cross sectional study.

BACKGROUND: Precarious work is a broad definition for non-standard employment, often including unstable and insecure positions where workers permanently experience uncertainty; these types of jobs are growing steadily around the planet. Since the coup d'état in 1973, Chile has experienced a series of structural economic changes framed by neoliberal ideas cemented in the "Constitution of Pinochet." Precarious work in Chile is a direct consequence of these ideas. This multidimensional phenomenon has progressively been entering employment areas where it was not previously present. As a result, there has been a rise in work precarization and its full impact on health is not well known. The goal of this study was to estimate the association of work precariousness with mental health outcomes in Chilean workers. METHODS: Data were obtained from the Chilean Survey of Work and Health 2009-2010 (ENETS). Only valid records of salaried workers (excluding hourly-only or commission-only workers) in the private sector without missing values were included (n = 1900). After applying appropriate sampling weights, 1,461,727 workers were represented. Mental health was estimated as anxiety/depression levels using the 12-item General Health Questionnaire (GHQ-12). A multilevel multivariate generalized linear mixed model (GLMM) with negative binomial and log link distribution was used to study the association between precariousness and depression/anxiety. RESULTS: Looking at the overall precariousness scale (range from zero to four), we observed an increase of approximately 34% in the depression/anxiety score (scale range from 0 to 36) for every unit on the precarious work overall scale (Relative Risk = 1.34, 95% CI = 1.28, 1.42) controlling for age, sex, and occupational group. CONCLUSION: Precarious work was associated with anxiety and depression as measured with the 12-item General Health Questionnaire. Controlling for demographic variables changed neither the direction nor the magnitude of the association.

The Contribution of Occupation-Specific Factors to the Deaths of Despair, Massachusetts, 2005-2015.

OBJECTIVES: In the USA, deaths from poisonings (especially opioids), suicides, and alcoholic liver disease, collectively referred to as 'deaths of despair', have been increasing rapidly over the past two decades. The risk of deaths from these causes is known to be higher among certain occupations. It may be that specific exposures and experiences of workers in these occupations explain these differences in risk. This study sought to determine whether differences in the risk of deaths of despair were associated with rate of occupational injuries and illnesses, job insecurity, and temporal changes in employment in non-standard work arrangements. METHODS: Usual occupation information was collected from death certificates of Massachusetts residents aged 16-64 with relevant causes of death between 2005 and 2015. These data were combined with occupation-level data about occupational injuries and illnesses, job insecurity, and non-standard work arrangements. We calculated occupation-specific mortality rates for deaths of despair, categorized by occupational injury and illnesses rates and job insecurity. We calculated trends in mortality according to changes in non-standard work arrangements. RESULTS: Workers in occupations with higher injury and illnesses rates and more job insecurity had higher rates of deaths of despair, especially opioid-related deaths. Rates of deaths of despair increased most rapidly for occupations with increasing prevalence of workers employed in non-standard work arrangements. CONCLUSIONS: The findings suggest occupational factors that may contribute to the risk of deaths of despair. Future studies should examine these factors with individual-level data. In the meantime, efforts should be made to address these factors, which also represent known or suspected hazards for other adverse health outcomes.

COVID-19 deaths by occupation, Massachusetts, March 1-July 31, 2020.

BACKGROUND: Exposure to COVID-19 is more likely among certain occupations compared with others. This descriptive study seeks to explore occupational differences in mortality due to COVID-19 among workers in Massachusetts. METHODS: Death certificates of those who died from COVID-19 in Massachusetts between March 1 and July 31, 2020 were collected. Occupational information was coded and age-adjusted mortality rates were calculated according to occupation. RESULTS: There were 555 deaths among MA residents of age 16-64, with usable occupation information, resulting in an age-adjusted mortality rate of 16.4 per 100,000 workers. Workers in 11 occupational groups including healthcare support and transportation and material moving had mortality rates higher than that for workers overall. Hispanic and Black workers had age-adjusted mortality rates more than four times higher than that for White workers overall and also had higher rates than Whites within high-risk occupation groups. CONCLUSION: Efforts should be made to protect workers in high-risk occupations identified in this report from COVID-19 exposure.

Hypertension, medications, and risk of severe COVID-19: A Massachusetts community-based observational study.

It remains uncertain whether the hypertension (HT) medications angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) mitigate or exacerbate SARS-CoV-2 infection. We evaluated the association of ACEi and ARB with severe coronavirus disease 19 (COVID-19) as defined by hospitalization or mortality among individuals diagnosed with COVID-19. We investigated whether these associations were modified by age, the simultaneous use of the diuretic thiazide, and the health conditions associated with medication use. In an observational study utilizing data from a Massachusetts group medical practice, we identified 1449 patients with a COVID-19 diagnosis. In our study, pre-infection comorbidities including HT, cardiovascular disease, and diabetes were associated with increased risk of severe COVID-19. Risk was further elevated in patients under age 65 with these comorbidities or cancer. Twenty percent of those with severe COVID-19 compared to 9% with less severe COVID-19 used ACEi, 8% and 4%, respectively, used ARB. In propensity score-matched analyses, use of neither ACEi (OR = 1.30, 95% CI 0.93 to 1.81) nor ARB (OR = 0.94, 95% CI 0.57 to 1.55) was associated with increased risk of severe COVID-19. Thiazide use did not modify this relationship. Beta blockers, calcium channel blockers, and anticoagulant medications were not associated with COVID-19 severity. In conclusion, cardiovascular-related comorbidities were associated with severe COVID-19 outcomes, especially among patients under age 65. We found no substantial increased risk of severe COVID-19 among patients taking antihypertensive medications. Our findings support recommendations against discontinuing use of renin-angiotensin system (RAS) inhibitors to prevent severe COVID-19.