Using advanced racial and ethnic identity demographics to improve surveillance of work-related conditions in an occupational clinic setting.

BACKGROUND: Although racial and ethnic identities are associated with a multitude of disparate medical outcomes, surveillance of these subpopulations in the occupational clinic setting could benefit enormously from a more detailed and nuanced recognition of racial and ethnic identity. METHODS: The research group designed a brief questionnaire to capture several dimensions of this identity and collected data from patients seen for work-related conditions in four occupational medicine clinics from May 2019 through March 2020. Responses were used to calculate the sensitivity and specificity of extant racial/ethnic identity data within our electronic health records system, and were compared to participants' self-reported industry and occupation, coded according to North American Industry Classification System and Standard Occupational Classification System listings. RESULTS: Our questionnaire permitted collection of data that defined our patients' specific racial/ethnic identity with far greater detail, identified patients with multiple ethnic identities, and elicited their preferred language. Response rate was excellent (94.2%, n = 773). Non-White participants frequently selected a racial/ethnic subcategory (78.1%-92.2%). Using our race/ethnicity data as a referent, the electronic health record (EHR) had a high specificity (>87.1%), widely variable sensitivity (11.8%-82.2%), and poorer response rates (75.1% for race, 82.5% for ethnicity, as compared to 93.8% with our questionnaire). Additional analyses revealed some industries and occupations disproportionately populated by patients of particular racial/ethnic identities. CONCLUSIONS: Our project demonstrates the usefulness of a questionnaire which more effectively identifies racial/ethnic subpopulations in an occupational medicine clinic, permitting far more detailed characterization of their occupations, industries, and diagnoses.

Cardiorespiratory Fitness of Firefighters: Initial Results of a Multi-Phased Study.

OBJECTIVE: To address which body composition (BC) measures best correlate with cardiorespiratory fitness (CRF) in firefighters and develop a model for accurate CRF estimation compared with traditional methods. METHODS: Career firefighters had body mass index (BMI) and waist circumference (WC) measured in addition to body fat percentage (FM%) by dual-energy x-ray absorptiometry (DXA). CRF as maximum oxygen uptake (VO2max) was estimated by rowing machine and measured by indirect calorimetry in a treadmill exercise test. RESULTS: Fifty two firefighters participated (92.3% men). Univariate correlations with BMI were best with WC. Univariate correlations with VO2max were best with FM%. Obesity classifications by BC measures agreed weakly at best. Multivariate analysis of several variables yielded an improved VO2max estimate (R2 = 0.70). CONCLUSIONS: Fire departments may benefit from more sophisticated measures of BC and CRF to evaluate firefighter fitness.

Occupational medicine clinical practice data reveal increased injury rates among Hispanic workers.

BACKGROUND: Minnesota has an ethnically diverse labor force, with the largest number of refugees per capita in the United States. In recent years, Minnesota has been and continues to be a major site for immigrant and refugee resettlement in the United States, with a large population of both immigrant and native born Hmong, Hispanic, and East Africans. This study seeks to evaluate the injury risk among the evolving minority workforce in the Minnesota Twin Cities region. METHODS: A retrospective cohort study identifying work-related injuries following pre-employment examinations was performed using electronic health records from a large multi-clinic occupational medicine practice. Preplacement examinations and subsequent work-related injuries were pulled from the electronic health record using representative ICD-10 codes for surveillance examinations and injuries. This study included patient records collected over a 2-year period from January 1, 2015, through December, 2016. The patients in this cohort worked in a wide-array of occupations including production, assembly, construction, law enforcement, among others. RESULTS: Hispanic minority workers were twice as likely to be injured at work compared with White workers. Hispanics were 2.89 times more likely to develop back injuries compared with non-Hispanic workers, and 1.86 times more likely to develop upper extremity injuries involving the hand, wrist, or elbow. CONCLUSION: Clinical practice data shows that Hispanic workers are at increased risk for work-related injuries in Minnesota. They were especially susceptible to back and upper extremity injuries. Lower injury rates in non-Hispanic minority workers, may be the result of injury underreporting and require further investigation.

Health status and health behaviors among citizen endurance Nordic skiers in the United States.

BACKGROUND: More than two-thirds of Americans are overweight or obese (69%) placing them at high risk for a wide array of chronic diseases. Physical activity anchors most approaches to obesity prevention and weight management, but physical activity levels remain low in the general US population. As a group, citizen athletes who compete in Nordic skiing events such as the American Birkebeiner participate in fitness cultures that promote physical activity. METHODS: During October-November 2014, we emailed a 48 question online survey to 23,611 individuals who had participated in the American Birkebeiner ski event, the largest citizen ski race in North America. Descriptive statistics were used to summarize data. Binomial and student t test were used to compare binary and continuous outcomes to health behaviors of the US population. RESULTS: 5433 individuals responded. Obesity prevalence (BMI ≥30) was 3% and average BMI was 24. Skiers reported very good health (88%), higher fitness than peers (99%), freedom from depression (93%) low levels of smoking (3%), high consumption of fruits and vegetables, moderate alcohol use, and high levels of physical activity. Fifteen percent practiced all 4 healthy living characteristics known to reduce cardiovascular event risk. CONCLUSIONS: As a group, citizen endurance Nordic skiers enjoy low levels of obesity, below average BMI, and report lifestyle behaviors known to decrease obesity, promote health, and reduce cardiovascular disease risk. Future research should explore hypotheses that explain how the fitness cultures surrounding citizen athletic events support weight loss, cardiovascular fitness, and healthy lifestyle habits.

A survey of social support for exercise and its relationship to health behaviours and health status among endurance Nordic skiers.

OBJECTIVES: Regular exercise is a key component of obesity prevention and 48% of Americans do not meet minimum guidelines for weekly exercise. Social support has been shown to help individuals start and maintain exercise programmes. We evaluated social support among endurance athletes and explored the relationship between social support for exercise, health behaviours and health status. DESIGN: Survey. SETTING: The largest Nordic ski race in North America. PARTICIPANTS: 5433 past participants responded to an online questionnaire. OUTCOME MEASURES: Social support, health behaviours and health status. RESULTS: The mean overall support score was 32.1 (SD=16.5; possible range=-16.0 to 88.0). The most common forms of social support were verbal such as discussing exercise, invitations to exercise and celebrating the enjoyment of exercise. We found that an increase of 10 points in the social support score was associated with a 5 min increase in weekly self-reported exercise (5.02, 95% CI 3.63 to 6.41). CONCLUSIONS: Physical activity recommendations should incorporate the importance of participation in group activities, especially those connected to strong fitness cultures created by community and competitive events.

Risk behaviors in high school and college sport.

Athletes have traditionally been considered greater risk takers than their peers. Some research suggests that athletic participation is associated with increased risk behaviors in males but may be protective in females. Still there is significant intersport variability, and some "nonathlete" risk behaviors exceed those of athletes. Motor vehicle accidents, sensation-seeking behaviors that contribute to unintentional injury and violence, alcohol, illicit drug and tobacco use, sexual misadventure, unhealthy dietary habits, and physical inactivity and obesity are major health risk considerations. There is new focus upon the negative health-related consequences of other risk behaviors such as gambling, sleep apnea and obesity, inappropriate medication, energy drink or contaminated supplement use, and depression/suicide. While it is important to look at the prevalence of "risk behaviors in sport," our cautions regarding these behaviors need to be shared with all youth regardless of athletic disposition.