Visual Acuity and Self-Reported Visual Function among Migrant Farmworkers.

PURPOSE: Visual impairment presents significant risks for occupational injuries among farmworkers, a vulnerable population with limited access to vision care. Although previous research has noted farmworkers' low lifetime experience with vision screening and high rates of complaints of eye ailments and poor vision, there have been few screening data collected to evaluate these self-reports. The objectives of this analysis are to (1) describe farmworker visual health using standardized visual acuity screening data and self-reported visual function, and (2) to compare the screening and self-report data. METHODS: Data are from a cross-sectional study of eye health among Latino migrant farmworkers in North Carolina with uncorrected vision (n = 289). Workers were recruited using methods to achieve a representative sample of a hard-to-reach population. Visual acuity data were collected using Snellen Tumbling E charts for nearsightedness and farsightedness. Binocular data are reported here. Interviews were conducted to obtain personal characteristics and self-assessed visual function. RESULTS: About 75% of farmworkers reported never having had a vision screening. Based on binocular screening, 1.7% (distance vision) and 6.9% (near vision) had moderate to severe visual impairment (>20/40). Farmworkers self-reported poorer visual function, compared with screening results; only 36.4% reported good or very good vision. Sensitivity of distance and near vision self-reports were 60 and 20%, respectively, but specificity was high. CONCLUSIONS: This study confirms past reports of little vision screening among farmworkers. Visual impairment for distance is comparable to other studies of Latinos in the US, though these studies have not reported near vision. Self-reports of vision problems are not a sensitive measure of visual acuity among farmworkers. Screening is needed to identify visual impairment that can create occupational safety risks in this health disparate population.

Comparison of Estimations Versus Measured Oxygen Consumption at Rest in Patients With Heart Failure and Reduced Ejection Fraction Who Underwent Right-Sided Heart Catheterization.

Cardiac output during right-sided heart catheterization is an important variable for patient selection of advanced therapies (cardiac transplantation and left ventricular assist device implantation). The Fick method to determine cardiac output is commonly used and typically uses estimated oxygen consumption (VO2) from 1 of 3 published empirical formulas. However, these estimation equations have not been validated in patients with heart failure and reduced ejection fraction (HFrEF). The objectives of the present study were to determine the accuracy of 3 equations for estimating VO2 compared with direct measurement of VO2 and determine the extent clinically significant error occurred in calculating cardiac output of patients with HFrEF. Breath-by-breath measurements of VO2 from 44 patients who underwent cardiac catheterization (66% men; age, 65 ± 11 years, left ventricular ejection fraction, 22 ± 6%) were compared with the derived estimations of LaFarge and Miettinen, Dehmer et al, and Bergstra et al. Single-sample t tests found only the mean difference between the estimation of LaFarge and Miettinen and the measured VO2 to be nonsignificant (-10.3 ml/min ± 6.2 SE, p = 0.053). Bland-Altman plots demonstrated unacceptably large limits of agreement for all equations. The rate of ≥25% error in the equations by LaFarge and Miettinen, Dehmer et al, and Bergstra et al occurred in 11%, 23%, and 45% of patients, respectively. Misclassification of cardiac index derived from each equation for 2 clinically important classifications: cardiogenic shock-21%, 23%, and 32% and hypoperfusion-16%, 16%, and 25%; respectively. In conclusion, these findings do not support the use of these empiric formulas to estimate the VO2 at rest in patients with HFrEF who underwent right-sided heart catheterization.

Does providing nutrition information at vending machines reduce calories per item sold?

In 2010, the United States (US) enacted a restaurant menu labeling law. The law also applied to vending machine companies selling food. Research suggested that providing nutrition information on menus in restaurants might reduce the number of calories purchased. We tested the effect of providing nutrition information and 'healthy' designations to consumers where vending machines were located in college residence halls. We conducted our study at one university in Southeast US (October-November 2012). We randomly assigned 18 vending machines locations (residence halls) to an intervention or control group. For the intervention we posted nutrition information, interpretive signage, and sent a promotional email to residents of the hall. For the control group we did nothing. We tracked sales over 4 weeks before and 4 weeks after we introduced the intervention. Our intervention did not change what the residents bought. We recommend additional research about providing nutrition information where vending machines are located, including testing formats used to present information.

Airway obstruction among Latino poultry processing workers in North Carolina.

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

Factors related to the number of fast food meals obtained by college meal plan students.

OBJECTIVES: This study tested whether days on campus, financial access through a meal plan, and health consciousness were associated with number of meals that college students obtained from fast food restaurants. PARTICIPANTS AND METHODS: In April 2013, all students currently enrolled in a meal plan were invited to participate in an online survey (N = 1,246). Students were asked to report the total number of meals eaten in the past week and where they obtained them. RESULTS: Negative binomial regression was used, and it was found that the number of meals obtained from fast food restaurants was positively associated with financial access and negatively associated with health consciousness. An association between days on campus and the number of meals obtained from fast food restaurants was not found. CONCLUSIONS: Increasing levels of health consciousness and reducing access to fast food restaurants through flex plans may reduce college students' consumption of fast food.

One-year incidence of carpal tunnel syndrome in Latino poultry processing workers and other Latino manual workers.

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

Prevalence of bifid median nerves and persistent median arteries and their association with carpal tunnel syndrome in a sample of Latino poultry processors and other manual workers.

INTRODUCTION: The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially. METHODS: We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound. RESULTS: A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist. CONCLUSIONS: The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS.

Predictors of uncontrolled hypertension in the Stroke Belt.

Inadequate control of high systolic blood pressure in older adults has been largely attributable to poor control of overall hypertension (HTN). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines emphasize the importance of controlling isolated systolic HTN in older adults. The study examined demographics, self-reported health information, and clinical measures as predictors of uncontrolled HTN among individuals taking antihypertensive medications. The Community Initiative to Eliminate Stroke, a stroke risk factor screening and prevention project, collected data in two North Carolina counties. Statistical modeling of predictors included odds ratios (ORs) and logistic regression analyses. Of the 2663 participants, 43.5% and 22.8% had uncontrolled systolic and diastolic HTN, respectively. African Americans were more likely to have uncontrolled systolic (60%) or diastolic HTN (70.9%) compared with whites (40% and 29.1%, respectively). Participants 55 years and older were more likely to have uncontrolled systolic HTN compared with younger individuals. Regression analyses showed that race (OR, 1.239; P=.00), age (OR, 1.683; P=.00), and nonadherence with medications (OR, 2.593; P=.00) were significant predictors of uncontrolled systolic HTN. Future interventions should focus on improving management of isolated systolic HTN in older adults and African Americans to increase overall control of HTN.

Ultrasound for carpal tunnel syndrome screening in manual laborers.

INTRODUCTION: Manual laborers are at increased risk for carpal tunnel syndrome (CTS), and a combination of history, physical examination, and nerve conduction studies is often used to screen for CTS in this population. Neuromuscular ultrasound may be a better screening tool, because it is painless. In this study we compare the accuracy of nerve conduction studies and ultrasound for CTS screening. METHODS: Five hundred thirteen manual laborers were screened prospectively for CTS using nerve conduction studies and neuromuscular ultrasound, and the accuracy of the 2 techniques was compared using the Katz hand diagram as the diagnostic standard. RESULTS: The ROC curves for the 2 techniques were not significantly different (P = 0.542), indicating that the approaches had similar diagnostic accuracy. CONCLUSIONS: Neuromuscular ultrasound is a painless technique that has diagnostic accuracy similar to nerve conduction studies and can be used to screen large populations at risk for CTS.

Predictors of congruency between self-reported hypertension status and measured blood pressure in the stroke belt.

BACKGROUND: Few studies have comprehensively investigated the validity of self-reported hypertension (HTN) and assessed predictors of HTN status in the stroke belt. This study evaluates validity self-reporting as a tool to screen large study populations and determine predictors of congruency between self-reported HTN and clinical measures. METHODS: Community Initiative to Eliminate Stroke project (n = 16,598) was conducted in two counties of North Carolina in 2004 to 2007, which included collection of self-reported data and clinical data of stroke-related risk factors. Congruency between self-reported HTN status and clinical measures was based on epidemiological parameters of sensitivity, specificity, and predictive values. McNemar's test and Kappa agreement levels assessed differences in congruency, while odds ratios and logistic regression determined significant predictors of congruency. RESULTS: Sensitivity of self-reported HTN was low (33.3%), but specificity was high (89.5%). Prevalence of self-reported HTN was 16.15%. Kappa agreement between self-report and clinical measures for blood pressure was fair (k = 0.25). Females, whites, and young adults were most likely to be positively congruent, whereas individuals in high risk categories for total blood cholesterol, low density lipoproteins, triglycerides, and diabetes were least likely to accurately capture their HTN status. CONCLUSION: Self-report HTN information should be used with caution as an epidemiological investigation tool.

Dermatologist-diagnosed skin diseases among immigrant Latino poultry processors and other manual workers in North Carolina, USA.

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

Upper body musculoskeletal symptoms of Latino poultry processing workers and a comparison group of Latino manual workers.

BACKGROUND: Upper body musculoskeletal injuries are often attributed to rapid work pace and repetitive motions. These job features are common in poultry processing, an industry that relies on Latino immigrants. Few studies document the symptom burden of immigrant Latinos employed in poultry processing or other manual jobs. METHODS: Latino poultry processing workers (n = 403) and a comparison population of 339 Latino manual workers reported symptoms for six upper body sites during interviews. We tabulated symptoms and explored factors associated with symptom counts. RESULTS: Back symptoms and wrist/hand symptoms lasting more than 1-day were reported by over 35% of workers. Poultry processing workers reported more symptoms than comparison workers, especially wrist and elbow symptoms. The number of sites at which workers reported symptoms was elevated for overtime workers and workers who spoke an indigenous language during childhood. CONCLUSION: Workplace conditions facing poultry processing and indigenous language speaking workers deserve further exploration.

Prevalence of epicondylitis, rotator cuff syndrome, and low back pain in Latino poultry workers and manual laborers.

BACKGROUND: The goal of this study is to improve understanding of immigrant Latino manual workers' occupational health, focusing on upper body musculoskeletal injury. METHODS: Physical exams were conducted with a representative sample of 516 Latino poultry workers and manual laborers in western North Carolina; outcome measures were prevalence of epicondylitis, rotator cuff syndrome, and low back pain. RESULTS: Low back pain (n = 89; 17.2%) and rotator cuff syndrome (n = 76; 14.7%) indicated by physical exam was common. Epicondylitis was less common, but still frequent (n = 30; 5.8%). Prevalence of each outcome did not differ between poultry processing workers and other manual workers. Workers >40 years old had greater incidence of rotator cuff syndrome and epicondylitis. CONCLUSIONS: Epicondylitis, rotator cuff syndrome, and low back pain are common in immigrant Latino workers, and may negatively impact long-term health and contribute to occupational health disparities.

Work organization and musculoskeletal health: clinical findings from immigrant Latino poultry processing and other manual workers.

OBJECTIVE: To determine the potential role of differential exposure to work organization hazards in musculoskeletal disorders among immigrant Latino workers. METHOD: Self-reported work organization data were obtained from immigrant Latino workers in poultry processing and nonpoultry, manual occupations (N = 742). Clinical evaluations for epicondylitis, rotator cuff syndrome, and back pain were obtained from a subsample (n = 518). RESULTS: Several work organization hazards (eg, low job control, high psychological demands) were elevated among poultry processing workers. Job control predicted epicondylitis (odds ratio [OR] = 0.77) and rotator cuff syndrome (OR = 0.79); psychological demand predicted rotator cuff syndrome (OR = 1.30) and back pain (OR = 1.24); awkward posture and repeated movements predicted all three outcomes; and management safety commitment predicted rotator cuff syndrome (OR = 1.65) and back pain (OR = 1.81). DISCUSSION: Immigrant poultry processing workers are exposed to greater work organization hazards that may contribute to occupational health disparities.

The prevalence of carpal tunnel syndrome in Latino poultry-processing workers and other Latino manual workers.

OBJECTIVE: To determine the prevalence of carpal tunnel syndrome (CTS) in Latino poultry-processing workers. METHODS: Symptoms and nerve conduction studies were used to prospectively assess 287 Latino poultry-processing workers and 226 Latinos in other manual-labor occupations. RESULTS: The prevalence of CTS was higher in poultry-processing (8.7%) compared with nonpoultry manual workers (4.0%; P < 0.0001). The adjusted odds ratio for the prevalence of CTS in poultry workers was 2.51 (95% confidence interval, 1.80-3.50) compared with nonpoultry workers. Within the poultry workers, those who performed packing, sanitation, and chilling had a trend toward less CTS than those who performed tasks requiring more repetitive and strenuous hand movements. DISCUSSION: Latino poultry-processing workers have a high prevalence of CTS, which likely results from the repetitive and strenuous nature of the work.

Poultry processing work and respiratory health of Latino men and women in North Carolina.

OBJECTIVE: To evaluate associations between poultry processing work and respiratory health among working Latino men and women in North Carolina. METHODS: Between May 2009 and November 2010, 402 poultry processing workers and 339 workers in a comparison population completed interviewer-administered questionnaires. Of these participants, 279 poultry processing workers and 222 workers in the comparison population also completed spirometry testing to provide measurements of forced expiratory volume in 1 second and forced vital capacity. RESULTS: Nine percent of poultry processing workers and 10% of workers in the comparison population reported current asthma. Relative to the comparison population, adjusted mean forced expiratory volume in 1 second and forced vital capacity were lower in the poultry processing population, particularly among men who reported sanitation job activities. CONCLUSIONS: Despite the low prevalence of respiratory symptoms reported, poultry processing work may affect lung function.

Ethnic and racial differences of baseline stroke knowledge in a "stroke belt" community.

Acute stroke is often a treatable condition; however, intervention is time dependent and typically should ensue within 3 hr from onset of symptoms. The ability of individuals to understand stroke risk factors to reduce individual risk and to recognize warning signs and symptoms of stroke as signals to initiate medical care is paramount to decreasing stroke-related morbidity and mortality. This descriptive study presents ethnic and racial differences of baseline stroke knowledge among residents (n = 1,904) of two North Carolina counties situated in the Stroke Belt. Findings suggest a global stroke knowledge deficit that is more pronounced among Hispanics. Future community stroke education campaigns need to consider various educational mediums and outlets to ensure inclusion of persons at highest risk for stroke. Suggestions are provided for possible content of future stroke knowledge and prevention campaigns.

Occupational eye injuries experienced by migrant farmworkers.

Migrant farmworkers in North Carolina (n = 300) reported eye injuries, circumstances of injuries, and outcomes during lifetime U.S. agriculture work. Seventeen injuries were reported by 15 farmworkers; five resulted in lost work time. Most reported injuries were penetrating or open wounds, often caused by branches or other foreign objects. Injuries were seldom reported to employers; and treatment at clinics, when received, was often delayed. The incidence rate of lost work-time injuries of 23.8/10,000 worker years (95% confidence interval 7.5, 55.9), exceeds the 2009 national incidence rate (6.9/10,000). Migrant farmworkers constitute a vulnerable population; better occupational safety protections should be considered.

Eye health and safety among Latino farmworkers.

Farmworkers face a variety of risk factors for eye injuries. Measures of eye protection use and of eye safety knowledge and beliefs are based on a survey of 300 Latino farmworkers in North Carolina. Few farmworkers report using eye protection (8.3%); most (92.3%) report that employers do not provide eye protection. Approximately 70% report that they are not trained in preventing eye injuries; 81% believe that their chances of getting an eye injury are low. Many farmworkers choose to take risks in order to save time. Interventions are needed that target farmworker knowledge and beliefs about eye safety.

Lower body stiffness and muscle activity differences between female dancers and basketball players during drop jumps.

BACKGROUND: Anterior cruciate ligament (ACL) injuries often occur during landing, with female athletes at higher injury risk than male athletes. Interestingly, female dancers have lower ACL injury rates than do female athletes in general. HYPOTHESIS: Female dancers will have earlier and greater lower extremity muscle activity and higher sagittal knee joint and leg stiffness than will female basketball players. STUDY DESIGN: Cross-sectional group comparison. METHODS: Fifty-five healthy female athletes (35 dancers, 20 basketball players) performed 5 double-leg drop jumps from a 45-cm box. Surface electromyography (onsets and amplitudes; prelanding and postlanding) was recorded from the lateral gastrocnemius, medial and lateral hamstrings, lateral quadriceps muscles with a 3-dimensional electromagnetic tracking system, and forceplates recording biomechanics (leg spring stiffness and knee joint stiffness). RESULTS: Compared with basketball players, dancers had greater leg spring stiffness (P = 0.047) but similar knee joint stiffness (P = 0.44). Although no significant differences were observed in overall muscle onset times (P = 0.22) or activation amplitudes (prelanding, P = 0.60; postlanding, P = 0.78), small to moderate effect sizes (ESs) suggest trends in dancers toward earlier (ES = 0.53) and higher medial hamstrings activation pre- (ES = 0.55) and post- (ES = 0.41) landing and lower lateral quadriceps (ES = 0.30) and higher gastrocnemius (ES = 0.33) postlanding muscle activation. CONCLUSIONS: In dancers, the higher leg spring stiffness and trends toward higher hamstrings prelanding and postlanding, as well as lower quadriceps and higher gastrocnemius activation postlanding with similar knee joint stiffness, indicate lower extremity neuromechanical differences across other joints. CLINICAL RELEVANCE: Female dancers may have lower extremity neuromechanics that are different from those of basketball players during drop jumps. If dancers use ACL-protective strategies during activity, then their training routines should be further investigated to improve ACL injury prevention programs.