Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 54 Records) |
Query Trace: Baron S[original query] |
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Adolescent dating violence prevention programmes: a global systematic review of evaluation studies
McNaughton Reyes HL , Graham LM , Chen MS , Baron D , Gibbs A , Groves AK , Kajula L , Bowler S , Maman S . Lancet Child Adolesc Health 2020 5 (3) 223-232 Adolescent dating violence negatively affects millions of young people worldwide. Through a global systematic review, we synthesised evidence from rigorous studies of prevention programmes for adolescent dating violence. Our aims were to: (1) describe the breadth of research in this area and evidence of programme effects, and (2) identify gaps in the evidence base. We included experimental and controlled quasi-experimental programme evaluations, published before Jan 1, 2020, that assessed effects on victimisation or perpetration, or both, in adolescent dating violence and in which at least half of the study population was 10-19 years old. Study design, programme elements, and outcomes were compared between evaluations implemented in high-income countries (HICs) and low-income and middle-income countries (LMICs). 52 evaluations met inclusion criteria, of which 20 (38%) were implemented in LMICs. Evaluations in HICs were more likely to assess effects on adolescent dating violence victimisation and perpetration, rather than just victimisation, than those in LMICs, and they were also more likely to include boys and girls, as opposed to just a single sex. Overall, 26 (50%) of the 52 evaluations reported a significant preventive effect on at least one outcome for adolescent dating violence, of which nine were implemented in LMICs. Across LMICs and HICs, findings suggest research is needed to shed light on how adolescent dating violence prevention programmes work and to identify whether programme effects generalise across different settings, outcomes, and subgroups. TRANSLATIONS: For the Chinese, French and Spanish translations of the abstract see Supplementary Materials section. |
Clinical decision support for worker health: A five-site qualitative needs assessment in primary care settings
Ash JS , Chase D , Baron S , Filios MS , Shiffman RN , Marovich S , Wiesen J , Luensman GB . Appl Clin Inform 2020 11 (4) 635-643 BACKGROUND: Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. OBJECTIVE: This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. METHODS: We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. RESULTS: We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. CONCLUSION: We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health. |
Worker well-being in the United States: Finding variation across job categories
Stiehl E , Jones-Jack NH , Baron S , Muramatsu N . Prev Med Rep 2019 13 5-10 Job categories shape the contexts that contribute to worker well-being, including their health, connectivity, and engagement. Using data from the 2014 Gallup Daily tracking survey, this study documented the distribution of worker well-being across 11 broad job categories among a national sample of employed adults in the United States. Well-being was measured by Gallup-Sharecare Well-Being 5TM, a composite measure of five well-being dimensions (purpose, community, physical, financial, and social). Analysis of variance (ANOVA) was used to examine how well-being varied across job categories and the extent to which household income modified that relationship, controlling for demographic factors. Well-being varied significantly across job categories, even after adjusting for household income and demographic factors. Well-being was higher among business owners, professionals, managers, and farming/fishing workers and lower among clerical/office, service, manufacturing/production, and transportation workers. Purpose well-being (e.g., liking what you do and being motivated to achieve your goals) showed the greatest variability across job categories-there were small differences across income levels for business owners, professionals, managers, and farming/fishing workers, and statistically significant gaps between the high income group and the two lower income groups among clerical/office, service, manufacturing/production, and transportation workers. Physical well-being exhibited the smallest gaps across income groups within job categories. The findings suggest that job category is an important component of worker well-being that extends beyond the financial dimension to purpose well-being. Our results suggest well-being inequity across job categories, and highlight areas for future research, policy and practice, including targeted interventions to promote worker and workplace well-being. |
Research methodologies for Total Worker Health(R): Proceedings from a workshop
Tamers SL , Goetzel R , Kelly KM , Luckhaupt S , Nigam J , Pronk NP , Rohlman DS , Baron S , Brosseau LM , Bushnell T , Campo S , Chang CC , Childress A , Chosewood LC , Cunningham T , Goldenhar LM , Huang TT , Hudson H , Linnan L , Newman LS , Olson R , Ozminkowski RJ , Punnett L , Schill A , Scholl J , Sorensen G . J Occup Environ Med 2018 60 (11) 968-978 OBJECTIVE: There is growing interest in the NIOSH Total Worker Health program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs. METHODS: Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise. RESULTS: TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature. CONCLUSIONS: This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research. |
Enhancing worker health through clinical decision support (CDS): An introduction to a compilation
Filios MS , Storey E , Baron S , Luensman GB , Shiffman RN . J Occup Environ Med 2017 59 (11) e227-e230 OBJECTIVE: This article outlines an approach to developing clinical decision support (CDS) for conditions related to work and health. When incorporated in electronic health records, such CDS will assist primary care providers (PCPs) care for working patients. METHODS: Three groups of Subject Matter Experts (SMEs) identified relevant clinical practice guidelines, best practices, and reviewed published literature concerning work-related asthma, return-to-work, and management of diabetes at work. RESULTS: SMEs developed one recommendation per topic that could be supported by electronic CDS. Reviews with PCPs, staff, and health information system implementers in five primary care settings confirmed that the approach was important and operationally sound. CONCLUSION: This compendium is intended to stimulate a dialogue between occupational health specialists and PCPs that will enhance the use of work information about patients in the primary care setting. |
Development of a diabetes mellitus knowledge resource for clinical decision support assisting primary care physicians with work-related issues
Allen A , Welch L , Kirkland K , Trout D , Baron S . J Occup Environ Med 2017 59 (11) e236-e239 OBJECTIVE: The aim of this study was to describe the process by which a group of subject matter experts (SMEs) in the area of occupational health and primary care developed a clinical decision support (CDS) tool addressing work-related issues, which are important in the care of patients with diabetes mellitus (DM). The CDS is intended for primary care clinicians caring for employed adults with DM. METHODS: The SME's selected guidelines for the management of DM in working adults, reviewed pertinent literature, and developed specific recommendations for action in the clinical setting. RESULTS: Multiple factors at work may adversely affect DM management. Clinicians can support working patients through education and care strategies to improve control. CONCLUSION: Improved recognition of factors at work that can have an impact on DM care provides opportunities for improved management of DM among working adults. |
Recognition of the relationship between patients' work and health: A qualitative evaluation of the need for clinical decision support (CDS) for worker health in five primary care practices
Baron S , Filios MS , Marovich S , Chase D , Ash JS . J Occup Environ Med 2017 59 (11) e245-e250 OBJECTIVE: The aim of this study was to determine the perceived value and feasibility of increased access to information about workers' health for primary care providers (PCPs) by evaluating the need for clinical decision support (CDS) related to worker health in primary care settings. METHODS: Qualitative methods, including semi-structured interviews and observations, were used to evaluate the value and feasibility of three examples of CDS relating work and health in five primary care settings. RESULTS: PCPs and team members wanted help addressing patients' health in relation to their jobs; the proposed CDS examples were perceived as valuable because they provided useful information, promoted standardization of care, and were considered technically feasible. Barriers included time constraints and a perceived inability to act on the findings. CONCLUSION: PCPs recognize the importance and impact of work on their patients' health but often lack accessible knowledge at the right time. Occupational health providers can play an important role through contributions to the development of CDS that assists PCPs in recognizing and addressing patients' health, as well as through the provision of referral guidelines. |
Screen collection efficiency of airborne fibers with monodisperse length
Ku BK , Deye G , Turkevich LA . J Aerosol Sci 2017 114 250-262 Fiber length is believed to be an important variable in determining various toxicological responses to asbestos and other elongate mineral particles. In this study we investigated screen collection characteristics using monodisperse-length glass fibers (i.e., 11, 15, 25, and 53 µm in length), to better understand the collection of fibers with different lengths on screens with different mesh sizes. A well-dispersed aerosol of glass fibers (geometric mean length ~ 20 µm), generated by vortex shaking, was fed directly into the Baron Fiber Length Classifier, in order to produce monodisperse length fibers. With nylon mesh screens (10, 20, 30, 41 and 60 µm mesh sizes), the screen collection efficiency was measured using an aerodynamic particle sizer. As the screen mesh size decreases from 60 µm to 10 µm, the screen collection efficiency for 53 µm fibers increases (from 0.3 to 0.9) while 11 µm fibers exhibited a collection efficiency independent of screen mesh size. The collection efficiency for the longest fibers was found to be nearly constant for aerodynamic diameters 1–4 µm for screens 20 and 30 µm, but to rise significantly at aerodynamic diameters larger than 4 µm. For the 20 µm screen, the collection efficiency for fibers with lengths > 20 µm is a factor of two to five larger than that for spherical particles with the same aerodynamic diameter. We believe that fibers are collected on the screen primarily by interception below 4 µm in aerodynamic diameter, and by impaction above 4 µm. This study represents a fundamental advance in the understanding of the interaction of screens with a fibrous aerosol. |
Prevalence of cardiovascular health by occupation: A cross-sectional analysis among U.S. workers aged ≥45 years
MacDonald LA , Bertke S , Hein MJ , Judd S , Baron S , Merritt R , Howard VJ . Am J Prev Med 2017 53 (2) 152-161 INTRODUCTION: Identification of groups with poor cardiovascular health (CVH) can inform where and how to target public health efforts. National prevalence estimates of CVH were derived for clinical (blood glucose, total cholesterol, blood pressure) and behavioral (BMI, diet quality, physical activity, smoking) factors among U.S. workers aged ≥45 years. METHODS: This cross-sectional analysis included 6,282 employed black and white men and women aged ≥45 years enrolled in the national population-based REasons for Geographic And Racial Differences in Stroke study from 2003 to 2007. Each CVH factor was scored as ideal (2); intermediate (1); or poor (0) according to American Heart Association criteria, and summed to define optimal composite scores: CVH (sum, 10-14); clinical (sum, 5-6); and behavioral (sum, 6-8) health. Occupational data were collected 2011-2013. Analyses were conducted in 2016. RESULTS: Only 14% met ideal criteria for all three clinical health factors, and none met ideal criteria for all four behavioral health factors. Sales and low status office workers had a low prevalence of optimal CVH. Service workers in protective services and the food preparation and serving occupations had a low prevalence of optimal clinical health; computer and healthcare support workers had a low prevalence of optimal behavioral health. CONCLUSIONS: The prevalence of optimal CVH among middle-aged and older workers in the U.S. is low, but considerable differences exist by occupation. Targeted public health interventions may improve the CVH of at-risk older workers with different clinical and behavioral risk factor profiles employed in diverse occupational settings. |
Importance of implementation economics for program planning-evaluation of CDC's colorectal cancer control program
Tangka FK , Subramanian S . Eval Program Plann 2016 62 64-66 Understanding the cost of initiating and operationalizing colorectal cancer (CRC) control programs is essential for planning successful implementation of evidence-based recommendations to reduce disparities in the use and quality of CRC cancer screening services. Currently, only about 58% of adults ages 50–75 years in the United States are up-to-date with CRC screening recommendations; adults without health insurance have a much lower uptake of about 24% (Sabatino, White, Thompson, & Klabunde, 2015). Targeted interventions and programs, especially those focused on the uninsured and underinsured populations, are required to meet the population-wide target of 80% by 2018 set by The National Colorectal Cancer Roundtable (NCCRT, n.d.). The Community Guide contains several evidence-based recommendations for screening promotion interventions but there are very few studies on the economics of screening program implementation (Baron et al., 2010; Sabatino et al., 2012). There is an urgent need to increase the number of ‘implementation economics’ studies to develop the evidence-base to guide funding decision making, design cost-effective programs and ensure optimal use of limited resources. We define ‘implementation economics’ as a sub-discipline within implementation science that focusses on economic evaluation related to cost (cost-of-illness analysis, program cost analysis), cost-effectiveness, cost-benefit, cost-utility, budget impact, and cost minimization. | For more than a decade, CDC has funded and provided technical support to a range of grantee programs to implement CRC screening and implementation economics has been a cornerstone of the evaluations of these programs. Between 2005 and 2009, CDC administered the Colorectal Cancer Screening Demonstration Program (CRCSDP) in five programs [Baltimore, Maryland; St. Louis, Missouri; the entire state of Nebraska; Suffolk County, New York; and King, Clallam and Jefferson counties in Washington] (Centers for Disease Control and Prevention, 2013a). These programs provided CRC screening for low-income, underinsured, or uninsured men and women between the ages of 50 and 64 years. In 2009, successes and lessons learned (Centers for Disease Control and Prevention, 2013b; Joseph, DeGroff, Hayes, Wong, & Plescia, 2011) from the CRCSDP informed planning and funding of the first round of CDC’s Colorectal Cancer Control Program (CRCCP) (2009–2015). Through the CRCCP, CDC provided funding to 22 states and 4 tribal organizations to implement CRC programs starting in 2009 and another 3 states were added to the program in 2010. Fig. 1 provides a map of the United States highlighting the CRCCP grantees. |
Association of MHC region SNPs with irritant susceptibility in healthcare workers.
Yucesoy B , Talzhanov Y , Michael Barmada M , Johnson VJ , Kashon ML , Baron E , Wilson NW , Frye B , Wang W , Fluharty K , Gharib R , Meade J , Germolec D , Luster MI , Nedorost S . J Immunotoxicol 2016 13 (5) 1-7 Irritant contact dermatitis is the most common work-related skin disease, especially affecting workers in "wet-work" occupations. This study was conducted to investigate the association between single nucleotide polymorphisms (SNPs) within the major histocompatibility complex (MHC) and skin irritant response in a group of healthcare workers. 585 volunteer healthcare workers were genotyped for MHC SNPs and patch tested with three different irritants: sodium lauryl sulfate (SLS), sodium hydroxide (NaOH) and benzalkonium chloride (BKC). Genotyping was performed using Illumina Goldengate MHC panels. A number of SNPs within the MHC Class I (OR2B3, TRIM31, TRIM10, TRIM40 and IER3), Class II (HLA-DPA1, HLA-DPB1) and Class III (C2) genes were associated (p < 0.001) with skin response to tested irritants in different genetic models. Linkage disequilibrium patterns and functional annotations identified two SNPs in the TRIM40 (rs1573298) and HLA-DPB1 (rs9277554) genes, with a potential impact on gene regulation. In addition, SNPs in PSMB9 (rs10046277 and ITPR3 (rs499384) were associated with hand dermatitis. The results are of interest as they demonstrate that genetic variations in inflammation-related genes within the MHC can influence chemical-induced skin irritation and may explain the connection between inflamed skin and propensity to subsequent allergic contact sensitization. |
Genetic Basis of Irritant Susceptibility in Health Care Workers.
Yucesoy B , Talzhanov Y , Barmada MM , Johnson VJ , Kashon ML , Baron E , Wilson NW , Frye B , Wang W , Fluharty K , Gharib R , Meade J , Germolec D , Luster MI , Nedorost S . J Occup Environ Med 2016 58 (8) 753-9 OBJECTIVE: The aim of this study was to investigate the association of single nucleotide polymorphisms (SNPs) within genes involved in inflammation, skin barrier integrity, signaling/pattern recognition, and antioxidant defense with irritant susceptibility in a group of health care workers. METHODS: The 536 volunteer subjects were genotyped for selected SNPs and patch tested with three model irritants: sodium lauryl sulfate (SLS), sodium hydroxide (NaOH), and benzalkonium chloride (BKC). Genotyping was performed on genomic DNA using Illumina Goldengate custom panels. RESULTS: The ACACB (rs2268387, rs16934132, rs2284685), NTRK2 (rs10868231), NTRK3 (rs1347424), IL22 (rs1179251), PLAU (rs2227564), EGFR (rs6593202), and FGF2 (rs308439) SNPs showed an association with skin response to tested irritants in different genetic models (all at P < 0.001). Functional annotations identified two SNPs in PLAU (rs2227564) and ACACB (rs2284685) genes with a potential impact on gene regulation. In addition, EGF (rs10029654), EGFR (rs12718939), CXCL12 (rs197452), and VCAM1 (rs3917018) genes showed an association with hand dermatitis (P < 0.005). CONCLUSIONS: The results demonstrate that genetic variations in genes related to inflammation and skin homeostasis can influence responses to irritants and may explain inter-individual variation in the development of subsequent contact dermatitis. |
Chikungunya and dengue virus infections among United States community service volunteers returning from the Dominican Republic, 2014
Millman AJ , Esposito DH , Biggs HM , Decenteceo M , Klevos A , Hunsperger E , Munoz-Jordan J , Kosoy OI , McPherson H , Sullivan C , Voorhees D , Baron D , Watkins J , Gaul L , Sotir MJ , Brunette G , Fischer M , Sharp T , Jentes ES . Am J Trop Med Hyg 2016 94 (6) 1336-41 Chikungunya spread throughout the Dominican Republic (DR) after the first identified laboratory-confirmed cases were reported in April 2014. In June 2014, a U.S.-based service organization operating in the DR reported chikungunya-like illnesses among several staff. We assessed the incidence of chikungunya virus (CHIKV) and dengue virus (DENV) infection and illnesses and evaluated adherence to mosquito avoidance measures among volunteers/staff deployed in the DR who returned to the United States during July-August 2014. Investigation participants completed a questionnaire that collected information on demographics, medical history, self-reported illnesses, and mosquito exposures and avoidance behaviors and provided serum for CHIKV and DENV diagnostic testing by reverse transcription polymerase chain reaction and IgM enzyme-linked immunosorbent assay. Of 102 participants, 42 (41%) had evidence of recent CHIKV infection and two (2%) had evidence of recent DENV infection. Of the 41 participants with evidence of recent CHIKV infection only, 39 (95%) reported fever, 37 (90%) reported rash, and 37 (90%) reported joint pain during their assignment. All attended the organization's health trainings, and 89 (87%) sought a pretravel health consultation. Most ( approximately 95%) used insect repellent; however, only 30% applied it multiple times daily and < 5% stayed in housing with window/door screens. In sum, CHIKV infections were common among these volunteers during the 2014 chikungunya epidemic in the DR. Despite high levels of preparation, reported adherence to mosquito avoidance measures were inconsistent. Clinicians should discuss chikungunya with travelers visiting areas with ongoing CHIKV outbreaks and should consider chikungunya when diagnosing febrile illnesses in travelers returning from affected areas. |
Job strain, occupational category, systolic blood pressure, and hypertension prevalence: the Multi-Ethnic Study of Atherosclerosis
Landsbergis PA , Diez-Roux AV , Fujishiro K , Baron S , Kaufman JD , Meyer JD , Koutsouras G , Shimbo D , Shrager S , Stukovsky KH , Szklo M . J Occup Environ Med 2015 57 (11) 1178-84 OBJECTIVE: To assess associations of occupational categories and job characteristics with prevalent hypertension. METHODS: We analyzed 2517 Multi-Ethnic Study of Atherosclerosis participants, working 20+ hours per week, in 2002 to 2004. RESULTS: Higher job decision latitude was associated with a lower prevalence of hypertension, prevalence ratio = 0.78 (95% confidence interval 0.66 to 0.91) for the top versus bottom quartile of job decision latitude. Associations, however, differed by occupation: decision latitude was associated with a higher prevalence of hypertension in health care support occupations (interaction P = 0.02). Occupation modified associations of sex with hypertension: a higher prevalence of hypertension in women (vs men) was observed in health care support and in blue-collar occupations (interaction P = 0.03). CONCLUSIONS: Lower job decision latitude is associated with hypertension prevalence in many occupations. Further research is needed to determine reasons for differential impact of decision latitude and sex on hypertension across occupations. |
Clinical laboratory analytics: challenges and promise for an emerging discipline
Shirts BH , Jackson BR , Baird GS , Baron JM , Clements B , Grisson R , Hauser RG , Taylor JR , Terrazas E , Brimhall B . J Pathol Inform 2015 6 9 The clinical laboratory is a major source of health care data. Increasingly these data are being integrated with other data to inform health system-wide actions meant to improve diagnostic test utilization, service efficiency, and "meaningful use." The Academy of Clinical Laboratory Physicians and Scientists hosted a satellite meeting on clinical laboratory analytics in conjunction with their annual meeting on May 29, 2014 in San Francisco. There were 80 registrants for the clinical laboratory analytics meeting. The meeting featured short presentations on current trends in clinical laboratory analytics and several panel discussions on data science in laboratory medicine, laboratory data and its role in the larger healthcare system, integrating laboratory analytics, and data sharing for collaborative analytics. One main goal of meeting was to have an open forum of leaders that work with the "big data" clinical laboratories produce. This article summarizes the proceedings of the meeting and content discussed. |
Leveraging biospecimen resources for discovery or validation of markers for early cancer detection.
Schully SD , Carrick DM , Mechanic LE , Srivastava S , Anderson GL , Baron JA , Berg CD , Cullen J , Diamandis EP , Doria-Rose VP , Goddard KA , Hankinson SE , Kushi LH , Larson EB , McShane LM , Schilsky RL , Shak S , Skates SJ , Urban N , Kramer BS , Khoury MJ , Ransohoff DF . J Natl Cancer Inst 2015 107 (4) Validation of early detection cancer biomarkers has proven to be disappointing when initial promising claims have often not been reproducible in diagnostic samples or did not extend to prediagnostic samples. The previously reported lack of rigorous internal validity (systematic differences between compared groups) and external validity (lack of generalizability beyond compared groups) may be effectively addressed by utilizing blood specimens and data collected within well-conducted cohort studies. Cohort studies with prediagnostic specimens (eg, blood specimens collected prior to development of clinical symptoms) and clinical data have recently been used to assess the validity of some early detection biomarkers. With this background, the Division of Cancer Control and Population Sciences (DCCPS) and the Division of Cancer Prevention (DCP) of the National Cancer Institute (NCI) held a joint workshop in August 2013. The goal was to advance early detection cancer research by considering how the infrastructure of cohort studies that already exist or are being developed might be leveraged to include appropriate blood specimens, including prediagnostic specimens, ideally collected at periodic intervals, along with clinical data about symptom status and cancer diagnosis. Three overarching recommendations emerged from the discussions: 1) facilitate sharing of existing specimens and data, 2) encourage collaboration among scientists developing biomarkers and those conducting observational cohort studies or managing healthcare systems with cohorts followed over time, and 3) conduct pilot projects that identify and address key logistic and feasibility issues regarding how appropriate specimens and clinical data might be collected at reasonable effort and cost within existing or future cohorts. |
Associations of work hours, job strain, and occupation with endothelial function: the Multi-Ethnic Study of Atherosclerosis (MESA)
Charles LE , Fekedulegn D , Landsbergis P , Burchfiel CM , Baron S , Kaufman JD , Stukovsky KH , Fujishiro K , Foy CG , Andrew ME , Diez Roux AV . J Occup Environ Med 2014 56 (11) 1153-60 OBJECTIVE: To investigate associations of work hours, job control, job demands, job strain, and occupational category with brachial artery flow-mediated dilation (FMD) in 1499 Multi-Ethnic Study of Atherosclerosis participants. METHODS: Flow-mediated dilation was obtained using high-resolution ultrasound. Mean values of FMD were examined across categories of occupation, work hours, and the other exposures using regression analyses. RESULTS: Occupational category was significantly associated with FMD overall, with blue-collar workers showing the lowest mean values-management/professional = 4.97 +/- 0.22%; sales/office = 5.19 +/- 0.28%; services = 4.73 +/- 0.29%; and blue-collar workers = 4.01 +/- 0.26% (adjusted P < 0.001). There was evidence of effect modification by sex (interaction P = 0.031)-significant associations were observed among women (adjusted P = 0.002) and nearly significant results among men (adjusted P = 0.087). Other exposures were not significantly associated with FMD. CONCLUSIONS: Differences in endothelial function may account for some of the variation in cardiovascular disease across occupational groups. |
Psychosocial work characteristics of personal care and service occupations: a process for developing meaningful measures for a multiethnic workforce
Hoppe A , Heaney CA , Fujishiro K , Gong F , Baron S . Ethn Health 2014 20 (5) 1-19 BACKGROUND AND OBJECTIVES: Despite their rapid increase in number, workers in personal care and service occupations are underrepresented in research on psychosocial work characteristics and occupational health. Some of the research challenges stem from the high proportion of immigrants in these occupations. Language barriers, low literacy, and cultural differences as well as their nontraditional work setting (i.e., providing service for one person in his/her home) make generic questionnaire measures inadequate for capturing salient aspects of personal care and service work. This study presents strategies for (1) identifying psychosocial work characteristics of home care workers that may affect their occupational safety and health and (2) creating survey measures that overcome barriers posed by language, low literacy, and cultural differences. DESIGN AND RESULTS: We pursued these aims in four phases: (Phase 1) Six focus groups to identify the psychosocial work characteristics affecting the home care workers' occupational safety and health; (Phase 2) Selection of questionnaire items (i.e., questions or statements to assess the target construct) and first round of cognitive interviews (n = 30) to refine the items in an iterative process; (Phase 3) Item revision and second round of cognitive interviews (n = 11); (Phase 4) Quantitative pilot test to ensure the scales' reliability and validity across three language groups (English, Spanish, and Chinese; total n = 404). Analysis of the data from each phase informed the nature of subsequent phases. This iterative process ensured that survey measures not only met the reliability and validity criteria across groups, but were also meaningful to home care workers. CONCLUSION: This complex process is necessary when conducting research with nontraditional and multilingual worker populations. |
Numerical investigation of sheath and aerosol flows in the flow combination section of a Baron fiber classifier
Dubey P , Ghia U , Turkevich LA . Aerosol Sci Technol 2014 48 (8) 896-905 The Baron fiber classifier is an instrument used to separate fibers by length. The flow combination section (FCS) of this instrument is an upstream annular region, where an aerosol of uncharged fibers is introduced along with two sheath flows; length separation occurs by dielectrophoresis downstream in the flow classification section. In its current implementation at NIOSH, the instrument is capable of processing only very small quantities of fibers. In order to prepare large quantities of length-separated fibers for toxicological studies, the throughput of the instrument needs to be increased, and hence, higher aerosol flow rates need to be considered. However, higher aerosol flow rates may give rise to flow separation or vortex formation in the FCS, arising from the sudden expansion of the aerosol at the inlet nozzle. The goal of the present investigation is to understand the interaction of the sheath and aerosol flows inside the FCS, using computational fluid dynamics (CFD), and to identify possible limits to increasing aerosol flow rates. Numerical solutions are obtained using an axisymmetric model of the FCS, and solving the Navier-Stokes equations governing these flows; in this study, the aerosol flow is treated purely aerodynamically. Results of computations are presented for four different flow rates. The geometry of the converging outer cylinder, along with the two sheath flows, is effective in preventing vortex formation in the FCS for aerosol-to-sheath flow inlet velocity ratios below ~50. For higher aerosol flow rates, recirculation is observed in both inner and outer sheaths. Results for velocity, streamlines, and shear stress are presented. |
Introduction to a special issue: eliminating health and safety inequities at work
Baron SL , Steege AL , Hughes JT Jr , Beard SD . Am J Ind Med 2014 57 (5) 493-4 In 2011, the National Institute for Occupational Safety and Health along with the National Institute of Environmental Health Sciences and in partnership with the Occupational Safety and Health Administration and the Environmental Protection Agency convened a national conference on Eliminating Health and Safety Disparities at Work (www.aoecdata.org/conferences/healthdisparities/). In this issue Steege et al. [2014] present new analyses of the Bureau of Labor Statistics data on occupational injuries and illnesses and work-related fatalities, which indicate that workers who are African American, Hispanic, immigrant, who earn low wages and who have lower levels of educational attainment are at greater risk of working in occupations where occupational injuries and illnesses occur at more than twice the national rate. These data clearly demonstrate the need for more targeted and comprehensive occupational safety and health prevention programs aimed at reducing these disparities. |
Occupational risk factors for COPD phenotypes in the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study
Doney B , Hnizdo E , Graziani M , Kullman G , Burchfiel C , Baron S , Fujishiro K , Enright P , Hankinson JL , Stukovsky KH , Martin CJ , Donohue KM , Barr RG . COPD 2014 11 (4) 368-80 INTRODUCTION: The contribution of occupational exposure to the risk of chronic obstructive pulmonary disease COPD in population-based studies is of interest. We compared the performance of self-reported exposure to a newly developed JEM in exposure-response evaluation. METHODS: We used cross-sectional data from Multi-Ethnic Study of Atherosclerosis (MESA), a population-based sample of 45-84 year olds free of clinical cardiovascular disease at baseline. MESA ascertained the most recent job and employment, and the MESA Lung Study measured spirometry, and occupational exposures for 3686 participants. Associations between health outcomes (spirometry defined airflow limitation and Medical Research Council-defined chronic bronchitis) and occupational exposure [self-reported occupational exposure to vapor-gas, dust, or fumes (VGDF), severity of exposure, and a job-exposure matrix (JEM)-derived score] were evaluated using logistic regression models adjusted for non-occupational risk factors. RESULTS: The prevalence of airflow limitation was associated with self-reported exposure to vapor-gas (OR 2.6, 95%CI 1.1-2.3), severity of VGDF exposure (P-trend < 0.01), and JEM dust exposure (OR 2.4, 95%CI 1.1-5.0), and with organic dust exposure in females; these associations were generally of greater magnitude among never smokers. The prevalence of chronic bronchitis and wheeze was associated with exposure to VGDF. The association between airflow limitation and the combined effect of smoking and VGDF exposure showed an increasing trend. Self-reported vapor-gas, dust, fumes, years and severity of exposure were associated with increased prevalence of chronic bronchitis and wheeze (P < 0.001). CONCLUSIONS: Airflow limitation was associated with self-reported VGDF exposure, its severity, and JEM-ascertained dust exposure in smokers and never-smokers in this multiethnic study. |
Examining occupational health and safety disparities using national data: a cause for continuing concern
Steege AL , Baron SL , Marsh SM , Menendez CC , Myers JR . Am J Ind Med 2014 57 (5) 527-38 BACKGROUND: Occupational status, a core component of socioeconomic status, plays a critical role in the well-being of U.S. workers. Identifying work-related disparities can help target prevention efforts. METHODS: Bureau of Labor Statistics workplace data were used to characterize high-risk occupations and examine relationships between demographic and work-related variables and fatality. RESULTS: Employment in high-injury/illness occupations was independently associated with being male, Black, ≤high school degree, foreign-birth, and low-wages. Adjusted fatal occupational injury rate ratios for 2005-2009 were elevated for males, older workers, and several industries and occupations. Agriculture/forestry/fishing and mining industries and transportation and materials moving occupations had the highest rate ratios. Homicide rate ratios were elevated for Black, American Indian/Alaska Native/Asian/Pacific Islanders, and foreign-born workers. CONCLUSIONS: These findings highlight the importance of understanding patterns of disparities of workplace injuries, illnesses and fatalities. Results can improve intervention efforts by developing programs that better meet the needs of the increasingly diverse U.S. workforce. |
Nonfatal work-related injuries and illnesses - United States, 2010
Baron SL , Steege AL , Marsh SM , Menéndez CC , Myers JR . MMWR Suppl 2013 62 (3) 35-40 In 2012, the U.S. civilian labor force comprised an estimated 155 million workers. Although employment can contribute positively to a worker's physical and psychological health, each year, many U.S. workers experience a work-related injury or illness. In 2011, approximately 3 million workers in private industry and 821,000 workers in state and local government experienced a nonfatal occupational injury or illness. Nonfatal workplace injuries and illnesses are estimated to cost the U.S. economy approximately $200 billion annually. Identifying disparities in work-related injury and illness rates can help public health authorities focus prevention efforts. Because work-related health disparities also are associated with social disadvantage, a comprehensive program to improve health equity can include improving workplace safety and health. |
Fatal work-related injuries - United States, 2005-2009
Marsh SM , Menéndez CC , Baron SL , Steege AL , Myers JR . MMWR Suppl 2013 62 (3) 41-5 In 2012, the U.S. civilian labor force comprised an estimated 155 million workers. Although employment can contribute positively to a worker's physical and psychological health, each year, many U.S. workers are fatally injured at work. In 2011, a total of 4,700 U.S. workers died from occupational injuries. Workplace deaths are estimated to cost the U.S. economy approximately $6 billion annually. Identifying disparities in work-related fatality rates can help public health authorities focus prevention efforts. Because work-related health disparities also are associated with social disadvantage, a comprehensive program to improve health equity should include improving workplace safety and health. |
Winter season, frequent hand washing, and irritant patch test reactions to detergents are associated with hand dermatitis in health care workers
Callahan A , Baron E , Fekedulegn D , Kashon M , Yucesoy B , Johnson VJ , Domingo DS , Kirkland B , Luster MI , Nedorost S . Dermatitis 2013 24 (4) 170-5 BACKGROUND: Irritant hand dermatitis (IHD) is common in health care workers. OBJECTIVE: We studied endogenous irritant contact dermatitis threshold by patch testing and exogenous factors such as season and hand washing for their association with IHD in health care workers. METHODS: Irritant patch testing with sodium lauryl sulfate (SLS), sodium hydroxide, and benzalkonium chloride at varying concentrations was measured in 113 health care workers. Examination for hand dermatitis occurred at 1-month intervals for a period of 6 months in the Midwestern United States. RESULTS: Positive patch testing to low-concentration SLS was associated with IHD (P = 0.0310) after adjusting for age, sex, ethnicity, season, history of childhood flexural dermatitis, mean indoor relative humidity, and glove and hand sanitizer usage. Subjects with a positive patch test to SLS were 78% more likely to have occurrence of IHD (incidence rate ratio [IRR] = 1.78; 95% confidence interval [CI], 0.92-3.45). Hand washing frequency (≥10 times a day; IRR = 1.55; 95% CI, 1.01-2.39) and cold season (IRR = 2.76; 95% CI, 1.35-5.65) were associated with IHD. No association was found between history of childhood flexural dermatitis and IHD in this population. CONCLUSIONS: Both genetic and environmental factors are important in the etiology of IHD and should be considered in designing strategies to protect, educate, and treat susceptible individuals. |
The proportion of work-related emergency department visits not expected to be paid by workers' compensation: implications for occupational health surveillance, research, policy, and health equity
Groenewold MR , Baron SL . Health Serv Res 2013 48 1939-59 OBJECTIVE: To examine trends in the proportion of work-related emergency department visits not expected to be paid by workers' compensation during 2003-2006, and to identify demographic and clinical correlates of such visits. DATA SOURCE: A total of 3,881 work-related emergency department visit records drawn from the 2003-2006 National Hospital Ambulatory Medical Care Surveys. STUDY DESIGN: Secondary, cross-sectional analyses of work-related emergency department visit data were performed. Odds ratios and 95 percent confidence intervals were modeled using logistic regression. PRINCIPAL FINDINGS: A substantial and increasing proportion of work-related emergency department visits in the United States were not expected to be paid by workers' compensation. Private insurance, Medicaid, Medicare, and workers themselves were expected to pay for 40 percent of the work-related emergency department visits with this percentage increasing annually. Work-related visits by blacks, in the South, to for-profit hospitals and for work-related illnesses were all more likely not to be paid by workers' compensation. CONCLUSIONS: Emergency department-based surveillance and research that determine work-relatedness on the basis of expected payment by workers' compensation systematically underestimate the occurrence of occupational illness and injury. This has important methodological and policy implications. |
Promoting integrated approaches to reducing health inequities among low-income workers: applying a social ecological framework
Baron SL , Beard S , Davis LK , Delp L , Forst L , Kidd-Taylor A , Liebman AK , Linnan L , Punnett L , Welch LS . Am J Ind Med 2013 57 (5) 539-56 BACKGROUND: Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity. METHODS: We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations. RESULTS: Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work-related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers. CONCLUSIONS: Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed. (Am. J. Ind. Med. (c) 2013 Wiley Periodicals, Inc.) |
Dustiness of fine and nanoscale powders
Evans DE , Turkevich LA , Roettgers CT , Deye GJ , Baron PA . Ann Occup Hyg 2012 57 (2) 261-77 Dustiness may be defined as the propensity of a powder to form airborne dust by a prescribed mechanical stimulus; dustiness testing is typically intended to replicate mechanisms of dust generation encountered in workplaces. A novel dustiness testing device, developed for pharmaceutical application, was evaluated in the dustiness investigation of 27 fine and nanoscale powders. The device efficiently dispersed small (mg) quantities of a wide variety of fine and nanoscale powders, into a small sampling chamber. Measurements consisted of gravimetrically determined total and respirable dustiness. The following materials were studied: single and multiwalled carbon nanotubes, carbon nanofibers, and carbon blacks; fumed oxides of titanium, aluminum, silicon, and cerium; metallic nanoparticles (nickel, cobalt, manganese, and silver) silicon carbide, Arizona road dust; nanoclays; and lithium titanate. Both the total and respirable dustiness spanned two orders of magnitude (0.3-37.9% and 0.1-31.8% of the predispersed test powders, respectively). For many powders, a significant respirable dustiness was observed. For most powders studied, the respirable dustiness accounted for approximately one-third of the total dustiness. It is believed that this relationship holds for many fine and nanoscale test powders (i.e. those primarily selected for this study), but may not hold for coarse powders. Neither total nor respirable dustiness was found to be correlated with BET surface area, therefore dustiness is not determined by primary particle size. For a subset of test powders, aerodynamic particle size distributions by number were measured (with an electrical low-pressure impactor and an aerodynamic particle sizer). Particle size modes ranged from approximately 300nm to several micrometers, but no modes below 100nm, were observed. It is therefore unlikely that these materials would exhibit a substantial sub-100nm particle contribution in a workplace. |
Using the associative imagery technique in qualitative health research: the experiences of homecare workers and consumers
Gong F , Castaneda D , Zhang X , Stock L , Ayala L , Baron S . Qual Health Res 2012 22 (10) 1414-24 The associative imagery technique is a qualitative tool with which researchers use carefully selected photographs or images to trigger participants' responses to explain difficult behavioral and social concepts. In this article, we describe the development and implementation of the associative imagery method in focus groups to understand the complex relationships between homecare workers and their clients as part of a larger health and safety intervention project conducted by the National Institute for Occupational Safety and Health. A total of 116 homecare workers and clients were recruited for the study. We found that participants used images mainly in two ways. First, the images served to remind participants of specific persons, events, and/or objects. Second, the images facilitated recollections and reflections that allowed participants to metaphorically describe their experiences, feelings, and emotions. Both usages of imagery generated comments that answered the research question in a more relevant, descriptive, and vivid way. |
Neurodegenerative causes of death among retired National Football League players
Lehman EJ , Hein MJ , Baron SL , Gersic CN . Neurology 2012 79 (19) 1970-4 OBJECTIVE: To analyze neurodegenerative causes of death, specifically Alzheimer disease (AD), Parkinson disease, and amyotrophic lateral sclerosis (ALS), among a cohort of professional football players. METHODS: This was a cohort mortality study of 3,439 National Football League players with at least 5 pension-credited playing seasons from 1959 to 1988. Vital status was ascertained through 2007. For analysis purposes, players were placed into 2 strata based on characteristics of position played: nonspeed players (linemen) and speed players (all other positions except punter/kicker). External comparisons with the US population used standardized mortality ratios (SMRs); internal comparisons between speed and nonspeed player positions used standardized rate ratios (SRRs). RESULTS: Overall player mortality compared with that of the US population was reduced (SMR 0.53, 95% confidence interval [CI] 0.48-0.59). Neurodegenerative mortality was increased using both underlying cause of death rate files (SMR 2.83, 95% CI 1.36-5.21) and multiple cause of death (MCOD) rate files (SMR 3.26, 95% CI 1.90-5.22). Of the neurodegenerative causes, results were elevated (using MCOD rates) for both ALS (SMR 4.31, 95% CI 1.73-8.87) and AD (SMR 3.86, 95% CI 1.55-7.95). In internal analysis (using MCOD rates), higher neurodegenerative mortality was observed among players in speed positions compared with players in nonspeed positions (SRR 3.29, 95% CI 0.92-11.7). CONCLUSIONS: The neurodegenerative mortality of this cohort is 3 times higher than that of the general US population; that for 2 of the major neurodegenerative subcategories, AD and ALS, is 4 times higher. These results are consistent with recent studies that suggest an increased risk of neurodegenerative disease among football players. (Neurology 2012;79:1-1) |
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