Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 74 Records) |
Query Trace: Flynn A[original query] |
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Work-related factors associated with psychological distress among grocery workers during the COVID-19 pandemic
Payne J , Esquivel NS , Strazza K , Viator C , Durocher B , Sivén J , Flynn MA , Menéndez CC , Kaur H . AJPM Focus 2024 3 (6) 100272 INTRODUCTION: During the COVID-19 pandemic, grocery workers experienced new (in addition to existing) work-related stressors that put them at risk for psychological distress. This study uses the job demands-resources theory to identify and describe the job demands and resources associated with grocery worker distress. METHODS: This study analyzed data from 75 90-minute interviews focusing on grocery workers' experiences during the COVID-19 pandemic. During the interviews, participants also answered questions associated with the Patient Health Questionnaire 4, a validated measure of psychological distress. RESULTS: Overall, the study found that 36% of study participants exhibited mild to severe psychological distress at the time of their interviews, and a greater proportion of young, female, and White participants reported mild to severe psychological distress than did participants in other subgroups. Qualitative data suggest that the prevalence of psychological distress among participants was likely higher at the beginning of the pandemic and resulted from fear of SARS-CoV-2 exposure, conflict with customers, workplace discrimination, increased workload, and designation as an essential worker. Although about half of the participants in the sample said that their employers provided support to improve workers' mental health, the interviews suggest that more could be done. CONCLUSIONS: These findings may lead to opportunities to improve worker well-being during the COVID-19 pandemic and to prepare for future public health emergencies. Proposed strategies include implementing public health measures as advised by infectious disease experts; offering information and training; providing sick leave, long-term hazard pay, higher wages, and mental health benefits; and better distribution of workloads. |
Innate immune activation restricts priming and protective efficacy of the radiation-attenuated PfSPZ malaria vaccine
Senkpeil L , Bhardwaj J , Little MR , Holla P , Upadhye A , Fusco EM , Swanson Ii PA , Wiegand RE , Macklin MD , Bi K , Flynn BJ , Yamamoto A , Gaskin EL , Sather DN , Oblak AL , Simpson E , Gao H , Haining WN , Yates KB , Liu X , Murshedkar T , Richie TL , Sim BKL , Otieno K , Kariuki S , Xuei X , Liu Y , Polidoro RB , Hoffman SL , Oneko M , Steinhardt LC , Schmidt NW , Seder RA , Tran TM . JCI Insight 2024 ![]() ![]() ![]() A systems analysis was conducted to determine the potential molecular mechanisms underlying differential immunogenicity and protective efficacy results of a clinical trial of the radiation-attenuated whole sporozoite PfSPZ Vaccine in African infants. Innate immune activation and myeloid signatures at pre-vaccination baseline correlated with protection from Pf parasitemia in placebo controls. These same signatures were associated with susceptibility to parasitemia among infants who received the highest and most protective PfSPZ Vaccine dose. Machine learning identified spliceosome, proteosome, and resting dendritic cell signatures as pre-vaccination features predictive of protection after highest-dose PfSPZ vaccination, whereas baseline CSP-specific IgG predicted non-protection. Pre-vaccination innate inflammatory and myeloid signatures were associated with higher sporozoite-specific IgG Ab response but undetectable PfSPZ-specific CD8+ T-cell responses post-vaccination. Consistent with these human data, innate stimulation in vivo conferred protection against infection by sporozoite injection in malaria-naïve mice while diminishing the CD8+ T-cell response to radiation-attenuated sporozoites. These data suggest a dichotomous role of innate stimulation for malaria protection and induction of protective immunity of whole-sporozoite malaria vaccines. The uncoupling of vaccine-induced protective immunity achieved by Abs from more protective CD8+ T cell responses suggest that PfSPZ Vaccine efficacy in malaria-endemic settings may be constrained by opposing antigen presentation pathways. |
Disparities in COVID-19 vaccine uptake, attitudes, and experiences between food system and non–food system essential workers
Smarsh BL , Yankey D , Hung MC , Blanck HM , Kriss JL , Flynn MA , Lu PJ , McGarry S , Eastlake AC , Lainz AR , Singleton JA , Lincoln JM . J Agric Food Syst Community Dev 2024 13 (2) The COVID-19 pandemic has disproportionately affected the health of food system (FS) essential workers compared with other essential and non-essential workers. Even greater disparity exists for workers in certain FS work settings and for certain FS worker subpopulations. We analyzed essential worker respondents (n = 151,789) in May–Novem-ber 2021 data from the National Immunization Survey Adult COVID Module (NIS-ACM) to assess and characterize COVID-19 vaccination uptake (≥1 dose) and intent (reachable, reluctant), attitudes about COVID-19 and the vaccine, and experiences and difficulties getting the vaccine. We compared rates, overall and by certain characteristics, between workers of the same group, and between FS (n = 17,414) and non–food system (NFS) worker groups (n = 134,375), to determine if differences exist. FS worker groups were classified as “agriculture, forestry, fishing, or hunting” (AFFH; n = 2,730); “food manufacturing facility” (FMF; n = 3,495); and “food and beverage store” (FBS; n = 11,189). Compared with NFS workers, significantly lower percentages of FS workers reported >1 dose of COVID-19 vaccine or vaccine requirements at work or school, but overall vaccine experiences and difficulties among vaccinated FS workers were statistically similar to NFS workers. When we examined intent regarding COVID-19 vaccination among unvaccinated FS workers compared with NFS counterparts, we found a higher percentage of FMF and FBS workers were reachable whereas a higher percentage of AFFH workers were reluctant about vaccination, with differences by sociodemographic characteristics. Overall, results showed differences in uptake, intent, and attitudes between worker groups and by some sociodemographic characteristics. The findings reflect the diversity of FS workers and underscore the importance of collecting occupational data to assess health inequalities and of tailoring efforts to worker groups to improve confidence and uptake of vaccinations for infectious diseases such as COVID-19. The findings can inform future research, adult infectious disease interventions, and emergency management planning. © 2024 by the Authors. |
Factors associated with the awareness of and willingness to use HIV pre-exposure prophylaxis among gay, bisexual, and other men who have sex with men, Baltimore, MD, 2017-2019
King H , Thornton N , Evans KN , Tadfor Y , German D , Flynn C , Jennings J , Fields EL . J Racial Ethn Health Disparities 2024 Pre-exposure prophylaxis (PrEP) is an effective tool in protecting persons from acquiring HIV infection through sex or injection drug use. However, awareness and willingness to use PrEP among Black gay, bisexual, and other men who have sex with men (BMSM) remain suboptimal compared to White MSM (WMSM) in the United States. Our aims were to (1) assess the factors associated with PrEP awareness and willingness to use PrEP among MSM and (2) compare the PrEP perceptions among BMSM versus non-Black MSM. Data were drawn from two cross-sectional behavioral surveys in Baltimore, MD: Behavioral Surveillance Research (BESURE) conducted in 2017, and Safe Spaces 4 Sexual Health (SS4SH), conducted in 2018 and 2019. Descriptive statistics were used to summarize the study population. We used Poisson regression models to identify variables associated with awareness of PrEP and willingness to use PrEP. PrEP perceptions were assessed via 13 items scored on a 5-point Likert scale. Finally, we conducted a post-hoc exploratory bivariate analysis of the relationship between PrEP perception and willingness to use PrEP, stratified by race/ethnicity. A total of 261 MSM participated in this study. Many of the participants were aware of PrEP (75.1%). Factors associated with greater PrEP awareness included having greater than a high school education (aRR 1.22, 95% CI 1.04, 1.43); and earning more than $25,000 annually (aRR 1.24, 95% CI 1.08, 1.42). Participants who had received money in exchange for sex one or more times were less likely to be aware of PrEP (aRR 0.59, 95% CI 0.36, 0.95). More than half of the participants were willing to use PrEP (55.3%). In bivariate and multivariable analyses, demographic or behavioral characteristics were not significantly associated with willingness to use PrEP. Higher agreement with the following statements was associated with lower willingness to use PrEP: "Having to take a pill every day is difficult" (RR 0.89, 95% CI 0.82-0.97) and, "I am concerned about the side effects of PrEP" (RR 0.89, 95% CI 0.82-0.96), and "PrEP is for people who have riskier sex lives than I do" (RR 0.86, 95% CI 0.78-0.95). Conversely, higher willingness to use PrEP was associated with comfortable having sex without a condom (RR 1.11, 95% CI 1.02-1.21), less anxious about sex (RR 1.12, 95% CI 1.02-1.24), and my friends think that I should take PrEP (RR 1.19, 95% CI 1.07-1.32). We found BMSM compared to non-Black MSM had higher mean scores related to taking a daily pill (p = 0.041), concerns about side effects (p = 0.012), concerns about people thinking they had HIV (p = 0.001), concerns about the financial costs of PrEP (p = 0.038) and caution when dealing with healthcare organizations/medical mistrust (p = 0.019). Perceptions with a statistically significant lower score among BMSM versus non-Black MSM included statements such as, comfortable having sex without a condom (p = 0.003) and less anxious about sex (p < 0.001). We conclude HIV prevention strategies, programs, and interventions should be cognizant of PrEP perceptions that facilitate or hinder PrEP uptake in Baltimore City, MD. |
Assessing the role of social determinants of health in health disparities: The need for data on work
Silver SR , Sweeney MH , Sanderson WT , Pana-Cryan R , Steege AL , Quay B , Carreón T , Flynn MA . Am J Ind Med 2023 BACKGROUND: Work is a key social determinant of health. Without the collection of work-related information in public health data systems, the role of social determinants in creating and reinforcing health disparities cannot be fully assessed. METHODS: The Centers for Disease Control and Prevention (CDC) maintains or supports a number of public health surveillance and health monitoring systems, including surveys, case-based disease and exposure systems, vital status records, and administrative data systems. We evaluated a convenience sample of these systems for inclusion of information in three work-related domains: employment status, industry and occupation, and working conditions. RESULTS: While 12 of 39 data systems were identified as collecting work-related data, this information was often minimal (e.g., only employment status), restricted to a subset of respondents, or only gathered periodically. Information on working conditions was particularly sparse. CONCLUSION: Historically, the limited and inconsistent collection of work-related information in public health data systems has hindered understanding of the role work plays in health disparities. Current CDC data modernization efforts present opportunities to enhance the identification and mitigation of health disparities by prioritizing inclusion of an expanded set of work-related data elements. |
Rural health and rural industries: Opportunities for partnership and action
Scott KA , Elliott KC , Lincoln J , Flynn MA , Hill R , Hall DM . J Rural Health 2023 A recent article in Morbidity and Mortality Weekly Report1 describes the Fatalities in Oil and Gas Extraction (FOG) database—an industry-specific database created to help researchers understand patterns of deaths among US oil and gas extraction (OGE) workers. Among other strengths, the database includes detailed geographic data on fatal incidents–a feature lacking in other systems that track workplace fatalities. It is clear that the majority of OGE worker fatalities occurred in rural micropolitan and noncore counties (Figure 1). This finding may not be surprising to people in the industry. However, it does raise questions about relationships between work, health, and rurality that are rarely explored explicitly or systematically. |
Occupational safety and health equity impacts of artificial intelligence: A scoping review
Fisher E , Flynn MA , Pratap P , Vietas JA . Int J Environ Res Public Health 2023 20 (13) ![]() Artificial intelligence (AI) has the potential to either reduce or exacerbate occupational safety and health (OSH) inequities in the workplace, and its impact will be mediated by numerous factors. This paper anticipates challenges to ensuring that the OSH benefits of technological advances are equitably distributed among social groups, industries, job arrangements, and geographical regions. A scoping review was completed to summarize the recent literature on AI's role in promoting OSH equity. The scoping review was designed around three concepts: artificial intelligence, OSH, and health equity. Scoping results revealed 113 articles relevant for inclusion. The ways in which AI presents barriers and facilitators to OSH equity are outlined along with priority focus areas and best practices in reducing OSH disparities and knowledge gaps. The scoping review uncovered priority focus areas. In conclusion, AI's role in OSH equity is vastly understudied. An urgent need exists for multidisciplinary research that addresses where and how AI is being adopted and evaluated and how its use is affecting OSH across industries, wage categories, and sociodemographic groups. OSH professionals can play a significant role in identifying strategies that ensure the benefits of AI in promoting workforce health and wellbeing are equitably distributed. |
Mixed messages and COVID-19 prevention: Why information isn't always enough to protect meat processing workers
Sivén JM , Coburn J , Call TP , Mahoney D , Flores RR , Kaur H , Flynn MA , Menéndez CC . AJPM Focus 2023 100128 INTRODUCTION: The objective of this project was to investigate U.S. meat and poultry processing workers' knowledge of COVID-19, perceived ability to protect themselves from infection, and perspectives on COVID-19 vaccines to inform COVID-19 prevention efforts within this linguistically, racially, and ethnically diverse workforce. METHODS: Qualitative semi-structured in-depth interviews were conducted with Mexican, Central American, Congolese refugee, and Black or African American meat/poultry processing workers from Mississippi, Minnesota, Virginia, and Kentucky (N=40). Data were collected from December 5, 2020, to January 28, 2021. Interview audio was transcribed, and rapid qualitative data analysis was used to analyze transcripts. RESULTS: Most participants expressed receiving mixed messages about COVID-19 protection measures: they were told how to protect themselves (n=38), but workplace policies (such as lack of paid sick leave) often undermined their efforts. Participants who were asked about COVID-19 vaccines (n=31) were aware there were one or more vaccines available to protect them from COVID-19; one-third were eager to get vaccinated. CONCLUSIONS: Community-based efforts may consider supplementing large scale unified information campaigns in order to prevent mixed messages, address worker needs to accurately gauge the threat of illness to their families and communities and empower them to prevent infection. |
Overlapping vulnerabilities in workers of the electronics recycling industry formal sector: A commentary
Ceballos DM , Côté D , Bakhiyi B , Flynn MA , Zayed J , Gravel S , Herrick RF , Labrèche F . Am J Ind Med 2020 63 (11) 955-962 Vulnerabilities in workers performing electronics recycling (e-recycling) in the informal sector worldwide have been well documented. However, the growing e-recycling industry in the formal sector still brings many challenges to protect the health of workers and their environment. This commentary aims to draw attention to the overlooked vulnerabilities faced by the workers of the e-recycling industry formal sector in high-income countries and discuss the potential impact on health inequalities experienced by these workers. Expanding the definition of vulnerability, not limited to the biological susceptibility to chemical and physical exposures, the demographic characteristics of workers in the e-recycling formal sector often reveal social groups known to be disadvantaged regarding occupational exposures and health effects, including young workers, immigrant or ethnic minorities, and workers with mental or physical health issues or disabilities. Overlapping structural vulnerabilities of the e-recycling industry stem from its newness, its working conditions, its conditions of employment, and the sociodemographic characteristics of its workforce. This phenomenon in high-income countries is not restricted to the e-recycling industry alone. It is rather a symptom of more generalized macro socioeconomical phenomena. The present challenges are in line with the new gig and green economies and changes in the global market, and their consequences on the solid waste sector. Continued efforts to strengthen the inclusion of social aspects of health into the complex interaction of the structural vulnerabilities met by e-recycling workers will be essential to anticipate and prevent health issues in this essential but still emerging workforce. |
Flynn et al. Respond
Flynn MA , Cunningham TR , Ahonen EQ , Fujishiro K . Am J Public Health 2018 108 (9) e3-e4 We would like to thank Wegman and Davis for their response to our article and congratulate them and their colleagues on the recent report from the National Academies of Science, Engineering, and Medicine: A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century (NAS report).1 We share Wegman and Davis’s optimism that this moment offers an opportunity for developing systems that generate better, more comprehensive data to improve our understanding of the social determinants that drive health inequities and empower society to eliminate health inequities. Whether arguing for a greater recognition for the influence of work on population health or a greater accounting for the role social structures play in health inequalities manifest in the workplace, the need for a more inclusive, social determinant approach to health inequity2 is a central theme of both documents. |
Updated assessment of occupational safety and health hazards of climate change
Schulte PA , Jacklitsch BL , Bhattacharya A , Chun H , Edwards N , Elliott KC , Flynn MA , Guerin R , Hodson L , Lincoln JM , MacMahon KL , Pendergrass S , Siven J , Vietas J . J Occup Environ Hyg 2023 20 1-36 Workers, particularly outdoor workers, are among the populations most disproportionately affected by climate-related hazards. However, scientific research and control actions to comprehensively address these hazards are notably absent. To assess this absence, a seven-category framework was developed in 2009 to characterize the scientific literature published from 1988 through 2008. Using this framework, a second assessment examined the literature published through 2014, and the current one examines literature from 2014 through 2021. The objectives were to present literature that updates the framework and related topics and increases awareness of the role of climate change in occupational safety and health. In general, there is substantial literature on worker hazards related to ambient temperatures, biological hazards, and extreme weather but less on air pollution, ultraviolet radiation, industrial transitions, and the built environment. There is growing literature on mental health and health equity issues related to climate change, but much more research is needed. The socioeconomic impacts of climate change also require more research. This study illustrates that workers are experiencing increased morbidity and mortality related to climate change. In all areas of climate-related worker risk, including geoengineering, research is needed on the causality and prevalence of hazards, along with surveillance to identify, and interventions for hazard prevention and control. |
Etiology of acute febrile illness in the peruvian amazon as determined by modular formatted quantitative PCR: a protocol for RIVERA, a health facility-based case-control study.
Peñataro Yori P , Paredes Olórtegui M , Schiaffino F , Colston JM , Pinedo Vasquez T , Garcia Bardales PF , Shapiama Lopez V , Zegarra Paredes LF , Perez K , Curico G , Flynn T , Zhang J , Ramal Asayag C , Meza Sanchez G , Silva Delgado H , Casapia Morales M , Casanova W , Jiu B , Oberhelman R , Munayco Escate C , Silver R , Henao O , Cooper KK , Liu J , Houpt ER , Kosek MN . BMC Public Health 2023 23 (1) 674 ![]() ![]() BACKGROUND: The study of the etiology of acute febrile illness (AFI) has historically been designed as a prevalence of pathogens detected from a case series. This strategy has an inherent unrealistic assumption that all pathogen detection allows for causal attribution, despite known asymptomatic carriage of the principal causes of acute febrile illness in most low- and middle-income countries (LMICs). We designed a semi-quantitative PCR in a modular format to detect bloodborne agents of acute febrile illness that encompassed common etiologies of AFI in the region, etiologies of recent epidemics, etiologies that require an immediate public health response and additional pathogens of unknown endemicity. We then designed a study that would delineate background levels of transmission in the community in the absence of symptoms to provide corrected estimates of attribution for the principal determinants of AFI. METHODS: A case-control study of acute febrile illness in patients ten years or older seeking health care in Iquitos, Loreto, Peru, was planned. Upon enrollment, we will obtain blood, saliva, and mid-turbinate nasal swabs at enrollment with a follow-up visit on day 21-28 following enrollment to attain vital status and convalescent saliva and blood samples, as well as a questionnaire including clinical, socio-demographic, occupational, travel, and animal contact information for each participant. Whole blood samples are to be simultaneously tested for 32 pathogens using TaqMan array cards. Mid-turbinate samples will be tested for SARS-CoV-2, Influenza A and Influenza B. Conditional logistic regression models will be fitted treating case/control status as the outcome and with pathogen-specific sample positivity as predictors to attain estimates of attributable pathogen fractions for AFI. DISCUSSION: The modular PCR platforms will allow for reporting of all primary results of respiratory samples within 72 h and blood samples within one week, allowing for results to influence local medical practice and enable timely public health responses. The inclusion of controls will allow for a more accurate estimate of the importance of specific prevalent pathogens as a cause of acute illness. STUDY REGISTRATION: Project 1791, Registro de Proyectos de Investigación en Salud Pública (PRISA), Instituto Nacional de Salud, Perú. |
Mobile Health and Wellness Project: A binational collaboration of frontline health services to the Latino population in the United States in times of COVID-19
Rosales CB , Dávila Chávez H , Flynn MA , Lara J , Lira Chávez IA , Olivares Marín L , Romero Rangel A , Hirata Okamoto R , Rangel Gómez MG . Front Public Health 2022 10 1022772 Hardly reached communities in the United States greatly benefit from collective efforts and partnerships from Community Based Organizations, Health Institutions and Government Agencies, yet the effort to engage in this collaborative effort is minimal and funding to support these projects is lacking. The COVID-19 Pandemic exacerbated on a national scale what many vulnerable communities experience regularly; difficult access to basic medical care, information and support. In an effort to directly engage with community organizations and curb the infection rate of the COVID-19 virus within vulnerable communities, the US Centers for Disease Control and Prevention (CDC) launched its first targeted effort to partner directly with community based organizations. This article will highlight the first pilot year of activities and key results of COVID-19 education and vaccination efforts by the Mobile Health and Wellness project. This is a fleet of 11 Mobile Health Vehicles managed by the Mexico Section US-Mexico Border Health Commission in partnership with Alianza Americas, Latino Commission on AIDS, and the CDC, targeting Latino, Immigrant and rural communities across the US. |
Occupational safety and health with technological developments in livestock farms: A literature review
Hayden MA , Barim MS , Weaver DL , Elliott KC , Flynn MA , Lincoln JM . Int J Environ Res Public Health 2022 19 (24) In recent decades, there have been considerable technological developments in the agriculture sector to automate manual processes for many factors, including increased production demand and in response to labor shortages/costs. We conducted a review of the literature to summarize the key advances from installing emerging technology and studies on robotics and automation to improve agricultural practices. The main objective of this review was to survey the scientific literature to identify the uses of these new technologies in agricultural practices focusing on new or reduced occupational safety risks affecting agriculture workers. We screened 3248 articles with the following criteria: (1) relevance of the title and abstract with occupational safety and health; (2) agriculture technologies/applications that were available in the United States; (3) written in English; and (4) published 2015-2020. We found 624 articles on crops and harvesting and 80 articles on livestock farming related to robotics and automated systems. Within livestock farming, most (78%) articles identified were related to dairy farms, and 56% of the articles indicated these farms were using robotics routinely. However, our review revealed gaps in how the technology has been evaluated to show the benefits or potential hazards to the safety and well-being of livestock owners/operators and workers. |
Differences in geographic patterns of absolute and relative black-white disparities in stroke mortality in the United States
Flynn A , Vaughan AS , Casper M . Prev Chronic Dis 2022 19 E63 In the US, racial disparities in stroke death rates are particularly large among working age adults, for whom the stroke death rate in 2019 among non-Hispanic Black adults aged 35 to 64 years was 2.4 times that of their non-Hispanic White counterparts (1,2). These national disparities occur in the context of marked local variation in stroke death rates among both Black and White populations. Within the Stroke Belt (a band of southern US states with high stroke mortality), stroke death rates for both Black and White populations are persistently high (3). However, county-level racial disparities in stroke death rates have not been documented. These data are critical to addressing racial inequities in stroke mortality by shaping public health agendas, engaging communities, and guiding prioritization and development of programs, interventions, and policies (2,4). Therefore, we calculated race-specific stroke death rates in 2019 for adults aged 35 to 64 years and mapped the geographic variation of the largest absolute and relative BlackWhite disparities in stroke death rates (Map A) and of the highest stroke death rates for Black populations and White populations (Map B). |
Epidemiology and risk factors related to severity of clinical manifestations of COVID-19 in outpatients: A retrospective study in Haiti.
Lucien MAB , Pierre K , Jean-Denis G , Rigodon J , Worrell CM , Couture A , Flynn A , Calderon MC , Codina LF , Vicari AS , Marseille S , Jean Baptiste KT , Fouche B , Joseph G , Journel I , Rendel K , Grant-Greene Y , Jean-Charles NP , Lafontant D , Amouzou S , Pierre W , Clement MGR , Juin S , Boncy J , Dely P . PLoS One 2022 17 (9) e0274760 BACKGROUND: Haiti's first COVID-19 cases were confirmed on March 18, 2020, and subsequently spread throughout the country. The objective of this study was to describe clinical manifestations of COVID-19 in Haitian outpatients and to identify risk factors for severity of clinical manifestations. METHODS: We conducted a retrospective study of COVID-19 outpatients diagnosed from March 18-August 4, 2020, using demographic, epidemiological, and clinical data reported to the Ministry of Health (MoH). We used univariate and multivariate analysis, including multivariable logistic regression, to explore the risk factors and specific symptoms related to persons with symptomatic COVID-19 and the severity of symptomatic COVID-19 disease. RESULTS: Of 5,389 cases reported to MOH during the study period, 1,754 (32.5%) were asymptomatic. Amongst symptomatic persons 2,747 (75.6%) had mild COVID-19 and 888 (24.4%) had moderate-to-severe disease; the most common symptoms were fever (69.6%), cough (51.9%), and myalgia (45.8%). The odds of having moderate-to-severe disease were highest among persons with hypertension (aOR = 1.72, 95% Confidence Interval [CI] (1.34, 2.20), chronic pulmonary disease (aOR = 3.93, 95% CI (1.93, 8.17)) and tuberculosis (aOR = 3.44, 95% CI (1.35, 9.14)) compared to persons without those conditions. The odds of having moderate-to-severe disease increased with age but was also seen among children aged 0-4 years (OR: 1.73, 95% CI (0.93, 3.08)), when using 30-39 years old as the reference group. All of the older age groups, 50-64 years, 65-74 years, 75-84 years, and 85+ years, had significantly higher odds of having moderate-to-severe COVID-19 compared with ages 30-39 years. Diabetes was associated with elevated odds of moderate-to-severe disease in bivariate analysis (OR = 2.17, 95% CI (1.58,2.98) but, this association did not hold in multivariable analyses (aOR = 1.22,95%CI (0.86,1.72)). CONCLUSION: These findings from a resource-constrained country highlight the importance of surveillance systems to track emerging infections and their risk factors. In addition to co-morbidities described elsewhere, tuberculosis was a risk factor for moderate-to-severe COVID-19 disease. |
Working hours, sleep, and fatigue in the agriculture, forestry, and fishing sector: A scoping review
Elliott KC , Lincoln JM , Flynn MA , Levin JL , Smidt M , Dzugan J , Ramos AK . Am J Ind Med 2022 65 (11) 898-912 INTRODUCTION: Agriculture, forestry, and fishing industry (AgFF) workers often work extremely long hours during peak production seasons, resulting in sleep deprivation and fatigue. The National Occupational Research Agenda has classified fatigue as a "significant safety issue" and area of concern for many industry sectors, including AgFF. This review explores current research and practice in AgFF and proposes next steps. METHODS: We conducted a scoping literature review to examine the extent and nature of research in this area. Article inclusion criteria included peer-reviewed journal articles written in English; published after 1989; covering AgFF workers in high-income countries; with data on working hours/schedules and sleep related to safety and health. RESULTS: Limited research has addressed long hours and sleep deprivation among AgFF workers. We identified 8350 articles for title and abstract review. Among those, 407 underwent full-text review and 96 met all inclusion criteria (67% agriculture, 25% fishing/seafood processing, 8% forestry). The literature provided some evidence fatigue contributes to fatalities, injuries, and illnesses in AgFF. Older, new, young, foreign-born, and female workers, as well as those who work in small organizations or longer hours (40+) may be at higher risk for fatigue-related injury and illness. Few studies have developed or evaluated interventions to control risks. DISCUSSION: Given that fatigue is a factor in injury and illness for this sector, future AgFF surveillance and research should increase efforts to capture fatigue and sleep data, directly investigate the role of long hours and nonstandard work schedules in the sector, and most importantly, create practical interventions to manage fatigue. |
Preventing suicidal behavior among American Indian and Alaska Native adolescents and young adults
Mpofu JJ , Crosby A , Flynn MA , LaFromboise T , Iskander J , Hall JE , Penman-Aguilar A , Thorpe P . Public Health Rep 2022 138 (4) 333549221108986 From 2009 to 2018, overall suicide rates in the United States increased by 20.3% and increased by 43.5% among non-Hispanic American Indian and Alaska Native (AI/AN) communities. Combining years 2009 through 2018, suicide rates per 100 000 population among non-Hispanic AI/AN adolescents and young adults aged 15 to 34 years were 2 to 4 times higher than those of adolescents and young adults of other races and ethnicities. An estimated 14% to 27% of non-Hispanic AI/AN adolescents attempted suicide during that time. The elevated rates of suicidal behavior among non-Hispanic AI/AN adolescents and young adults reflect inequities in the conditions that create health. In this topical review, we describe school-based educational efforts that are driven by local AI/AN communities, such as the American Indian Life Skills curriculum, that teach stress and coping skills and show promise in reducing suicidal ideation attempts and fatalities among AI/AN adolescents. Using a social-determinants-of-health lens, we review the availability and quality of employment as an important influencer of suicidal behavior, as well as the role of the workplace as an environment for suicide prevention in AI/AN communities. Working with tribal, state, local, and federal colleagues, the public health community can implement programs known to be effective and create additional comprehensive strategies to reduce inequities and ultimately reduce suicide rates. |
The where of when: Geographic variation in the timing of recent increases in US county-level heart disease death rates
Vaughan AS , Flynn A , Casper M . Ann Epidemiol 2022 72 18-24 ![]() PURPOSE: Within the context of local increases in US heart disease death rates, we estimated when increasing heart disease death rates began by county among adults aged 35-64 years and characterized geographic variation. METHODS: We applied Bayesian spatiotemporal models to vital statistics data to estimate the timing (i.e., the year) of increasing county-level heart disease death rates during 1999-2019 among adults aged 35-64 years. To examine geographic variation, we stratified results by US Census region and urban-rural classification. RESULTS: The onset of increasing heart disease death rates among adults aged 35-64 years spanned the two-decade study period from 1999 through 2019. Overall, 43.5% (95% CI: 41.3, 45.6) of counties began increasing before 2011, with early increases more prevalent outside of the most urban counties and outside of the Northeast. Roughly one-in-five (18.4% [95% CI: 15.6, 20.7]) counties continued to decline throughout the study period. CONCLUSIONS: This variation suggests that factors associated with these geographic classifications may be critical in establishing the timing of changing trends in heart disease death rates. These results reinforce the importance of spatiotemporal surveillance in the early identification of adverse trends and in informing opportunities for tailored policies and programs. |
Violence against children: multifaceted approaches to a complex problem
Villaveces A , Viswanathan S . Int J Inj Contr Saf Promot 2022 29 (1) 1-2 In this issue of the Journal, we highlight the problem of violence against children globally. We conceptualized this process and the thematic focus and widely disseminated an invitation to submit manuscripts. Each of us took the lead editorial role in a group of manuscripts submitted for this issue. Dr. Viswanathan led the review process for manuscripts submitted by Moe et. al, Seff et. al., Couture et. al, Osborne et. al, Khan et. al., and Friedman et. al. Dr Villaveces led the reviews of Pendharkar et. al, Tang et. al, Ryan et. al, Bravo Sanzana et. al, Flynn O'Brien et. al., Silverman et. al., and Taliep et.al. We hope that readers will see the complexities related to violence against children and get a better sense of the global implications of this problem. |
Health equity and a paradigm shift in occupational safety and health
Flynn MA , Check P , Steege AL , Sivén JM , Syron LN . Int J Environ Res Public Health 2022 19 (1) Despite significant improvements in occupational safety and health (OSH) over the past 50 years, there remain persistent inequities in the burden of injuries and illnesses. In this commen-tary, the authors assert that addressing these inequities, along with challenges associated with the fundamental reorganization of work, will require a more holistic approach that accounts for the social contexts within which occupational injuries and illnesses occur. A biopsychosocial approach explores the dynamic, multidirectional interactions between biological phenomena, psychological factors, and social contexts, and can be a tool for both deeper understanding of the social determinants of health and advancing health equity. This commentary suggests that reducing inequities will require OSH to adopt the biopsychosocial paradigm. Practices in at least three key areas will need to adopt this shift. Research that explicitly examines occupational health inequities should do more to elucidate the effects of social arrangements and the interaction of work with other social determinants on work-related risks, exposures, and outcomes. OSH studies regardless of focus should incorporate inclusive methods for recruitment, data collection, and analysis to reflect societal diversity and account for differing experiences of social conditions. OSH researchers should work across disciplines to integrate work into the broader health equity research agenda. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. |
Public health impacts of underemployment and unemployment in the United States: Exploring perceptions, gaps and opportunities
Pratap P , Dickson A , Love M , Zanoni J , Donato C , Flynn MA , Schulte PA . Int J Environ Res Public Health 2021 18 (19) Background: Unemployment, underemployment, and the quality of work are national occupational health risk factors that drive critical national problems; however, to date, there have been no systematic efforts to document the public health impact of this situation. Methods: An environmental scan was conducted to explore the root causes and health impacts of underemployment and unemployment and highlight multilevel perspectives and factors in the landscape of underemploy-ment and unemployment. Methods: included a review of gray literature and research literature, followed by key informant interviews with nine organizational representatives in employment research and policy, workforce development, and industry to assess perceived needs and gaps in practice. Results: Evidence highlights the complex nature of underemployment and unemployment, with multiple macro-level underlying drivers, including the changing nature of work, a dynamic labor market, inadequate enforcement of labor protection standards, declining unions, wage de-pression, and weak political will interacting with multiple social determinants of health. Empirical literature on unemployment and physical, mental, and psychological well-being, substance abuse, depression in young adults, and suicides is quite extensive; however, there are limited data on the impacts of underemployment on worker health and well-being. Additionally, organizations do not routinely consider health outcomes as they relate to their work in workforce or policy development. Discussion and Conclusions: Several gaps in data and research will need to be addressed in order to assess the full magnitude of the public health burden of underemployment and unemployment. Public health needs to champion a research and practice agenda in partnership with multisector stakeholders to illuminate the role of employment quality and status in closing the gap on health inequities, and to integrate workforce health and well-being into labor and economic development agendas across government agencies and industry. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. |
Using Event-Based Web-Scraping Methods and Bidirectional Transformers to Characterize COVID-19 Outbreaks in Food Production and Retail Settings
Miano J , Hilton C , Gangrade V , Pomeroy M , Siven J , Flynn M , Tilashalski F . International Conference on Artificial Intelligence in Medicine 2021 187-198 ![]() Current surveillance methods may not capture the full extent of COVID-19 spread in high-risk settings like food establishments. Thus, we propose a new method for surveillance that identifies COVID-19 cases among food establishment workers from news reports via web-scraping and natural language processing (NLP). First, we used web-scraping to identify a broader set of articles (n = 67,078) related to COVID-19 based on keyword mentions. In this dataset, we used an open-source NLP platform (ClarityNLP) to extract location, industry, case, and death counts automatically. These articles were vetted and validated by CDC subject matter experts (SMEs) to identify those containing COVID-19 outbreaks in food establishments. CDC and Georgia Tech Research Institute SMEs provided a human-labeled test dataset containing 388 articles to validate our algorithms. Then, to improve quality, we fine-tuned a pretrained RoBERTa instance, a bidirectional transformer language model, to classify articles containing ≥ 1 positive COVID-19 cases in food establishments. The application of RoBERTa decreased the number of articles from 67,078 to 1,112 and classified (≥ 1 positive COVID-19 cases in food establishments) articles with 88% accuracy in the human-labeled test dataset. Therefore, by automating the pipeline of web-scraping and COVID-19 case prediction using RoBERTa, we enable an efficient human in-the-loop process by which COVID-19 data could be manually collected from articles flagged by our model, thus reducing the human labor requirements. Furthermore, our approach could be used to predict and monitor locations of COVID-19 development by geography and could also be extended to other industries and news article datasets of interest. © 2021, Springer Nature Switzerland AG. |
Reaching "hard to reach" workers: Evaluating approaches to disseminate worker safety information via the Mexican consular network
Flynn MA , Eggerth DE , Keller BM , Check P . J Occup Environ Hyg 2021 18 1-17 Mexican immigrants suffer a disproportionately large number of work-related injuries and deaths given their share of the workforce. Barriers of language, culture, and mistrust are often cited as factors that complicate efforts to reach these workers with occupational safety and health (OSH) interventions. By partnering with the Mexican government and its consulate network in the United States, researchers from the National Institute for Occupational Safety and Health were able to assess the impact of four different information dissemination approaches (posters, passively distributed brochures, actively distributed brochures, and video kiosks) in Spanish in a five-phase study. Exit interviews conducted with Mexicans seeking consular services indicated that while nearly all respondents considered OSH to be of importance, significant differences in impact measures, such as noticing the materials and liking of content, were found when comparing the different approaches. Despite these differences, even the least effective approaches were noticed by large numbers of individuals and significantly increased their stated behavioral intentions regarding OSH. Considering all materials together, significantly more participants reported liking the materials (p < 0.001) than did not, learning something new (p < 0.01), trusting the information (p < 0.05), intending to seek out additional OSH information (p < 0.01), and intending to speak to their bosses about OSH (p < 0.05). These findings contribute to building an evidence base for moving research knowledge into practice, which is an essential, but often overlooked, element of occupational safety and health research, particularly among workers from underserved communities. |
American Academy of Optometry Microbial Keratitis Think Tank.
Szczotka-Flynn LB , Shovlin JP , Schnider CM , Caffery BE , Alfonso EC , Carnt NA , Chalmers RL , Collier S , Jacobs DS , Joslin CE , Kroken AR , Lakkis C , Pearlman E , Schein OD , Stapleton F , Tu E , Willcox MDP . Optom Vis Sci 2021 98 (3) 182-198 ![]() SIGNIFICANCE: Think Tank 2019 affirmed that the rate of infection associated with contact lenses has not changed in several decades. Also, there is a trend toward more serious infections associated with Acanthamoeba and fungi. The growing use of contact lenses in children demands our attention with surveillance and case-control studies. PURPOSE: The American Academy of Optometry (AAO) gathered researchers and key opinion leaders from around the world to discuss contact lens-associated microbial keratitis at the 2019 AAO Annual Meeting. METHODS: Experts presented within four sessions. Session 1 covered the epidemiology of microbial keratitis, pathogenesis of Pseudomonas aeruginosa, and the role of lens care systems and storage cases in corneal disease. Session 2 covered nonbacterial forms of keratitis in contact lens wearers. Session 3 covered future needs, challenges, and research questions in relation to microbial keratitis in youth and myopia control, microbiome, antimicrobial surfaces, and genetic susceptibility. Session 4 covered compliance and communication imperatives. RESULTS: The absolute rate of microbial keratitis has remained very consistent for three decades despite new technologies, and extended wear significantly increases the risk. Improved oxygen delivery afforded by silicone hydrogel lenses has not impacted the rates, and although the introduction of daily disposable lenses has minimized the risk of severe disease, there is no consistent evidence that they have altered the overall rate of microbial keratitis. Overnight orthokeratology lenses may increase the risk of microbial keratitis, especially secondary to Acanthamoeba, in children. Compliance remains a concern and a significant risk factor for disease. New insights into host microbiome and genetic susceptibility may uncover new theories. More studies such as case-control designs suited for rare diseases and registries are needed. CONCLUSIONS: The first annual AAO Think Tank acknowledged that the risk of microbial keratitis has not decreased over decades, despite innovation. Important questions and research directions remain. |
An application of agent-based modeling to explore the impact of decreasing incarceration rates and increasing drug treatment access on sero-discordant partnerships among people who inject drugs
Linton SL , Jarlais DCD , Ornstein JT , Kasman M , Hammond R , Kianian B , Smith JC , Wolfe ME , Ross Z , German D , Flynn C , Raymond HF , Klevens RM , Spencer E , Schacht JM , Finlayson T , Paz-Bailey G , Wejnert C , Cooper HLF . Int J Drug Policy 2021 94 103194 BACKGROUND: People who inject drugs (PWID) lag behind other key populations in HIV care continuum outcomes. The impacts of criminal justice reform and increasing drug treatment access on HIV have been underexplored. METHODS: We developed agent-based models (ABM) of sexual partnerships among PWID and non-PWID, and injection equipment-sharing partnerships among PWID in five US cities (Baltimore, Boston, Miami, New York City, San Francisco) over 3 years. The first set of ABM projected changes in partnership discordance among PWID as a function of decreasing ZIP code-level incarceration rates. The second set projected discordance as a function of increasing ZIP code-level drug treatment access. ABM were parameterized and validated overall, and by city and PWID race/ethnicity (Black, Latino, White) using National HIV Behavioral Surveillance data, administrative ZIP code-level data, surveillance reports and prior literature. Informed by research on prisoner release and community-level HIV prevalence, reductions in incarceration rates were fixed at 5% and 30% and respectively projected to increase ZIP code-level HIV prevalence by 2% and 12%. Increases in drug treatment access were fixed at 30% and 58%. RESULTS: In each city, a 30% reduction in ZIP code-level incarceration rates and 12% increase in ZIP code-level HIV prevalence significantly increased sero-discordance among at least one racial/ethnic group of PWID by 1-3 percentage points. A 5% reduction in incarceration rates, and 30% and 58% increases in drug treatment access, led to isolated significant changes in sero-discordance among Black and White PWID that were less than 1 percentage point. CONCLUSION: Reductions in incarceration rates may lead to short-term increases in sero-discordant partnerships among some PWID by increasing community-level HIV prevalence. Efforts to increase HIV testing, engagement in care and community reintegration post release, should be strengthened in the wake of incarceration reform. Additional research should confirm these findings and explore the lack of widespread impacts of drug treatment in this study. |
An innovative United States-Mexico community outreach initiative for Hispanic and Latino people in the United States: A collaborative public health network
Flynn MA , Rodriguez Lainz A , Lara J , Rosales C , Feldstein F , Dominguez K , Wolkin A , Sierra Medal IR , Tonda J , Romero-Steiner S , Dicent-Taillepierre J , Rangel Gómez MG . Public Health Rep 2021 136 (3) 287-294 Collaborative partnerships are a useful approach to improve health conditions of disadvantaged populations. The Ventanillas de Salud (VDS) ("Health Windows") and Mobile Health Units (MHUs) are a collaborative initiative of the Mexican government and US public health organizations that use mechanisms such as health fairs and mobile clinics to provide health information, screenings, preventive measures (eg, vaccines), and health services to Mexican people, other Hispanic people, and underserved populations (eg, American Indian/Alaska Native people, geographically isolated people, uninsured people) across the United States. From 2013 through 2019, the VDS served 10.5 million people (an average of 1.5 million people per year) at Mexican consulates in the United States, and MHUs served 115 461 people from 2016 through 2019. We describe 3 community outreach projects and their impact on improving the health of Hispanic people in the United States. The first project is an ongoing collaboration between VDS and the Centers for Disease Control and Prevention (CDC) to address occupational health inequities among Hispanic people. The second project was a collaboration between VDS and CDC to provide Hispanic people with information about Zika virus infection and health education. The third project is a collaboration between MHUs and the University of Arizona to provide basic health services to Hispanic communities in Pima and Maricopa counties, Arizona. The VDS/MHU model uses a collaborative approach that should be further assessed to better understand its impact on both the US-born and non-US-born Hispanic population and the public at large in locations where it is implemented. |
Envisioning the future of work to safeguard the safety, health, and well-being of the workforce: A perspective from the CDC's National Institute for Occupational Safety and Health
Tamers SL , Streit J , Pana-Cryan R , Ray T , Syron L , Flynn MA , Castillo D , Roth G , Geraci C , Guerin R , Schulte P , Henn S , Chang CC , Felknor S , Howard J . Am J Ind Med 2020 63 (12) 1065-1084 ![]() The future of work embodies changes to the workplace, work, and workforce, which require additional occupational safety and health (OSH) stakeholder attention. Examples include workplace developments in organizational design, technological job displacement, and work arrangements; work advances in artificial intelligence, robotics, and technologies; and workforce changes in demographics, economic security, and skills. This paper presents the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health's Future of Work Initiative; suggests an integrated approach to address worker safety, health, and well-being; introduces priority topics and subtopics that confer a framework for upcoming future of work research directions and resultant practical applications; and discusses preliminary next steps. All future of work issues impact one another. Future of work transformations are contingent upon each of the standalone factors discussed in this paper and their combined effects. Occupational safety and health stakeholders are becoming more aware of the significance and necessity of these factors for the workplace, work, and workforce to flourish, merely survive, or disappear altogether as the future evolves. The future of work offers numerous opportunities, while also presenting critical but not clearly understood difficulties, exposures, and hazards. It is the responsibility of OSH researchers and other partners to understand the implications of future of work scenarios to translate effective interventions into practice for employers safeguarding the safety, health, and well-being of their workers. |
Early use of the palliative approach to improve patient outcomes in HIV disease: Insights and findings from the Care and Support Access (CASA) Study 2013-2019
Alexander CS , Raveis VH , Karus D , Carrero-Tagle M , Lee MC , Pappas G , Lockman K , Brotemarkle R , Memiah P , Mulasi I , Hossain BM , Welsh C , Henley Y , Piet L , N'Diaye S , Murray R , Haltiwanger D , Smith CR , Flynn C , Redfield R , Silva CL , Amoroso A , Selwyn P . Am J Hosp Palliat Care 2020 38 (4) 332-339 Young men of color who have sex with men (yMSM) living with human immunodeficiency virus (HIV) in syndemic environments have been difficult-to-retain in care resulting in their being at-risk for poor health outcomes despite availability of effective once-daily antiretroviral treatment (ART). Multiple methods have been implemented to improve outcomes for this cohort; none with sustainable results. Outpatient HIV staff themselves may be a contributing factor. We introduced multidisciplinary staff to the concept of using a palliative approach early (ePA) in outpatient HIV care management to enable them to consider the patient-level complexity of these young men. Young MSM (18-35 years of age) enrolled in and cared for at the intervention site of the Care and Support Access Study (CASA), completed serial surveys over 18 months. Patients' Global and Summary quality of life (QoL) increased during the study at the intervention site (IS) where staff learned about ePA, compared with patients attending the control site (CS) (p=.021 and p=.018, respectively). Using serial surveys of staff members, we found that in the era of HIV disease control, outpatient staff are stressed more by environmental factors than by patients' disease status seen historically in the HIV epidemic. A Community Advisory Panel of HIV stakeholders contributed to all phases of this study and altered language used in educational activities with staff members to describe the patient cohort. |
Heart attacks, bloody noses, and other "emotional problems": Cultural and conceptual issues with the Spanish translation of self-report emotional health items
Flynn MA , Eggerth DE , Jacobson CJJr , Lyon SM . Fam Community Health 2020 44 (1) 1-9 This article examines how respondents understood items in the Spanish versions of the Short-Form 36 (SF-36v2). Cognitive interviews of the SF-36 were conducted in 2 phases with 46 Spanish speakers living in the United States. Roughly one-third (17/46) of respondents had difficulty understanding the Role Emotional items upon their initial reading, and almost half (21/46) provided examples that were inconsistent with the intended meaning of the items. The findings of this study underscore the importance of conducting cognitive testing to ensure conceptual equivalence of any instrument regardless of how well validated it appears to be. |
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