Occupational and Environmental Hazards of Correctional Settings: A Scoping Literature Review From ACOEM's Presidential Task Force on Correctional Institutions

OBJECTIVE

Maintaining healthful, safe, and productive work environments for workers in correctional settings is a matter of deep consequence to the workers themselves, the institutions they serve, the incarcerated individuals with whom they share space, and inevitably, to our wider community. We hypothesized that an examination of the academic literature would reveal opportunities for an improved approach to research in these settings.

METHODS

We performed a scoping literature review using search terms related to the occupational and environmental health of workers in correctional environments, limited to studies performed in the United States.

RESULTS

A total of 942 studies underwent title and abstract screening, 342 underwent full-text review, and 147 underwent data extraction by a single reviewer. The results revealed a body of literature that tends strongly toward analyses of stress and burnout of correctional staff, largely based on self-reported data from cross-sectional surveys. Those studies related to physical health were predominantly represented by topics of infectious disease. There were few or no studies examining exposures or outcomes related to diagnosable mental health conditions, musculoskeletal injury, environmental hazards, medical or mental health staff, immigration detention settings, or regarding incarcerated workers. There were very few studies that were experimental, longitudinal, or based on objective data.

DISCUSSION

The National Institute for Occupational Safety and Health (NIOSH) has promulgated a research strategy for correctional officers that should guide future research for all workers in correctional settings, but realization of these goals will rely upon multidisciplinary collaboration, specific grants to engage researchers, and an improved understanding of the barriers inherent to correctional research, all while maintaining rigorous protection for incarcerated persons as an especially vulnerable population.

Prevention of Occupational Heat-Related Illnesses

High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs.

Deep Remission at 1 Year Prevents Progression of Early Crohn's Disease

BACKGROUND & AIMS

We investigated the effects of inducing deep remission in patients with early Crohn's disease (CD).

METHODS

We collected follow-up data from 122 patients (mean age, 31.2 ± 11.3 y) with early, moderate to severe CD (median duration, 0.2 years; interquartile range, 0.1-0.5) who participated in the Effect of Tight Control Management on CD (CALM) study, at 31 sites, representing 50% of the original CALM patient population. Fifty percent of patients (n = 61) were randomly assigned to a tight control strategy (increased therapy based on fecal level of calprotectin, serum level of C-reactive protein, and symptoms), and 50% were assigned to conventional management. We categorized patients as those who were vs were not in deep remission (CD endoscopic index of severity scores below 4, with no deep ulcerations or steroid treatment, for 8 or more weeks) at the end of the follow-up period (median, 3.02 years; range, 0.05-6.26 years). The primary outcome was a composite of major adverse outcomes that indicate CD progression during the follow-up period: new internal fistulas or abscesses, strictures, perianal fistulas or abscesses, or hospitalization or surgery for CD. Kaplan-Meier and penalized Cox regression with bootstrapping were used to compare composite rates between patients who achieved or did not achieve remission at the end of the follow-up period.

RESULTS

Major adverse outcomes were reported for 34 patients (27.9%) during the follow-up period. Significantly fewer patients in deep remission at the end of the CALM study had major adverse outcomes during the follow-up period (P = .01). When we adjusted for potential confounders, deep remission (adjusted hazard ratio, 0.19; 95% confidence interval, 0.07-0.31) was significantly associated with a lower risk of major adverse outcome.

CONCLUSIONS

In an analysis of follow-up data from the CALM study, we associated induction of deep remission in early, moderate to severe CD with decreased risk of disease progression over a median time of 3 years, regardless of tight control or conventional management strategy.

Correlation of Stool Frequency and Abdominal Pain Measures With Simple Endoscopic Score for Crohn's Disease

BACKGROUND

The Crohn's Disease Activity Index (CDAI) has been criticized for being weakly correlated with bowel inflammation. We assessed correlation between Simple Endoscopic Score for Crohn's Disease (SES-CD) and individual CDAI items stratified by disease location to better understand this relationship.

METHODS

We pooled patient-level data from 3 placebo-controlled Crohn's disease (CD) trials that tested adalimumab, upadacitinib, and risankizumab. Disease location was defined as ileum only, colon only, or ileocolonic based upon colonoscopy at study entry. Pearson correlation coefficients and linear regression assessed correlations between items of the CDAI and SES-CD.

RESULTS

A total of 353 patients were included (20.7% ileal, 30.6% colonic, 48.7% ileocolonic disease). Crohn's Disease Activity Index and SES-CD scores were moderately correlated (R = 0.33; P < 0.001). Among CDAI items, the strongest correlations with SES-CD were seen with very soft or liquid stool frequency (SF) and patient-reported outcome 2 (PRO2; which includes SF and abdominal pain score; both R = 0.36; P < 0.001); these correlations were numerically stronger in colonic disease (SF: R = 0.46; P < 0.001; PRO2: R = 0.44; P < 0.001) than in ileal disease (SF: R = 0.14; P = 0.23; PRO2: R = 0.21; P = 0.07), although a test for interaction was not significant. In adjusted linear regression models, the proportion of mucosa that was inflamed and the proportion of mucosa with ulceration were positively correlated, whereas the presence of strictures was inversely correlated with SF.

CONCLUSIONS

The SF item of the CDAI is moderately correlated with SES-CD and independently correlated with mucosal ulceration, inflammation, and strictures. Understanding why bowel inflammation as measured endoscopically does not correlate more strongly with patients' symptoms could help develop scales that link CD pathology to patient experience.

Efficacy of transpupillary thermotherapy (TTT) in the treatment of occult subfoveal choroidal neovascularization in age-related macular degeneration

PURPOSE

To determine the efficacy of transpupillary thermotherapy (TTT) in the treatment of occult subfoveal choroidal neovascularization in patients with age-related macular degeneration (ARMD).

METHODS

We conducted a retrospective review of patients with ARMD treated with TTT from June, 1999 through July, 2000 at a retina referral practice. TTT was delivered through a slit-lamp using a modified diode laser at 810 nm wavelength and a spot size of 3 mm delivered at one location for a minimum of 60 seconds duration. Re-treatment was performed at 2-month intervals if indicated.

RESULTS

81 eyes of 77 patients were included in the study. Vision improved greater than one line Snellen in 18 eyes (22%), vision was stable within one line Snellen in 38 (47%), and worsened greater than one line Snellen in 25 (31%). Patients had a mean follow-up of 9 months. The average number of treatments was 1.37 (range 1 to 4). Pretreatment vision was less than or equal to 20/200 in 54% of eyes.

CONCLUSIONS

Transpupillary thermotherapy may stabilize visual acuity in a majority of patients with occult subfoveal choroidal neovascularization secondary to ARMD. Proof of therapeutic benefit is best determined by a randomized clinical trial that is currently underway (TTT4CNV).

Carbon monoxide poisoning in racing car drivers

BACKGROUND

To determine if carbon monoxide (CO) exposure during competition racing is significant enough to cause post-racing symptoms among professional racing drivers.

METHODS

Closed vehicle professional racing drivers were questioned after competition regarding symptoms consistent with heat exposure, dehydration, and carbon monoxide poisoning. All drivers, regardless of symptoms, underwent expired CO monitoring using a breath analyzer both before and after competition events. CO measurements were performed prior to any post-race interviews. Driver smoking history, laps at low speed (under caution), cockpit fire or damage to the exhaust system were also noted. An association between driver symptoms, track and vehicle condition, and increases in expired CO levels during racing was sought.

RESULTS

Twenty-eight drivers completed the study. Each driver was tested both before and after each competition event, and some drivers were tested at different tracks. All of the tested drivers experienced an increase in carboxyhemoglobin concentrations during the competition event. Drivers who smoked had higher baseline levels than non-smokers, but were no more likely to have symptoms. The driver with the highest post-race CO level was exposed to a fire which completely destroyed the vehicle, but he complained of no symptoms after the race. Most drivers complained of post-race symptoms or appeared symptomatic, but no correlation could be shown between post-race CO levels and symptoms.

CONCLUSIONS

There is a mild increase in driver CO levels during professional road racing competition, however, no correlation with CO level and driver symptomatology can be demonstrated. Carbon monoxide does not appear to be a significant cause of post-race driver symptoms such as fatigue, nausea, headache, and weakness.

Female United States Air Force (USAF) pilots: themes, challenges, and possible solutions

BACKGROUND

Identification of stresses of mixed-gender squadrons, attention to the psychological concerns of pilots in combat, and recognition of the difficulties of balancing a career and family are important in today's United States Air Force (USAF). What qualities are desirable in male and female pilots in combat situations, how do men and women view their career and family goals, and how do men and women work together in day-to-day squadron activities versus deployment and combat situations?

METHODS

A semi-structured clinical interview sought in formation about personal/family health, squadron relationships, and career/deployment stresses. The interview covered the effect of grounding for more than 30 d, motivation to fly, health decrements due to aircraft design, teamwork difficulties and blocks to success, career demands, combat and prisoner of war (POW) concerns, stress and coping styles, flying goals, and family/health concerns. There were 114 (64 male and 50 female) pilots who participated in the study.

RESULTS

The majority of male pilots interviewed asserted that they would be more protective of a woman in combat than a man and were concerned about their reaction to a female POW. Many women were concerned about being used to exploit men in a POW camp. The majority of pilots believed women were well integrated into their squadrons. Those interviewed reported that the squadron members with the most difficulty dealing with women were older males, including enlisted crew and some commanders.

CONCLUSION

The information gained from this study will assist the USAF in understanding and coping with the psychological stresses associated with combat, deployment, and mixed-gender squadrons.