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Chavez Santos E, Spector JT, Egbert J, Krenz J, Sampson PD, Palmández P, Torres E, Blancas M, Carmona J, Jung J, Flunker JC. The effect of the participatory heat education and awareness tools (HEAT) intervention on agricultural worker physiological heat strain: results from a parallel, comparison, group randomized study. BMC Public Health 2022; 22:1746. [PMID: 36104813 PMCID: PMC9476265 DOI: 10.1186/s12889-022-14144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Farmworkers are at risk of heat-related illness (HRI). We sought to: 1) evaluate the effectiveness of farmworker Spanish/English participatory heat education and a supervisor decision-support mobile application (HEAT intervention) on physiological heat strain; and 2) describe factors associated with HRI symptoms reporting. METHODS We conducted a parallel, comparison group intervention study from May-September of 2019 in Central/Eastern Washington State, USA. We used convenience sampling to recruit adult outdoor farmworkers and allocated participating crews to intervention (n = 37 participants) and alternative-training comparison (n = 38 participants) groups. We measured heat strain monthly using heart rate and estimated core body temperature to compute the maximum work-shift physiological strain index (PSImax) and assessed self-reported HRI symptoms using a weekly survey. Multivariable linear mixed effects models were used to assess associations of the HEAT intervention with PSImax, and bivariate mixed models were used to describe factors associated with HRI symptoms reported (0, 1, 2+ symptoms), with random effects for workers. RESULTS We observed larger decreases in PSImax in the intervention versus comparison group for higher work exertion levels (categorized as low, low/medium-low, and high effort), after adjustment for maximum work-shift ambient Heat Index (HImax), but this was not statistically significant (interaction - 0.91 for high versus low/medium-low effort, t = - 1.60, p = 0.11). We observed a higher PSImax with high versus low/medium-low effort (main effect 1.96, t = 3.81, p < 0.001) and a lower PSImax with older age (- 0.03, t = - 2.95, p = 0.004), after covariate adjustment. There was no clear relationship between PSImax and the number of HRI symptoms reported. Reporting more symptoms was associated with older age, higher HImax, 10+ years agricultural work, not being an H-2A guest worker, and walking > 3 min to get to the toilet at work. CONCLUSIONS Effort level should be addressed in heat management plans, for example through work/rest cycles, rotation, and pacing, in addition to education and other factors that influence heat stress. Both symptoms and indicators of physiological heat strain should be monitored, if possible, during periods of high heat stress to increase the sensitivity of early HRI detection and prevention. Structural barriers to HRI prevention must also be addressed. TRIAL REGISTRATION ClinicalTrials.gov Registration Number: NCT04234802 , date first posted 21/01/2020.
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Affiliation(s)
- Erica Chavez Santos
- grid.34477.330000000122986657Department of Health Systems and Population Health, University of Washington, Seattle, WA USA
| | - June T. Spector
- grid.34477.330000000122986657Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105 USA ,grid.34477.330000000122986657Department of Medicine, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105 USA
| | - Jared Egbert
- grid.34477.330000000122986657Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105 USA ,grid.416237.50000 0004 0418 9357Department of Preventive Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Seattle, WA USA
| | - Jennifer Krenz
- grid.34477.330000000122986657Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105 USA
| | - Paul D. Sampson
- grid.34477.330000000122986657Department of Statistics, University of Washington, Seattle, WA USA
| | - Pablo Palmández
- grid.34477.330000000122986657Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105 USA
| | - Elizabeth Torres
- Northwest Communities Education Center/Radio KDNA, Granger, WA USA
| | - Maria Blancas
- grid.34477.330000000122986657Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105 USA
| | - Jose Carmona
- grid.34477.330000000122986657Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105 USA
| | - Jihoon Jung
- grid.34477.330000000122986657Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105 USA
| | - John C. Flunker
- grid.34477.330000000122986657Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105 USA
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Egbert J, Krenz J, Sampson PD, Jung J, Calkins M, Zhang K, Palmández P, Faestel P, Spector JT. Accuracy of an estimated core temperature algorithm for agricultural workers. Arch Environ Occup Health 2022; 77:809-818. [PMID: 35114899 PMCID: PMC9346099 DOI: 10.1080/19338244.2022.2033672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There is a substantial burden of occupational health effects from heat exposure. We sought to assess the accuracy of estimated core body temperature (CBTest) derived from an algorithm that uses sequential heart rate and initializing CBT,1 compared with gastrointestinal temperature measured using more invasive ingestible sensors (CBTgi), among outdoor agricultural workers. We analyzed CBTest and CBTgi data from Washington State, USA, pear and apple harvesters collected across one work shift in 2015 (13,413 observations, 35 participants) using Bland Altman methods. The mean (standard deviation, range) CBTgi was 37.7 (0.4, 36.5-39.4)°C. Overall CBT bias (limits of agreement) was -0.14 (±0.76)°C. Biases ranged from -0.006 to -0.75 °C. The algorithm, which does not require the use of ingestible sensors, may be a practical tool in research among groups of workers for evaluating the effectiveness of interventions to prevent adverse occupational heat health effects.
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Affiliation(s)
- Jared Egbert
- Department of Preventive Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Paul D. Sampson
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Jihoon Jung
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Miriam Calkins
- Division of Field Studies and Engineering - Field Research Branch, National Institute for Occupational Safety & Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Kai Zhang
- Department of Environmental Health Sciences, University of Albany, State University of New York, Albany, NY, USA
| | - Pablo Palmández
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Paul Faestel
- Department of Preventive Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - June T. Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Krenz J, Santos EC, Torres E, Palmández P, Carmona J, Blancas M, Marquez D, Sampson P, Spector JT. The multi-level heat education and awareness tools [HEAT] intervention study for farmworkers: Rationale and methods. Contemp Clin Trials Commun 2021; 22:100795. [PMID: 34169175 PMCID: PMC8209069 DOI: 10.1016/j.conctc.2021.100795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background The burden of adverse health effects from heat exposure is substantial, and outdoor workers who perform heavy physical work are at high risk. Though heat prevention interventions have been developed, studies have not yet systematically evaluated the effectiveness of approaches that address risk factors at multiple levels. Objective We sought to test the effectiveness of a multi-level heat prevention approach (heat education and awareness tools [HEAT]), which includes participatory training for outdoor agricultural workers that addresses individual and community factors and a heat awareness mobile application for agricultural supervisors that supports decisions about workplace heat prevention, in the Northwest United States. Design We designed the HEAT study as a parallel, comparison, randomized group intervention study that recruited workers and supervisors from agricultural workplaces. In intervention arm crews, workers received HEAT training, and supervisors received the HEAT awareness application. In comparison arm crews, workers were offered non-HEAT training. Primary outcomes were worker physiological heat strain and heat-related illness (HRI) symptoms. In both worker groups, we assessed HRI symptoms approximately weekly, and heat strain physiological monitoring was conducted at worksites approximately monthly, from June through August. Discussion To our knowledge, this is the first study to evaluate the effectiveness of a multi-level heat prevention intervention on physiological heat strain and HRI symptoms for outdoor agricultural workers. Trial registration ClinicalTrials.gov Registration Number: NCT04234802;
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Affiliation(s)
- Jennifer Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | | | - Elizabeth Torres
- Northwest Communities Education Center/Radio KDNA, Granger, WA, USA
| | - Pablo Palmández
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Jose Carmona
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Maria Blancas
- College of the Environment, University of Washington, Seattle, WA, USA
| | - Diana Marquez
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Paul Sampson
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - June T Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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Masuda YJ, Garg T, Anggraeni I, Ebi K, Krenz J, Game ET, Wolff NH, Spector JT. Warming from tropical deforestation reduces worker productivity in rural communities. Nat Commun 2021; 12:1601. [PMID: 33707454 PMCID: PMC7952402 DOI: 10.1038/s41467-021-21779-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/22/2021] [Indexed: 12/01/2022] Open
Abstract
The accelerating loss of tropical forests in the 21st century has eliminated cooling services provided by trees in low latitude countries. Cooling services can protect rural communities and outdoor workers with little adaptive capacity from adverse heat exposure, which is expected to increase with climate change. Yet little is still known about whether cooling services can mitigate negative impacts of heat on labor productivity among rural outdoor workers. Through a field experiment in Indonesia, we show that worker productivity was 8.22% lower in deforested relative to forested settings, where wet bulb globe temperatures were, on average, 2.84 °C higher in deforested settings. We demonstrate that productivity losses are driven by behavioral adaptations in the form of increased number of work breaks, and provide evidence that suggests breaks are in part driven by awareness of heat effects on work. Our results indicate that the cooling services from forests have the potential for increasing resilience and adaptive capacity to local warming. It is expected that tropical deforestation and related increases in heat exposure have negative impacts on labour productivity, but the size of the effect is not well known. Here, the authors show that deforestation reduces productivity by 8.22% in rural Indonesia and causes behavioural adaptation responses like more work breaks.
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Affiliation(s)
- Yuta J Masuda
- Global Science, The Nature Conservancy, Arlington, TX, USA.
| | - Teevrat Garg
- School of Global Policy and Strategy, University of California, San Diego, La Jolla, CA, USA. .,Center for Effective Global Action (CEGA), Berkeley, CA, USA. .,Institute for the Study of Labor (IZA), Bonn, Germany.
| | - Ike Anggraeni
- Faculty of Public Health, Mulawarman University, Samarinda, Indonesia
| | - Kristie Ebi
- Department of Global Health, University of Washington, Washington, USA.,Department of Environmental and Occupational Health Sciences, University of Washington, Washington, USA
| | - Jennifer Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, Washington, USA
| | - Edward T Game
- Global Science, The Nature Conservancy, Arlington, TX, USA
| | | | - June T Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Washington, USA
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Suter MK, Miller KA, Anggraeni I, Ebi KL, Game ET, Krenz J, Masuda YJ, Sheppard L, Wolff NH, Spector JT. Association between work in deforested, compared to forested, areas and human heat strain: An experimental study in a rural tropical environment. Environ Res Lett 2019; 14:084012. [PMID: 31485260 PMCID: PMC6724538 DOI: 10.1088/1748-9326/ab2b53] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND With climate change, adverse human health effects caused by heat exposure are of increasing public health concern. Forests provide beneficial ecosystem services for human health, including local cooling. Few studies have assessed the relationship between deforestation and heat-related health effects in tropical, rural populations. We sought to determine whether deforested compared to forested landscapes are associated with increased physiological heat strain in a rural, tropical environment. METHODS We analyzed data from 363 healthy adult participants from ten villages who participated in a two-by-two factorial, randomized study in East Kalimantan, Indonesia from 10/1/17 to 11/6/17. Using simple randomization, field staff allocated participants equally to different conditions to conduct a 90-minute outdoor activity, representative of typical work. Core body temperature was estimated at each minute during the activity using a validated algorithm from baseline oral temperatures and sequential heart rate data, measured using chest band monitors. We used linear regression models, clustered by village and with a sandwich variance estimator, to assess the association between deforested versus forested conditions and the number of minutes each participant spent above an estimated core body temperature threshold of 38.5°C. RESULTS Compared to those in the forested condition (n=172), participants in the deforested condition (n=159) spent an average of 3.08 (95% CI 0.57, 5.60) additional minutes with an estimated core body temperature exceeding 38.5°C, after adjustment for age, sex, body mass index, and experiment start time, with a larger difference among those who began the experiment after 12 noon (5.17 [95% CI 2.20, 8.15]). CONCLUSIONS In this experimental study in a tropical, rural setting, activity in a deforested versus a forested setting was associated with increased objectively measured heat strain. Longer durations of hyperthermia can increase the risk of serious health outcomes. Land use decisions should consider the implications of deforestation on local heat exposure and health as well as on forest services, including carbon storage functions that impact climate change mitigation.
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Affiliation(s)
- Megan K. Suter
- Department of Epidemiology, University of Washington, Seattle, Washington, United States
| | - Kristin A. Miller
- Department of Epidemiology, University of Washington, Seattle, Washington, United States
| | - Ike Anggraeni
- Faculty of Public Health, Mulawarman University, Samarinda, Indonesia
| | - Kristie L. Ebi
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
- Department of Global Health, University of Washington, Seattle, Washington, United States
| | - Edward T. Game
- Global Science, The Nature Conservancy, Arlington, Virginia, United States
| | - Jennifer Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
| | - Yuta J. Masuda
- Global Science, The Nature Conservancy, Arlington, Virginia, United States
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
- Department of Biostatistics, University of Washington, Seattle, Washington, United States
| | - Nicholas H. Wolff
- Global Science, The Nature Conservancy, Arlington, Virginia, United States
| | - June T. Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
- Department of Medicine, University of Washington, Seattle, Washington, United States
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Spector JT, Krenz J, Calkins M, Ryan D, Carmona J, Pan M, Zemke A, Sampson PD. Associations between heat exposure, vigilance, and balance performance in summer tree fruit harvesters. Appl Ergon 2018; 67:1-8. [PMID: 29122180 PMCID: PMC5912891 DOI: 10.1016/j.apergo.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 07/12/2017] [Accepted: 09/02/2017] [Indexed: 05/29/2023]
Abstract
BACKGROUND We sought to evaluate potential mediators of the relationship between heat exposure and traumatic injuries in outdoor agricultural workers. METHODS Linear mixed models were used to estimate associations between maximum work-shift Wet Bulb Globe Temperature (WBGTmax) and post-shift vigilance (reaction time) and postural sway (total path length) in a cross-sectional sample of 46 Washington State tree fruit harvesters in August-September 2015. RESULTS The mean (SD) WBGTmax was 27.4 (3.2)°C in August and 21.2 (2.0)°C in September. The mean pre-work-shift participant urine specific gravity indicated minimal dehydration. Twenty-four percent of participants exhibited possible excessive sleepiness. There was no association between WBGTmax and post-shift reaction time or total path length. CONCLUSIONS Heat exposure was not associated with impaired vigilance or balance in this study, in which the overall mean (SD) WBGTmax was 25.9 (4.2)°C. However, the study identified opportunities to ensure adequate pre-work-shift hydration and to optimize sleep and work-shift timing in order to reduce occupational injury and heat-related illness risk.
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Affiliation(s)
- June T Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Jennifer Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Miriam Calkins
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Dawn Ryan
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Jose Carmona
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Mengjie Pan
- Department of Statistics, University of Washington, Seattle, WA, USA.
| | - Anna Zemke
- College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Paul D Sampson
- Department of Statistics, University of Washington, Seattle, WA, USA.
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Quiller G, Krenz J, Ebi K, Hess JJ, Fenske RA, Sampson PD, Pan M, Spector JT. Heat exposure and productivity in orchards: Implications for climate change research. Arch Environ Occup Health 2017; 72:313-316. [PMID: 28139172 PMCID: PMC5562533 DOI: 10.1080/19338244.2017.1288077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/25/2017] [Indexed: 05/27/2023]
Abstract
Recent studies suggest that heat exposure degrades work productivity, but such studies have not considered individual- and workplace-level factors. Forty-six tree-fruit harvesters (98% Latino/a) from 6 orchards participated in a cross-sectional study in central/eastern Washington in 2015. The association between maximum measured work-shift wet-bulb globe temperature (WBGTmax) and productivity (total weight of fruit bins collected per time worked) was estimated using linear mixed-effects models, adjusting for relevant confounders. The mean (standard deviation) WBGTmax was 27.9°C (3.6°C) in August and 21.2°C (2.0°C) in September. There was a trend of decreasing productivity with increasing WBGTmax, but this association was not statistically significant. When individual- and workplace-level factors were included in the model, the association approached the null. Not considering individual, work, and economic factors that affect rest and recovery in projections of the effects of climate change could result in overestimates of reductions in future productivity and underestimate risk of heat illness.
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Affiliation(s)
- Grant Quiller
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
| | - Jennifer Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
| | - Kristie Ebi
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
- Department of Global Health, University of Washington, Seattle, Washington, United States
| | - Jeremy J. Hess
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
- Department of Global Health, University of Washington, Seattle, Washington, United States
- Department of Medicine, University of Washington, Seattle, Washington, United States
| | - Richard A. Fenske
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
| | - Paul D. Sampson
- Department of Statistics, University of Washington, Seattle, Washington, United States
| | - Mengjie Pan
- Department of Statistics, University of Washington, Seattle, Washington, United States
| | - June T. Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, United States
- Department of Medicine, University of Washington, Seattle, Washington, United States
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Abstract
OBJECTIVES Although recommendations for preventing occupational heat-related illness among farmworkers include hydration and cooling practices, the extent to which these recommendations are universally practiced is unknown. The objective of this analysis was to compare hydration and cooling practices between farmworkers in Oregon and Washington. METHODS A survey was administered to a purposive sample of Oregon and Washington farmworkers. Data collected included demographics, work history and current work practices, hydration practices, access and use of cooling measures, and headwear and clothing worn. RESULTS Oregon farmworkers were more likely than those in Washington to consume beverages containing sugar and/or caffeine. Workers in Oregon more frequently reported using various cooling measures compared with workers in Washington. Availability of cooling measures also varied between the two states. CONCLUSIONS These results highlight the large variability between workers in two states regarding access to and use of methods to stay cool while working in the heat.
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Affiliation(s)
- Jeffrey W Bethel
- a School of Biological and Population Health Sciences, College of Public Health and Human Sciences , Oregon State University , Corvallis , Oregon , USA
| | - June T Spector
- b Department of Environmental and Occupational Health Sciences, School of Public Health , University of Washington , Seattle , Washington , USA
| | - Jennifer Krenz
- b Department of Environmental and Occupational Health Sciences, School of Public Health , University of Washington , Seattle , Washington , USA
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Abstract
Crop workers are at high risk of heat-related illness (HRI) from internal heat generated by heavy physical work, particularly when laboring in hot and humid conditions. The aim of this study was to identify risk factors for HRI symptoms in Washington crop workers using an audio computer-assisted self-interview (A-CASI) instrument that has undergone reliability and validity evaluation. A cross-sectional A-CASI survey of 97 crop workers in Washington State was conducted during the summer of 2013. Potential HRI risk factors in demographic, training, work, hydration, clothing, health, and environmental domains were selected a priori for evaluation. Mixed-effects logistic regression was used to identify risk factors for self-reported symptoms associated with heat strain and HRI (dizziness/light-headedness or heavy sweating) experienced at work in hot conditions. An increase in age was associated with a lower odds of HRI symptoms (odds ratio [OR] = 0.92; 95% confidence interval [CI] = 0.87-0.98). Piece rate compared with hourly payment (OR = 6.20; 95% CI = 1.11-34.54) and needing to walk for more than 3 minutes to get to the toilet, compared with less than 3 minutes (OR = 4.86; 95% CI = 1.18-20.06), were associated with a higher odds of HRI symptoms. In this descriptive study of risk factors for HRI symptoms in Washington crop workers, decreased age (and less work experience), piece rate pay, and longer distance to the toilet were associated with self-reported HRI symptoms. Modifiable workplace factors should be considered in HRI prevention efforts that are evaluated using objective measures in representative working populations.
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Affiliation(s)
- June T Spector
- a Department of Environmental and Occupational Health Sciences , University of Washington , Seattle , Washington , USA
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10
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Abstract
BACKGROUND We sought to describe heat-related illness (HRI) in agriculture and forestry workers in Washington State. METHODS Demographic and clinical Washington State Fund workers' compensation agriculture and forestry HRI claims data (1995-2009) and Washington Agriculture Heat Rule citations (2009-2012) were accessed and described. Maximum daily temperature (Tmax) and Heat Index (HImax) were estimated by claim date and location using AgWeatherNet's weather station network. RESULTS There were 84 Washington State Fund agriculture and forestry HRI claims and 60 Heat Rule citations during the study period. HRI claims and citations were most common in crop production and support subsectors. The mean Tmax (HImax) was 95°F (99°F) for outdoor HRI claims. Potential HRI risk factors and HRI-related injuries were documented for some claims. CONCLUSIONS Agriculture and forestry HRI cases are characterized by potential work-related, environmental, and personal risk factors. Further work is needed to elucidate the relationship between heat exposure and occupational injuries.
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Affiliation(s)
- June T Spector
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
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Abstract
This pilot project investigated agricultural-related safety and health issues among Hmong refugees working on family-operated farms. Novel approaches, namely participatory rural appraisal and photovoice, were used to conduct a qualitative occupational hazard assessment with a group of Hmong farmers in Washington State. These two methods were useful in gathering participants' own perspectives about priority concerns. Several identified problems were related to musculoskeletal disorders, handling and operating heavy machinery, heat and cold stress, respiratory exposures, pest management, and socioeconomic and language concerns. Findings from this study provide insight into the work-related challenges that Hmong refugee farmers encounter and can serve as a basis for occupational health professionals to develop interventions to assist this underserved group.
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Galvin K, Krenz J, Palmández P. Practical Solutions for Pesticide Safety: Translating and Disseminating Research, Evaluating Impact. J Agromedicine 2014. [DOI: 10.1080/1059924x.2014.891483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Agricultural workers have a high risk of occupational injuries, illnesses, and fatalities. However, there are very few standardized tools available to assess safety and health in agricultural operations. Additionally, there are a number of groups of agricultural workers, including Hmong refugees and immigrants, for which virtually no information on safety and health conditions is available. This study developed an observation-based methodology for systematically evaluating occupational health and safety hazards in agriculture, and pilot-tested this on several small-scale Hmong farming operations. Each observation assessed of range of safety and health hazards (e.g., musculoskeletal hazards, dust and pollen, noise, and mechanical hazards), as well as on factors such as type of work area, presence of personal protective equipment, and weather conditions. Thirty-six observations were collected on nine farms. The most common hazards observed were bending at the back and lifting <50 pounds. Use of sharp tools without adequate guarding mechanisms, awkward postures, repetitive hand motions, and lifting >50 pounds were also common. The farming activities observed involved almost no power equipment, and no pesticide or chemical handling was observed. The use of personal protective equipment was uncommon. The results of this assessment agreed well with a parallel study of perceived safety and health hazards among Hmong agricultural workers. This study suggests that small-scale Hmong farming operations involve a variety of hazards, and that occupational health interventions may be warranted in this community. The study also demonstrates the utility of standardized assessment tools and mixed-method approaches to hazard evaluation.
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Affiliation(s)
- R L Neitzel
- a R. L. Neitzel is affiliated with the Department of Environmental Health Sciences and Risk Science Center , University of Michigan , Ann Arbor , Michigan , USA
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Lam M, Krenz J, Palmández P, Negrete M, Perla M, Murphy-Robinson H, Spector JT. Identification of barriers to the prevention and treatment of heat-related illness in Latino farmworkers using activity-oriented, participatory rural appraisal focus group methods. BMC Public Health 2013; 13:1004. [PMID: 24156496 PMCID: PMC4015616 DOI: 10.1186/1471-2458-13-1004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/23/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Heat-related illness (HRI) is an important cause of non-fatal illness and death in farmworkers. We sought to identify potential barriers to HRI prevention and treatment in Latino farmworkers. METHODS We conducted three semi-structured focus group discussions with 35 Latino farmworkers in the Central Washington, USA area using participatory rural appraisal techniques. Interviews were audio taped and transcribed in Spanish. Three researchers reviewed and coded transcripts and field notes, and investigator triangulation was used to identify relevant themes and quotes. RESULTS Although the majority of participants in our study reported never receiving formal HRI training, most participants were aware that extreme heat can cause illness and were able to accurately describe HRI symptoms, risk factors, and certain prevention strategies. Four main observations regarding farmworkers' HRI-relevant beliefs and attitudes were identified: 1) farmworkers subscribe to varying degrees to the belief that cooling treatments should be avoided after heat exposure, with some believing that such treatments should be avoided after heat exposure, and others encouraging the use of such treatments; 2) the desire to lose weight may be reflected in behaviors that promote increased sweating; 3) highly caffeinated energy drinks are preferred to increase work efficiency and maintain alertness; and 4) the location of drinking water at work (e.g. next to restrooms) and whether water is clean, but not necessarily chemically-treated, are important considerations in deciding whether to drink the water provided at worksites. CONCLUSIONS We identified potential barriers to HRI prevention and treatment related to hydration, certain HRI treatments, clothing use, and the desire to lose weight among Latino farmworkers. Strategies to address potential barriers to HRI prevention and treatment in this population may include engineering, administrative, and health education and health promotion strategies at individual, workplace, community, and societal levels. Although farmworkers in our study were able to describe HRI risk factors, reported practices were not necessarily consistent with reported knowledge. Further study of potential knowledge-behavior gaps may uncover opportunities for additional HRI prevention strategies. Farmworkers and employers should be included in the development and evaluation of interventions to prevent HRI.
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Affiliation(s)
- Michelle Lam
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - Pablo Palmández
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - Maria Negrete
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - Martha Perla
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - Helen Murphy-Robinson
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - June T Spector
- School of Medicine, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Hartrick G, Brown D, Eastman M, Fong K, Johnson M, Krenz J, Lambrick C, Newman M, Thiessen J. The synergy of health promotion practice/research/education. Can J Nurs Leadersh 1999; 12:25-9. [PMID: 11094941 DOI: 10.12927/cjnl.1999.16295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Many nurses are concerned about the lack of connection among nursing practice, research and education. However, the assumption that nursing practice, research, and education represent separate domains or activities that need to be linked, may well contravene the relational synergy they share. This paper describes a project that sought to illustrate, and further explore, the synergistic, iterative relationship of health promoting practice/research/education. The project revealed how this synergy lives out within the daily practice of frontline practitioners and how the researched knowledge practitioners bring forth through their practice can transform care.
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Affiliation(s)
- G Hartrick
- School of Nursing, University of Victoria, BC
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17
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Brinckmann P, Krenz J, Polster J. [Measurements of the tensile force in the halo-pelvic apparatus and in the halo-Milwaukee brace (author' transl)]. Z Orthop Ihre Grenzgeb 1976; 114:889-95. [PMID: 1007503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A measuring device for static and dynamic recordings of the tensile force in the halo-pelvic apparatus and in the halo-Milwaukee brace was developed. The results present a survey of the tensil forces being effective during the preoperative traction in dependence on the extension distance and the duration of the treatment. The considerable variations of the tensile force, especially the high peak values, which were recorded during the normal day-to-day routine of the patients in the ward room, lead to the conclusion, that halo-gravity or halo-femoral traction is to be preferred to traction by the halo-pelvic apparatus or by the halo-Milwaukee-brace.
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Polster J, Krenz J, Brinckmann P. [Practical experiences and force measurements in halo-pelvic traction]. Z Orthop Ihre Grenzgeb 1976; 114:515-8. [PMID: 1007423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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19
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Sebbel J, Heine J, Krenz J. [Aims of occupational therapy in conservative and surgical therapy for scoliosis]. Z Orthop Ihre Grenzgeb 1976; 114:471-4. [PMID: 1007407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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20
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Brinckmann P, Krenz J, Polster J. [Dynamic halo-gravity traction in scoliosis (author's transl)]. Z Orthop Ihre Grenzgeb 1976; 114:305-13. [PMID: 941473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
First results obtained in halo-gravity traction employing a new developed traction assembly are reported.
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21
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Happle R, Krenz J, Pfeiffer R. [Ito's syndrome (incontinentia pigmenti achromians)]. Hautarzt 1976; 27:286-90. [PMID: 950303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Ito's syndrome is a distinct entity characterized by bilateral systematized linear depigmentations denominated by Ito as "incontinentia pigmentiachromians". The syndrome includes a variety of anomalies predominantly affecting the central nervous system, the eyes, and the muscular-skeletal-system. The patient described in this paper was a 26 year old man suffering from a sever scoliosis. This anomaly had not been mentioned in previous case reports.
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22
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Menzel W, Jensen H, Krenz J, Rode P, Vogel S. [Diagnostic bilance (medical audit) of a medical hospital department]. MMW Munch Med Wochenschr 1974; 116:P 18-25. [PMID: 4215007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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Krenz J, Troup JD. [Proceedings: Structure of the interarticular part of the lower lumbar spine]. Z Orthop Ihre Grenzgeb 1974; 112:853-6. [PMID: 4280778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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24
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Krenz J, Troup JDG. THE STRUCTURE OF THE PARS INTERARTICULARIS OF THE LOWER LUMBAR VERTEBRAE AND ITS RELATION TO THE ETIOLOGY OF SPONDYLOLYSIS. ACTA ACUST UNITED AC 1973. [DOI: 10.1302/0301-620x.55b4.735] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
1. An anatomical study of the bony structure of the pars interarticularis of the fourth and fifth lumbar vertebrae has been made in specimens from seven cadavers aged seventeen to sixty-seven. 2. Layers of cortical bone have been described antero-laterally and postero-medially which are thickest in the narrowest region of the pars. 3. In one specimen from a seventeen-year-old male, a healing fracture was found in the antero-lateral layer of cortical bone in the right neural arch of the fourth lumbar vertebra. 4. The stresses to which the pars is subject consist primarily of shear forces applied to the articular processes. The significance of these stresses to the etiology of spondylolysis is discussed.
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Krenz J, Troup JD. The structure of the pars interarticularis of the lower lumbar vertebrae and its relation to the etiology of spondylolysis, with a report of a healing fracture in the neural arch of a fourth lumbar vertebra. J Bone Joint Surg Br 1973; 55:735-41. [PMID: 4766177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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26
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Polster J, Spieker U, Hoefert H, Krenz J. [Biomechanics of hip arthrodesis]. Z Orthop Ihre Grenzgeb 1973; 111:413-8. [PMID: 4273421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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27
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Polster J, Krenz J, Brinckmann P. Die Problematik temporärer Implantate zur Behandlung der Skoliose. BIOMED ENG-BIOMED TE 1973. [DOI: 10.1515/bmte.1973.18.s1.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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28
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Polster J, Krenz J. [Observations on conservatively treated scoliotic patients from the sociological viewpoint]. Z Orthop Ihre Grenzgeb 1971; 109:637-49. [PMID: 4255737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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