Analyzing the predictors of health care utilization in the agricultural worker population using decision tree analysis: Does language matter?

OBJECTIVES

To analyze the predictors of health care utilization among respondents to the National Agricultural Worker Survey. Specifically, we hypothesized that English proficiency would predict utilization of health care services within the last 2 years.

METHODS

Using the 2015-2016 National Agricultural Worker Survey, we performed a secondary data analysis to analyze the predictors of health care utilization within the last 2 years in the United States' agricultural worker population. Data were cleaned and analyzed using decision tree analysis, which produced a classification tree model that was trained on 90% of the data and validated on 10%.

RESULTS

Exposure to English was not a predictor of health care utilization in our classification tree. The first major partition that predicted utilization was insurance status. Additional partitions were on age, gender, hypertension diagnosis, and public aid.

CONCLUSIONS

By partitioning on insurance status and use of public aid, the decision tree provided evidence that systemic factors are key determinants of health care utilization in the agricultural worker community. This highlights the importance of agencies that connect agricultural workers with resources that provide insurance and improve access to health care. This is especially important given that agricultural workers are one of the highest risk groups for occupational injury or death in the United States.

Sleeping Within Six Feet: Challenging Oregon's Labor Housing COVID-19 Guidelines

Facing the onset of the COVID-19 pandemic and increasing outbreaks among farmworkers and food processing workers across the nation, the Oregon Occupational Health and Safety Administration (OR OSHA) issued temporary regulations, in contrast to optional recommendations, in late spring. These regulations aimed to reduce the risk of COVID-19 transmission among farmworkers, but made compromises that may fail to reduce the risk of further outbreaks among Oregon's agricultural workers, particularly those living in agricultural labor housing. Instead of considering the scientific literature that called for attention to space and length of time for social distancing among unrelated persons in indoor areas, the agency accepted the 6-foot social distancing rule of thumb and allowed even shorter distances between beds with the installation of plastic or plywood barriers. The 6-foot distance (or less with a barrier) between people sleeping next to each other in poorly ventilated housing has proved disastrous. Additionally, testing for migrant and seasonal farmworkers is neither uniform nor thorough, and little data have been collected to assess the success of existing testing efforts. New regulations must be adopted for farm labor housing that limit occupancy to at most two unrelated individuals for a room of 200 square feet; include expanded specification on the provision of fresh air in shared living spaces; and support increased access to testing, surveillance testing, and alternative safe housing at labor housing sites for identified cases.

Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track

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Paper explores barriers to a universal DNP requirement for advanced practice nurses

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Includes cost analysis and perceptions of the DNP in today's professional environment

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Offers insight to help facilitate the implementation of a universal DNP standard

Background

In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry.

Purpose

The purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs.

Methods

Deans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education.

Findings

This paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition.

Discussion

This paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.

Physical activity and work activities in Florida agricultural workers

BACKGROUND

Laboring in hot and humid conditions is a risk factor for heat-related illnesses. Little is known about the amount of physical activity performed in the field setting by agricultural workers, a population that is among those at highest risk for heat-related mortality in the United States.

METHODS

We measured accelerometer-based physical activity and work activities performed in 244 Florida agricultural workers, 18 to 54 years of age, employed in the fernery, nursery, and crop operations during the summer work seasons of 2015-2017. Environmental temperature data during the participant's workdays were collected from the Florida Automated Weather Network and used to calculate wet bulb globe temperature (WBGT). Generalized linear mixed model regression was used to examine the association between WBGT on physical activity, stratified by the agricultural sector.

RESULTS

Fernery workers had the highest overall volume of physical activity, spending nearly 4 hours in moderate to vigorous activity per workday. Activity over the course of the workday also differed by the agricultural sector. A reduction on average physical activity with increasing environmental temperature was observed only among crop workers.

CONCLUSIONS

The quantity and patterns of physical activity varied by the agricultural sector, sex, and age, indicating that interventions that aim to reduce heat-related morbidity and mortality should be tailored to specific subpopulations. Some workers did not reduce overall physical activity under dangerously hot environmental conditions, which has implications for policies protecting worker health. Future research is needed to determine how physical activity and climatic conditions impact the development of heat-related disorders in this population.

Elevated Core Temperature in Florida Fernery Workers: Results of a Pilot Study

With expected increases in extreme weather, there may be a greater risk of injury from extreme heat in outdoor worker populations. To plan for future adaptation measures, studies are needed that can characterize workers’ physiologic responses to heat in outdoor settings such as agriculture. The objective of this study was to characterize occupational heat exposure, key vulnerability factors (e.g., gender, energy expenditure), and physiologic heat stress response in a sample of fernery workers. Forty-three fernery workers over 86 workdays were examined regarding heat-related illness (HRI) during the summer months of 2012 and 2013. The key outcome measure was whether a participant’s body core temperature (Tc) reached or exceeded 38.0°C (100.4ºF; Tc38). Participants’ Tc exceeded 38.0°C on 49 (57%) of the workdays, with 30 of 40 participants reaching or exceeding Tc38 on at least one workday. Adjusting for sex, there was a 12% increase in the odds of Tc38 for every 100 kilocalories of energy expended (OR: 1.12; 95% Confidence Interval [CI]: [1.03, 1.21]). Adjusting for energy expenditure, females had 5 times greater odds of Tc38 compared with males (OR: 5.38; 95% CI: [1.03, 18.30]). These findings provide evidence of elevated Tc in Florida fernery workers, indicating an increased risk of occupational HRI, and the need for policy and interventions to address this health risk.

Pesticide Exposure and Self Reported Home Hygiene: Practices in Agricultural Families

Little is known about environmental exposure to pesticides and the extent to which exposure is affected by drift from agricultural applications and take home exposure from agricultural workers. The study focused on 24 agricultural families in the northwestern United States and measured levels of organophosphate pesticides (OP) in house dust. Pesticide residues were significantly associated with the number of individuals in the home whose work included high exposure pesticide activities. Mean levels of pesticides were higher in the homes of workers who reported waiting more than 2 hours before changing out of their work clothes compared with homes where workers change within 2 hours after returning from work (p < .01). The results of this study provide evidence that workers can inadvertently carry agricultural chemicals from their work into their homes, thereby increasing the risk of pesticide exposure to other family members inside the home.

Classification of Heat-Related Illness Symptoms Among Florida Farmworkers

BACKGROUND

Farmworkers working in hot and humid environments have an increased risk for heat-related illness (HRI) if their thermoregulatory capabilities are overwhelmed. The manifestation of heat-related symptoms can escalate into life-threatening events. Increasing ambient air temperatures resulting from climate change will only exacerbate HRI in vulnerable populations. We characterize HRI symptoms experienced by farmworkers in three Florida communities.

METHODS

A total of 198 farmworkers enrolled in 2015-2016 were asked to recall if they experienced seven HRI symptoms during the previous work week. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between selected sociodemographic characteristics and reporting three or more symptoms. Latent class analysis was used to identify classes of symptoms representing the HRI severity range. We examined sociodemographic characteristics of the farmworkers across the latent classes.

RESULTS

The mean age (±SD) of farmworkers was 38.0 (±8) years; the majority were female (60%) and Hispanic (86%). Most frequently reported symptoms were heavy sweating (66%), headache (58%), dizziness (32%), and muscle cramps (30%). Females had three times the odds of experiencing three or more symptoms (OR = 2.86, 95% CI 1.18-6.89). Symptoms fell into three latent classes, which included mild (heavy sweating; class probability = 54%), moderate (heavy sweating, headache, nausea, and dizziness; class probability = 24%), and severe (heavy sweating, headache, nausea, dizziness, muscle cramps; class probability = 22%).

CONCLUSIONS

Farmworkers reported a high burden of HRI symptoms that appear to cluster in physiologic patterns. Unrecognized accumulation of symptoms can escalate into life-threatening situations if untreated. Our research can inform interventions to promote early recognition of HRI, on-site care, and appropriate occupational health policy. Administrative or engineering workplace controls may also reduce the manifestation of HRI.

CLINICAL RELEVANCE

This study advances the current knowledge of HRI symptoms in farmworkers and moves beyond reporting individual symptoms by utilizing latent class analysis to identify how symptoms tend to co-occur together in this population. It acknowledges multiple symptoms occurring as a result of occupational heat exposure and highlights the importance of symptom recognition.

Farmworker Vulnerability to Heat Hazards: A Conceptual Framework

PURPOSE

To review factors that impact the effect of hot environments on the human body in order to develop a conceptual model of human biological response.

METHODS

The organizing concept for the model development was the multilevel integration of three major factors, exposure to heat, sensitivity and adaptive capacity, and the heat stress response. Exposure of a vulnerable occupational group was used to illustrate the components of the model.

FINDINGS

Components of this framework include the hazard (environmental heat stress), vulnerability factors (workplace exposure, sensitivity and adaptive capacity), and the heat stress response. The combination of the vulnerability factors of workplace exposure (work intensity, duration), sensitivity (age, gender, etc.), and adaptive capacity (hydration, clothing, work hygiene) mediate a worker's heat stress response to the hazard. A worker's heat stress response can be classified as progressing towards two outcomes: physiologic equilibrium or physiologic disequilibrium.

CONCLUSIONS

This framework provides a starting point for the design and development of studies of heat-related illness (HRI) in farmworker and other vulnerable populations exposed to rising global temperatures.

CLINICAL RELEVANCE

Identification of vulnerability factors to HRI, informs research designs which will lead to the development of public health interventions.

Heat Exposure in Central Florida Fernery Workers: Results of a Feasibility Study

OBJECTIVE

The objective of this study was to determine the feasibility of field-based biomonitoring of heat-related illness (HRI) phenomena in Florida farmworkers. The authors determined feasibility through participant interviews regarding acceptability, data capture, recruitment and retention, and observed barriers and challenges to implementation.

METHODS

Study participants were employed in fernery operations in northeast Central Florida where ornamental ferns are grown and harvested in a seasonally high-heat environment. In this pilot, a total of 43 farmworkers participated during summers 2012 and 2013 and measurements included body core temperature, heart rate, energy expenditure, urine and blood osmolality, and self-reported HRI symptoms.

RESULTS

Data capture was approximately 90%. Participants reported that the study methods were nonobtrusive to their work, and that they were comfortable with study measures.

CONCLUSIONS

These results open possibilities for characterizing HRI utilizing physiologic biomonitoring in vulnerable occupational groups.

Deleterious Effects From Occupational Exposure to Ethylene Thiourea in Pregnant Women

Human exposure to endocrine disrupting chemicals (EDCs) has become common as a result of widespread application of these chemicals to the food supply, environmental contamination, and occupational exposures (Caserta et al., 2011). However, relatively little is known about the effects of EDCs such as ethylene thiourea (ETU) in developing fetuses and the lasting implications of this disruption on human development from birth through adulthood. Of highest concern are chronic, low-dose exposures among industrial and agricultural workers. Current knowledge regarding the significance of endocrine thyroid signaling on normal human development raises serious concerns about the possible deleterious effects of EDCs in the developing fetus, children, and mature adults. Occupational health nurses are critical in identifying women and families at increased risk of ETU exposure and mitigating early exposures in pregnancy.

Hispanic Adolescent Farmworkers’ Perceptions Associated with Pesticide Exposure1

The migrant farmworker population in the United States is a vulnerable and understudied population whose characteristics are constantly shifting. The number of youth involved in agriculture work is increasing, and they, in particular, may be at increased risk for occupational hazards, such as pesticide exposure. The present study utilized an ecological framework for focus group discussions with 33 adolescent migrant farmworkers in Oregon. Adolescents’ risk perception and health beliefs associated with pesticide exposure are examined on four levels of environmental influence: microenvironment, organizational environment, social/community environment, and macroenvironment. Adolescents provided insight on such topics as perceived vulnerability of illness due to pesticide exposure, attitudes toward farmwork, influence of their boss, knowledge of occupational hazards, safety training, and barriers to occupational choice. Cultural influences on occupational safety and health are discussed and increased attention to safety training is recommended.

Female farmworkers' health during pregnancy: health care providers' perspectives

Pregnant farmworkers and their fetuses are at increased risk of negative health outcomes due to environmental and occupational factors at their workplaces. Health care providers who serve farm communities can positively affect workers' health through the informed care they deliver. Yet, interviews with rural health care providers reveal limited knowledge about agricultural work or occupational and environmental health risks during pregnancy. Professional associations, government organizations, academic institutions, and practice settings must renew their efforts to ensure that environmental and occupational health education, especially as it relates to women and their children, is incorporated into academic and practice environments.

Female farmworkers' perceptions of heat-related illness and pregnancy health

Although agricultural workers have elevated risks of heat-related illnesses (HRI), pregnant farmworkers exposed to extreme heat face additional health risk, including poor pregnancy health and birth outcomes. Qualitative data from five focus groups with 35 female Hispanic and Haitian nursery and fernery workers provide details about the women's perceptions of HRI and pregnancy. Participants believe that heat exposure can adversely affect general, pregnancy, and fetal health, yet feel they lack control over workplace conditions and that they lack training about these specific risks. These data are being used to develop culturally appropriate educational materials emphasizing health promoting and protective behaviors during pregnancy.

Research to practice in occupational health nursing

Occupational health nursing research has gained a significant place in national and international nursing programs and has advanced occupational health nurses' understanding of the most effective ways to prevent occupational illness and injury, provide access to quality care for workers, and manage occupational injuries and return to work. This article describes the history of nursing research in general and highlights the current national shortages that must be addressed to ensure that nurses continue to impact the field. Occupational health nursing priorities are described and examples are given of nurse scientists who have established the foundation of occupational health nursing research and who illustrate varied expertise and the interdisciplinary context in which the work is conducted.

Phthalate exposures and human health concerns: A review and implications for practice

High levels of exposure to phthalates have been associated with an increased risk for adverse male fetal reproductive development. Although animal studies have consistently demonstrated reproductive health effects, additional human epidemiological studies are needed to fully understand the potential harm to humans. Recent findings reported for humans have demonstrated endocrine-disrupting action similar to that associated with phthalate exposures in animals. As a result, phthalate exposure is an emerging public health concern that warrants further review. This article explores the state of the science on phthalate exposure, reviews the literature, and provides recommendations occupational health nurses can use to optimize the health of susceptible populations.

Phthalate Exposures and Human Health Concerns

High levels of exposure to phthalates have been associated with an increased risk for adverse male fetal reproductive development. Although animal studies have consistently demonstrated reproductive health effects, additional human epidemiological studies are needed to fully understand the potential harm to humans. Recent findings reported for humans have demonstrated endocrine-disrupting action similar to that associated with phthalate exposures in animals. As a result, phthalate exposure is an emerging public health concern that warrants further review. This article explores the state of the science on phthalate exposure, reviews the literature, and provides recommendations occupational health nurses can use to optimize the health of susceptible populations.

Determining Severe Respiratory Distress in Older Out-of-Hospital Patients

OBJECTIVES

This preliminary investigation represents the first step in developing a clinical decision rule (CDR) to assist out-of-hospital providers in caring for older patients in respiratory distress. The specific aims of the study were: 1) to identify up to ten candidate clinical indicators of severe respiratory distress in older out-of-hospital patients and 2) to determine the feasibility of obtaining data on these indicators from out-of-hospital treatment records, and of obtaining a measure of severe respiratory distress from the emergency department (ED) medical record.

METHODS

This mixed-methods study included a qualitative component to list possible clinical indicators of severe respiratory distress, and a Delphi survey N = six experts) to reduce the comprehensive list that resulted (aim 1). The feasibility of gathering clinical indicators and a measure of severe distress was evaluated using a retrospective chart review (N = 640) of out-of-hospital and ED medical records (aim 2).

RESULTS

Nine clinical indicators were identified: level of consciousness/mentation, inability to speak in full sentences, position of the patient on arrival, decreased oxygen saturation, accessory muscle use, dyspnea, increased respiratory effort, altered respiratory rate, and retractions. There were sufficient data available on all indicators except dyspnea and retractions; a measure of severe distress was readily obtained from the ED medical record.

CONCLUSION

Medical record data were available on seven out-of-hospital clinical indicators and an ED measure of severe distress. Further work needs to be done to refine the operational definitions of the indicators and to standardize the way they are documented in the out-of-hospital medical record.

The potential toxicity of artificial sweeteners

Since their discovery, the safety of artificial sweeteners has been controversial. Artificial sweeteners provide the sweetness of sugar without the calories. As public health attention has turned to reversing the obesity epidemic in the United States, more individuals of all ages are choosing to use these products. These choices may be beneficial for those who cannot tolerate sugar in their diets (e.g., diabetics). However, scientists disagree about the relationships between sweeteners and lymphomas, leukemias, cancers of the bladder and brain, chronic fatigue syndrome, Parkinson's disease, Alzheimer's disease, multiple sclerosis, autism, and systemic lupus. Recently these substances have received increased attention due to their effects on glucose regulation. Occupational health nurses need accurate and timely information to counsel individuals regarding the use of these substances. This article provides an overview of types of artificial sweeteners, sweetener history, chemical structure, biological fate, physiological effects, published animal and human studies, and current standards and regulations.

The Potential Toxicity of Artificial Sweeteners

Since their discovery, the safety of artificial sweeteners has been controversial. Artificial sweeteners provide the sweetness of sugar without the calories. As public health attention has turned to reversing the obesity epidemic in the United States, more individuals of all ages are choosing to use these products. These choices may be beneficial for those who cannot tolerate sugar in their diets (e.g., diabetics). However, scientists disagree about the relationships between sweeteners and lymphomas, leukemias, cancers of the bladder and brain, chronic fatigue syndrome, Parkinson's disease, Alzheimer's disease, multiple sclerosis, autism, and systemic lupus. Recently these substances have received increased attention due to their effects on glucose regulation. Occupational health nurses need accurate and timely information to counsel individuals regarding the use of these substances. This article provides an overview of types of artificial sweeteners, sweetener history, chemical structure, biological fate, physiological effects, published animal and human studies, and current standards and regulations.

Health effects following 9/11: implications for occupational health nurses

The attacks on the World Trade Center in 2001 resulted in hazardous environmental exposures of enormous magnitude, bringing about persistent respiratory and psychological problems among survivors. Approximately 40,000 men and women worked at Ground Zero, the former site of the World Trade Center in New York City, and at the Staten Island landfill, the main wreckage depository, in the days, weeks, and months following 9/11. First responders such as firefighters and police, construction workers, and utility and public sector workers were involved. These individuals were at high risk for injury, respiratory complications, and psychological distress from the traumatic event. This article highlights the controversy surrounding 9/11 research and reports, identifies populations at high risk for exposure, and examines the health effects. Occupational health nurses should not only be empowered to provide the best care for workers affiliated with 9/11, but also contribute to research to protect worker health in future disaster responses.

Work–Heart Balance

The complexities of managing heart failure among employees have not been studied. In this mixed methods study, the authors explored how cognition, physical functioning, attitudes, and self-efficacy influence self-care among employees with heart failure. Forty-one adults (White, 68.3%; male, 63.4%; median age, 51 years; employed, 48.8%) completed in-depth interviews and standardized instruments. Content analysis was used to derive themes from narrative accounts of self-care practices, attitudes, and self-efficacy within the context of employment. Descriptive and nonparametric statistics were used to describe the sample and generate hypotheses about relationships among the variables. Most of the employed participants ( N = 13) worked full-time (65%), primarily in sedentary jobs. Cognition and physical functioning were better in those who were employed ( p = .02), but self-care practices were lower ( p = .03). Those who successfully managed heart failure and work described strategies to incorporate self-care into their workdays, self-efficacy in managing symptoms while at work, and favorable attitudes toward employment.

Controversy: neonatal exposure to plasticizers in the NICU

This article presents a review of extant literature that informs our current understanding of the effects of di-(2-ethylhexyl) phthalate (DEHP) exposure on neonates. Phthalates such as DEHP add flexibility to plastics. DEHP is a major component in the manufacturing of polyvinyl chloride devices commonly used in the healthcare setting. Premature and critically ill neonates and infants in the NICU are exposed to DEHP and may be at an increased risk for adverse health outcomes as a result. DEHP has been shown to be a developmental and endocrine disrupting toxicant and is a major component in polyvinyl chloride plastics, which are commonly found in medical equipment used in the NICU. Potential toxicities to infants in the NICU are a concern because infants' small body size and compromised physical condition necessitate a multitude of medical interventions, each increasing exposure levels. Expanding nurses' knowledge regarding DEHP research is important for implementing a precautionary approach to reduce DEHP exposure among NICU patients.

Risks of phthalate exposure among the general population: implications for occupational health nurses

Personal care items including lotions, perfumes, deodorants, shampoos, and cosmetics are sources of phthalate exposure. Women of childbearing age, children, and beauty salon workers are at greater risk for exposure. Occupational health nurses are in an ideal position to rally support for improved regulatory laws and for funding of evidence-based research that will reduce phthalate exposures and improve client health. Occupational health nurses must support the establishment and implementation of procedures for workplace safety inspections among susceptible populations. Information regarding reduction of overall phthalate exposure must be available for clients. Resources like phthalate-free product lists can be valuable tools in helping clients make informed decisions about alternatives to phthalates.

Effectiveness of cleaning practices in removing pesticides from home environments

The deposition of agricultural pesticides in the homes of agricultural workers and residents of agricultural communities is a major environmental health concern. The effectiveness of home cleaning activities in removing pesticides from home surfaces has not been tested. An intervention study was conducted to assess the effectiveness of cleaning windowsills, floors and carpets in a sample of 10 farmworker homes. Baseline measures of organophosphorus (OP) pesticide residues were obtained, a standardized cleaning intervention was applied and follow-up measures of pesticide residues were obtained within 24-48 hours after the cleaning and 12 months later. House dust was analyzed for six OP pesticides. All homes had detectable baseline levels of OP pesticides on floors and windowsills. Cleaning of linoleum floors was ineffective in removing total pesticide residues and cleaning effectiveness varied among the pesticides. The cleaning of total OP pesticides on the windowsills was effective (median decrease was 0.0029 microg/cm(2), 1-sided p-value = 0.01). Steam cleaning carpets essentially reduced the amounts to non-detectable levels. In 12 months the levels in carpets had accumulated to one-third of the baseline levels. These results provide evidence that cleaning practices can reduce the amount of pesticides in agricultural homes; however the type of surface being cleaned and the pesticides present in the home may influence results.

How to reduce DEHP in your NICU: a plan of simple steps to promote change

The integration of research into practice can be a challenge; however, the DEHP-reduction steps provided in this column should make the process simpler and faster. DEHP's link to adverse effects makes it crucial for neonatal nurses to do their best to protect their patients using a preventative approach. As critically ill neonates and infants continue to be exposed to DEHP-leaching devices, neonatal nurses can be at the forefront in taking precautionary action to reduce DEHP exposure among their most vulnerable patients.

Studying health outcomes in farmworker populations exposed to pesticides

A major goal of studying farmworkers is to better understand how their work environment, including exposure to pesticides, affects their health. Although a number of health conditions have been associated with pesticide exposure, clear linkages have yet to be made between exposure and health effects except in cases of acute pesticide exposure. In this article, we review the most common health end points that have been studied and describe the epidemiologic challenges encountered in studying these health effects of pesticides among farmworkers, including the difficulties in accessing the population and challenges associated with obtaining health end point data. The assessment of neurobehavioral health effects serves as one of the most common and best examples of an approach used to study health outcomes in farmworkers and other populations exposed to pesticides. We review the current limitations in neurobehavioral assessment and strategies to improve these analytical methods. Emerging techniques to improve our assessment of health effects associated with pesticide exposure are reviewed. These techniques, which in most cases have not been applied to farmworker populations, hold promise in our ability to study and understand the relationship between pesticide exposure and a variety of health effects in this population. Key words: biomarkers, cancer, epidemiology, health outcomes, immigrants, neurobehavioral, neuropathy, pesticides.

Occupational and environmental health in the 21st century: the new frontier in genetics and disease prevention

Society is currently on the threshold of a new revolution in understanding the interaction of genes and the environment. This research has profound implications for understanding occupational disease and will present ethical challenges to occupational health practice. The public must be educated about the potential promise, as well as the threats, posed by emerging genetic technologies.

Nanotechnology: are occupational health nurses ready?

Nanotechnology is a rapidly advancing area of science, and development increasingly will be seen in an array of manufacturing sectors, including sporting goods, cosmetics, clothing, transistors, and biomedical products. Nanoparticles are so small that they interact with other substances at the atomic or subatomic level. They do not behave like solids, liquids, or gases, and have unique mechanical and electronic properties. A serious lack of information about the human health and environmental implications of nanomaterials exists, but scientific experts agree that the potential effects of nanomaterials on working populations and the environment is a serious consideration. Occupational health nurses should be aware of the potential use of nanotechnology in their workplaces and stay aware of emerging information on methods to protect worker health.

Immigrant workers in the United States: recent trends, vulnerable populations, and challenges for occupational health

Immigrant workers are a rapidly growing segment of the U.S. work force, and these increasing numbers have resulted in a different ethnic mix in the work force than in previous decades. Immigrant workers are not a homogenous group, but are over-represented in low-paying occupations. Their diversity and vulnerability present distinct challenges for occupational health nurses. High-risk occupations in which a large proportion of immigrant workers are hired include agriculture, sweatshops, day laborers, and construction. Initiatives needed to improve the working conditions of this vulnerable population include improved surveillance and research, culturally competent care providers, improved health care access, advocacy, and changes in immigration and health policy.

Assessing pesticide safety knowledge among Hispanic migrant farmworkers in Oregon

The purpose of this article is to report on the development and initial use of a pesticide knowledge test (PKT) specifically designed to evaluate agricultural workers' knowledge of the content mandated by the federal Worker Protection Standard (WPS). The PKT is a 20-item, true-false test, used in a sample of 414 adult and adolescent migrant farmworkers in Oregon. The overall mean score, i.e., number correct, was 15.67(78.4%), with both adults and adolescents demonstrating the most difficulty with questions related to the overall health effects of pesticides. The internal consistency was 0.73, when estimated using a method to correct for small sample sizes. Only six items had less than 70% correct answers. Content validity was achieved by basing the items directly on the Worker Protection Standard; face validity was obtained by having the final version of the test reviewed by a bilingual (English-Spanish) educator familiar with the requirements of the WPS. Overall, adult participants scored better than adolescents, and those with previous pesticide training scored better than those without. There were no differences in scores based on gender or whether the test was taken in English or Spanish; however, participants who spoke indigenous languages scored significantly lower than those who did not. These results indicate that the PKT is a valid, reliable measure of worker knowledge of the content of the WPS, although it does not measure the extent to which that knowledge is actually used in the work setting.

SARS update: Winter, 2003 to 2004

Transmission of severe acute respiratory syndrome (SARS) related coronavirus (CoV) appears to be heterogeneous. Most transmission occurs through large droplets, but there is some evidence of spread through aerosol transmission. Proper use of personal protective equipment (PPE) and scrupulous attention to hand hygiene are critical to reducing transmission of SARS, especially in health care facilities. Surgical masks have been shown to be highly effective in reducing transmission when N-95 respirators are unavailable. Health care workers bore a large burden of illness during the 2002 to 2003 SARS epidemic. Occupational health nurses working in health care agencies will play a key role in preparing for a re-emergence of the disease. Occupational health nurses should "bookmark" the Centers for Disease Control and Prevention website for Public Health Guidance for Community-Level Preparedness and Response to SARS: www.cdc.gov/ncidod/sars/clinicalguidance.htm for easy retrieval and reference.

Pesticide exposure and self reported home hygiene: practices in agricultural families

Little is known about environmental exposure to pesticides and the extent to which exposure is affected by drift from agricultural applications and take home exposure from agricultural workers. The study focused on 24 agricultural families in the northwestern United States and measured levels of organophosphate pesticides (OP) in house dust. Pesticide residues were significantly associated with the number of individuals in the home whose work included high exposure pesticide activities. Mean levels of pesticides were higher in the homes of workers who reported waiting more than 2 hours before changing out of their work clothes compared with homes where workers change within 2 hours after returning from work (p < .01). The results of this study provide evidence that workers can inadvertently carry agricultural chemicals from their work into their homes, thereby increasing the risk of pesticide exposure to other family members inside the home.