Immigrants continue to face challenges after entering the labor market and remain overrepresented in ‘3-D jobs’ (dirty, difficult, degrading). This study aims to investigate the differences in occupational injury due to accidents (OIA) among immigrants compared to native-born workers in Sweden, and to examine the role of migrant-specific and work factors in these differences. This repeated cross-sectional study used nationwide registers including all gainfully employed individuals in 2004–2020 (average annual sample 4.5 million individuals). OIA was treated as a binary outcome and migrant status was categorized based on region of birth and reason for immigration. OIA odds were estimated using pooled logistic regression analyses, where the crude model was adjusted for sociodemographic factors, time since immigration, and work factors. First-generation immigrants (odds ratios [OR] 1.41; 95

Although there is a growing dependence on the immigrant workforce in many countries, recent trend analyses on the work-related health of immigrants are scarce. Thus, this study aims to fill this gap by comparing reported occupational injuries due to accidents (OIA) trends among native-born Swedes with first-generation immigrants arriving from different global regions now working in Sweden from 2003 to 2020. A repeated cross-sectional registered-based study was conducted including the total working population (18 years or older) (approximately 3.5-4 million individuals annually). Information on OIA and migrant status was obtained from nationwide registers. The incidence rate (IR) of an OIA per 1000 workers with 95

Background:Occupational heat stress mediated acute kidney injury (AKI) has been linked to the development of chronic kidney disease of non-traditional causes (CKDnt) in agriculture workers. Rest-shade-hydration-hygiene (RSHH) programs are promising interventions for preventing CKDnt. An obstacle to the implementation of RSHH programs is the concern that the reduced work time associated with these programs may reduce productivity and earnings. This case study analyzes the economic impact of an RSHH program implemented at a sugar mill in Nicaragua. Approach:Data were obtained from the sugar mill over a six-year, five-harvest period (Harvest 1: 2017-18 through Harvest 5: 2021-2022). Data included health and productivity metrics, and RSHH program costs. During Harvest 1 existing heat mitigation strategies were in place but were not optimal. Thus, 2017 was considered the pre-RSHH (baseline) period. Over subsequent harvests progressively improved RSHH programs were implemented. Analysis:A cost-benefit analysis was conducted to estimate the return on investment of the RSHH program. The analysis considered both fixed and variable costs associated with the program, including electrolyte beverage production, costs for AKI treatment and worker training. Benefits were calculated based on productivity improvements, including reductions in absenteeism, and reductions in AKI cases. Results:As soon as 2020, the costs of implementing the RSHH program were offset by savings resulting from increased productivity (i.e., reduced absenteeism and increased worker production) and reduced cases of AKI. The RSHH program yielded a positive return on investment from 2020 and onward. The average return on investment over the five-year period was 0.02 (or a return of $1.02 for every $1.00 invested), which takes into consideration the first two years of the intervention in which there was a negative return on investment. In 2022, every $1.00 invested in the RSHH program saw a return of $1.60. Discussion:This case study provides evidence that implementing an RSHH program can provide both economic and health benefits, particularly in locations where climate change is increasing the already present risk and burden of occupational heat stress. Teaser message:A rest-shade-hydration-hygiene intervention program at a sugar mill in Nicaragua produced a positive return on investment after five years by improving both health and productivity outcomes. Key findings and implications:A positive average return on investment of $1.60 USD for every $1.00 invested was identified after a five-year period following implementation of a rest-shade-hydration-hygiene (RSHH) program at a sugar mill in Nicaragua.Three years after implementation, the costs of implementing the RSHH program were offset by savings resulting from increased productivity (i.e., reduced absenteeism and increased worker production) and reduced cases of acute kidney injury.This case study provides evidence of the health and economic benefits of promoting an easily applicable workplace intervention that addresses current risks as well as the rising threat of climate change induced occupational heat stress.

[This corrects the article DOI: 10.1016/j.ekir.2024.08.035.].

OBJECTIVES:To investigate the effect of precarious employment (PE) on the risk of diagnosed chronic musculoskeletal disorders (MSDs) among Swedish workers in occupations with strenuous working conditions. METHODS:This nationwide register-based cohort study included workers registered as living in Sweden in 2005, aged 21-60 at the 2010 baseline. Three samples were included: workers with high biomechanical workload (n=680 841), repetitive work (n=659 422) or low job control (n=703 645). PE was evaluated using the SWE-ROPE (2.0) construct, which includes: contractual insecurity, temporariness, multiple jobs, income and collective bargaining agreement from 2010. Three exposure groups were created: PE, substandard and standard employment (SE). MSD data were obtained from outpatient registers (2011-2020). Cox proportional-hazards models estimated crude and adjusted sex-specific HRs with 95% CIs. Various outcomes were investigated for the different samples. RESULTS:Among workers with heavy biomechanical workload, results suggest increased risks of back MSDs in PE compared with those in SE. No association was found between PE and tendonitis in repetitive work, but PE was associated with an increased Carpal Tunnel Syndrome risk among men. Among workers with low job control, PE was associated with increased risks of soft tissue disorders among men and fibromyalgia among women. CONCLUSIONS:PE was associated with an increased risk of MSDs among workers with strenuous working conditions, with variations depending on disorder and sex. The findings suggest a differential exposure to biomechanical workload within occupations. Targeted interventions and strengthened workplace safety regulations are needed to protect the musculoskeletal health of workers in PE.

OBJECTIVES:To study the effect of a progressively enhanced rest-shade-hydration-hygiene (RSHH) intervention on kidney injury and inflammation biomarkers, and rates of clinical acute kidney injury (AKI) in Nicaraguan sugarcane workers with a very high rate of chronic kidney disease of non-traditional origin (CKDnt). METHODS:We analysed serum creatinine and C-reactive protein (CRP) and leukocyturia from samples obtained before and at the end of four harvest seasons (H1-4). An increase in creatinine≥0.30 mg/dL over the harvest was considered incident kidney injury (IKI). Rates of clinically diagnosed AKI were obtained from medical records. Each season the RSHH intervention included progressively longer and more frequent rest periods with improved access to shade and hydration, implementation monitoring, qualitative interviews and health outcome assessments. RESULTS:1044 workers were followed for 1938 person-harvests. Among burned cane cutters, the job group with the highest workload and worst outcomes initially, there were decreasing rates of IKI (21% in H1 to 1% in H4, p<0.01), AKI (20/1000 worker-months to 8/1000 worker-months, p<0.01) and end-harvest leukocyturia (26% to 1%, p<0.01), and less rise in cross-harvest CRP (median 1.75-fold increase in H1 to 1.00 in H4, p<0.01). CONCLUSION:Kidney outcomes among outdoor heat-stressed workers at high risk of CKDnt improved as a structured RSHH intervention was implemented and committed to by workplace management. The findings support a causal relationship between occupational heat stress, kidney injury and CKDnt and point to possibilities for prevention.

OBJECTIVE:To assess personal exposure to respirable and inhalable dust and its components endotoxin, black carbon and crystalline silica among sugarcane workers in Nicaragua. METHODS:Individual exposures to respirable (measurements=98) and inhalable (measurements=36) dust were collected in January and March 2020, with the month of March generally being hotter and less humid. Respirable dust and its components black carbon and crystalline silica, as well as inhalable dust and its component endotoxin, were personally measured. Linear mixed models were used to identify the determinants of occupational dust exposure considering different job tasks and meteorological conditions. RESULTS:Respirable dust and black carbon concentrations were higher in March among burned cane cutters compared with the other job groups (respirable dust geometric mean (GM)=1.9 mg m-3; black carbon GM=13.7 µg m-3), with considerably lower levels in January (respirable dust GM=0.2 mg m-3; black carbon GM=3.4 µg m-3). Almost all respirable crystalline silica measurements were below the limit of detection, except for four measurements, which ranged from 8 µg m-³ to 15 µg m-³. Seed cutters (GM=3.1 mg m-3) and weeders (GM=2.5 mg m-3) had the highest exposure to inhalable dust, while endotoxin concentrations were higher among seed cutters (GM=100 EU m-3) and burned cane cutters (GM=63 EU m-3) than the other work groups. CONCLUSIONS:Overall, exposure levels to the assessed agents varied across work groups, with higher levels observed among burned cane and seed cutters.

Precarious employment (PE) is a major determinant of population health and contributor to health and social inequities. The purpose of this article is to synthesize and critically appraise available evidence on labor market initiatives addressing PE identified through a systematic review. Of the 21 initiatives reviewed, grouped into four categories—labor market policies, legislation, and reforms; union strategies; apprenticeships and other youth programs; social protection programs—10 showed consistently positive outcomes and 11 a combination of negative, mixed, or inconclusive outcomes. In addition to reviewing the key findings, we discuss public health implications and recommendations related to PE and the implementation and evaluation of initiatives. Given the wide diversity of initiatives, implementation approaches, evaluation methods, and socioeconomic and historical contexts characterizing the labor markets of the countries studied, we refrain from making recommendations regarding the most effective initiatives to address PE. Instead, we discuss several implications concerning the four types of initiatives to further support those searching for solutions to address PE. We strongly recommend tailoring adopted initiatives to local contexts to match a country's specific PE problems and unique labor market and socioeconomic context.

Construction workers are 13 times more likely to die from heat-related illnesses than workers in other job industries. This elevated risk is attributed to excessive heat stress from environmental exposure, metabolic heat generated from physical labor, and the insulating effects of protective clothing. Levels of heat stress may vary across job types, reflecting the diversity of tasks performed and the work environment. Despite elevated risks, heat strain assessed by core temperature (Tcore) in construction workers during summertime in the United States has not been evaluated previously. Thirty-two construction workers (three females) were monitored over 3 summer workdays. Participants were categorized by job type (carpenter, concrete, laborer, roofer) and work environment (covered, uncovered). Heat index (HI), heart rate (HR), and Tcore were measured throughout the workday, while hydration was assessed through pre- and post-shift measurements of urine specific gravity (USG). Peak HI over the 3 days was 27.3, 35.2, and 33.7 °C, indicating the potential for low to moderate heat stress. Roofers experienced a higher peak HI compared to other job types (p < 0.01), but no differences were observed between workers in covered (28.8 ± 3.7 °C) and uncovered (32.1 ± 4.2 °C) areas (p = 0.37). The estimated peak metabolic rate was higher in workers in uncovered areas (868 ± 238 W) compared to covered (632 ± 130 W) (p < 0.01), with no differences among job types (p = 0.23). Forty-three percent of workers had Tcore exceeding 38.0 °C, with 4% exceeding 38.5 °C. Based on USG, 63% of workers began work dehydrated (1.022 ± 0.005), but urine did not become more concentrated during the workday (post-shift USG; 1.022 ± 0.007) (p = 0.78). Forward stepwise regression identified that peak metabolic rate plus post-shift USG were the combined variables most associated with peak Tcore (r2 = 0.55, p < 0.01). Construction workers, even in low to moderate environmental heat exposure, experienced significant heat strain, primarily due to an elevated metabolic rate. Environmental heat exposure and metabolic rate vary by job type and work environment.

Purpose To examine heat exposure at work and home and the work-recovery cycle and temporal variation of kidney strain, muscle injury and inflammation biomarkers in sugarcane workers. Methods 20 male sugarcane workers (age: 33 +/- 7 years) with a workplace Rest.Shade.Hydration (RSH) intervention were observed over 4 days, at the end (18 h post-shift recovery) and beginning of a work week (42 h post-shift recovery). Measures included work intensity (heart rate), gastro-intestinal temperature, estimated body core temperature (using heart rate), fluid consumption, pre- and post-work blood and urine samples, physical activity (accelerometery) away from work, plus ambient heat exposure at work and home. Results On workdays, workers awakened at approx. 02:40 after 5 h sleep in similar to 30 degrees C. Across work shifts, daily average WBGT ranged from 26 to 29 degrees C (cooler than normal) and average workload intensity ranged from 55 to 58%HRmax. Workers reported consuming similar to 8 L of water and similar to 4 x 300 mL bags of electrolyte fluid each day. Serum creatinine, cystatin C and creatine phosphokinase markedly increased post-work and decreased during recovery; serum potassium did the opposite (all p < 0.01). Biomarker concentration changes were similar between recovery periods (18 h vs. 42 h; all p > 0.27). C-reactive protein was the highest at the end of the work week (p = 0.01). Conclusion Despite RSH intervention, cross-shift kidney strain was marked (recovering overnight) and systemic inflammation increased over the work week. Thus, biomonitoring of kidney function in occupational populations should be performed before a work shift at any point in the work week. This is essential knowledge for field studies and surveillance.

In the summer season, road construction workers perform physically demanding tasks outdoors, placing them at greater risk for exertional heat illness conditions. Assessing core temperature (Tcore) is critical as it serves as a key indicator of heat strain and helps to estimate the risk of heat-related illness. Despite the increased risk of hyperthermia, previous research has not assessed Tcore in road construction workers in the United States during summer work. Purpose: To report heat strain and environmental heat stress in a pilot study of road construction workers during work in the summer. Methods: Seven male road construction workers in New Mexico were observed performing physically demanding work during a summer work shift. Environmental heat stress (heat index [HI], dry/wet bulb temperature, and relative humidity), Tcore, and skin temperature (Tskin) were measured continuously at a single job site throughout the workday. Hydration was assessed pre- and post-shift via measurements of urine specific gravity (USG) and changes in body weight. Results: The peak HI recorded throughout the workday was 34.1 degrees C, corresponding to a "warning" heat risk level according to the Occupational Safety and Health Administration Heat Safety Tool App. Two of seven (29%) workers reached a peak Tcore of greater than 38.0 degrees C, and 4 (57%) began the work shift dehydrated, indicated by a USG >1.020. Conclusions: Findings from this pilot study suggest that road construction workers may begin their shifts dehydrated and some experience moderate hyperthermia while performing physically demanding work in hot environmental conditions.

OBJECTIVES: The aim of this study was to examine the mediating effect of the psychosocial work environment on the association between precarious employment (PE) and increased risk of common mental disorders (CMD), substance use disorders and suicide attempts. METHODS: This longitudinal register-study was based on the working population of Sweden, aged 25–60 years in 2005 (N=2 552 589). Mediation analyses based on a decomposition of counterfactual effects were used to estimate the indirect effect of psychosocial risk factors (PRF) (mediators, measured in 2005) on the association between PE (exposure, measured in 2005) and the first diagnosis of CMD, substance use disorders, and suicide attempts occurring over 2006–2017. RESULTS: The decomposition of effects showed that the indirect effect of the PRF is practically null for the three outcomes considered, among both sexes. PE increased the odds of being diagnosed with CMD, substance use disorders, and suicide attempts, among both men and women. After adjusting for PE, low job control increased the odds of all three outcomes among both sexes, while high job demands decreased the odds of CMD among women. High job strain increased the odds of CMD and suicide attempts among men, while passive job increased the odds of all three outcomes among women. CONCLUSION: The results of this study did not provide evidence for the hypothesis that psychosocial risks could be the pathways linking precarious employment with workers` mental health. Future studies in different social contexts and labour markets are needed.

OBJECTIVES:Assess the impact of environmental heat and a rest-shade-hydration (RSH) intervention against heat stress on productivity of piece-paid Mesoamerican sugarcane cutters. These workers are at a high risk of chronic kidney disease of non-traditional origin (CKDnt), from the severe heat stress they experience due to heavy work under hot conditions. RSH interventions in these populations improve kidney health outcomes, but their impact on productivity has yet to be examined. METHODS:We accessed routine productivity data from seed (SC, N = 749) and burned (BCC, N = 535) sugarcane cutters observed over five harvest seasons with increasing RSH intervention at a large Nicaraguan sugarcane mill. Hourly field-site wet-bulb globe temperature (WBGT) was recorded by mill staff and summarized as a daily mean. Mixed linear regression was used to model daily productivity, adjusting for age (18-29, 30-44, and >45 years), sex, WBGT (<28, 28-29, 29-30, 30-31, and >31 °C) on the same and preceding day, harvest season (2017-18 to 2021-22), month, and acclimatization status (<1, 1-2, and >2 weeks). RESULTS:There was an inverse dose-response relationship between SC productivity and WBGT on the same and preceding days, decreasing by approximately 3%/°C WBGT. Productivity increased during the study period, i.e. coinciding with RSH scale-up, by approximately 19% in SC and 9% in BCC. CONCLUSION:Agricultural worker productivity was expected lower on hotter days, strengthening the interest in all stakeholders to mitigate increasing global temperatures and their impact. Despite decreasing the total time allocated for work each day, an RSH intervention appears to result in increased productivity and no apparent loss in productivity.

This article presents synthesized evidence from 16 studies examining initiatives with potential to mitigate workers’ exposure to precarious employment through the adoption of minimum wage policies. All studies were set in low-income countries and focused on both formal and informal workers. A systematic review of evaluated initiatives addressing precarious employment identified the evidence. We consider minimum wage policies as initiatives that could address precarious employment because of the central role of minimum wages in establishing employment terms for workers in precarious situations. We include initiatives aimed at formal and informal workers, given that precarious employment can exist in both sectors, that these workers share concerns regarding income and would benefit from minimum wage policies. The findings imply that minimum wage policies could increase precariously employed workers’ financial compensation, although with some differences and with little or no effect on employment security. It is not feasible to extend these conclusions beyond low-income economies due to differences with high-income economies in how the mechanisms through which minimum wage policies could impact worker compensation and employment security. However, they should serve as a reminder for high-income economies, many of which experience expanding informal sectors, about the need for related research and policy.