We aimed to identify circumstances associated with feelings of pride in healthcare workers (HCWs) during the COVID-19 pandemic. A prospective cohort of Canadian HCWs reported pride-reinforcing events in April 2020 (Phase 1). In spring/summer 2022 (Phase 4), they completed a self-reported retrospective comparison rating of whether they 'now feel more [professional] pride than before the pandemic'. Among 4964 HCWs, 4360 (88%) described pride-reinforcing events in Phase 1; 3926 (79%) rated feeling more professional pride than before the pandemic in Phase 4. Teamwork (34%) and public appreciation (13%) were most cited in Phase 1. At Phase 4, male and older HCWs and community-based staff reported feeling more pride. Working as a physician, in hospital, with COVID-19 patients, and early anxiety/depression were associated with lower pride. Higher ratings were associated with greater organizational support. Many HCWs reported feeling more professional pride than before the pandemic. External support may help mitigate negative feelings.

INTRODUCTION:Musculoskeletal disorders are known to result from physical demands at the workplace. Identification of risks specific to particular trades may encourage work modification to prevent new onset conditions. METHODS:In a Canadian cohort study of male and female welders and electrical workers, we collected self-reports of low-back pain, shoulder pain, and symptoms suggestive of vibration white finger (VWF) at each 6-monthly contact for up to 5 yr. Physician records of back and shoulder/joint disorders and Raynaud's syndrome were extracted from the Alberta administrative health database (AHDB). At each contact, participants completed questions on ergonomic work factors. We computed cumulative hours exposed for 6 factors: whole-body vibration, hand-arm vibration, manipulating heavy objects, working at or above shoulder height, working while crouching or kneeling, and work in cold environments. The relation of current and log cumulative exposures to health outcomes was identified by proportional hazards regression, adjusting for sex, age, body mass index, smoking, anxiety, and depression. RESULTS:Of 1,885 workers recruited January 2011 to September 2017, 872 welders and 812 electrical workers recorded symptoms and workplace demands on at least one occasion, with 693 welders and 567 electrical workers matched to the AHDB. In final models, whole-body vibration was related overall to each self-reported health outcome with backpain risk most in evidence for male welders (HR = 1.10 log increase/h of exposure: 95% CI, 1.05 to 1.15, P < 0.001). Working in a crouching position and in cold temperatures also contributed to back pain in welders. Cumulative hours working at or above shoulder height increased welders' risk of shoulder pain (HR = 1.07 log increase/h of exposure: 95% CI, 1.03 to 1.11, P = 0.001). Working at or above shoulder height was related to both back and shoulder pain in the electrical trades, where cumulative exposure to hand-arm vibration was an additional factor for shoulder pain (HR = 1.06 log increase/h of exposure: 95% CI, 1.01 to 1.10, P = 0.007). Manipulating heavy loads was a further risk factor for back and shoulder pain for women in electrical work. There were only 3 incident cases of Raynaud's syndrome in physician records: symptoms suggestive of VWF related strongly to work in cold environments but not to hand-arm vibration. Physician records of back pain did not reflect specific workplace demands, but physician records of shoulder/joint conditions were greater, overall, in those with longer exposure to whole-body vibration and to current hand-arm vibration in electrical workers. CONCLUSION:Vibration, a well-recognized hazard, was a risk factor for all outcomes but with whole-body vibration more evidently a risk for welders and hand-arm vibration for electrical workers. The final models of risk factors differed importantly between the two trades, suggesting specific targets for intervention.

Background Many studies have documented exposure to psychosocial factors in healthcare workers (HCWs) during the coronavirus disease 2019 (COVID-19) pandemic. Few have done it prospectively with open-ended questions.Aims To describe the evolution of stress factors reported by HCWs during the pandemic.Methods A prospective cohort of 4964 HCWs (physicians, nurses, healthcare aides and personal support workers), from four Canadian provinces, received four online questionnaires between the spring 2020 and 2022. Responses to an open-ended question on stressful events were coded into 25 stressors. Multilevel logistic regressions assessed trends in stressors, and the effect of gender, occupation and age.Results In 2020, 91% of participants reported at least one stressor compared to 51% in spring 2022. Overall, eight stressors were reported 1000 times or more among 16 786 questionnaires. Five stressors decreased over time: fear of COVID-19, problems with personal protective equipment, changing guidelines, management of difficult cases and changes to work routine. Conversely, an increasing trend was noted for volume of work, and poor behaviour from the public or colleagues. Difficulties managing patients' deaths remained steady. Changes in stressors over time were similar by gender, professional role and age group, although the reporting of some stressors varied within subgroups.Conclusions Reporting of most stressors decreased over the pandemic, except for stressors arising from the changing demands on staff and patients as the pandemic progressed. Such changes in workplace psychosocial factors need to be addressed by prevention programmes to ensure an appropriate support response to the needs of HCWs. There was a marked change in the stressors reported by healthcare workers to an open-ended question repeated between 2020 and 2022 during the coronavirus disease 2019 pandemic. The stressors associated with responding to a novel pathogen decreased but those from volume of work and poor behaviour from the public and co-workers increased as the pandemic progressed. Exposure to psychosocial factors fluctuates over time within a population and workplace prevention programs must be responsive to these changes.

The particle size distribution of welding fumes varies with welding parameters, particularly the welding process, the base material, and the consumable. Welding fumes are known to be hazardous to health through various mechanisms. The health hazard of welding fume exposure is dependent upon fume composition as well as size distribution. Smaller particles have a larger surface area, can travel deeper into the lungs, and can travel through olfactory receptors to the brain and other organs. Nanoparticles (< 100 nm) are of greatest concern. Welding fumes are composed of primary nanoparticles that collide and agglomerate. This study investigates how common combinations of welding process types, base materials, and consumables impact the mass and number concentrations as well as the size distribution of the fumes. Flux-cored arc welding had the largest total mass concentration of welding fume produced with a mass concentration of the respirable fraction approaching the occupational exposure limit. Furthermore, this type of welding had a higher amount of nanomaterials than some of the other process types. Gas tungsten arc welding had the lowest overall mass concentration of welding fumes but the highest number concentration of nanoparticles.

Les pompiers spécialisés en feu de forêt (« WLFF ») sont exposés de manière répétée à la fumée de la biomasse brûlée tout au long de la saison des incendies, mais sans porter d’équipement de protection respiratoire. Un grand nombre de ces WLFF saisonniers sont recrutés pour des saisons d’incendie successives pendant de nombreuses années. Nous nous sommes demandé si de telles expositions avaient des effets néfastes sur la santé respiratoire et si le port d’un équipement de protection respiratoire pouvait contribuer à la protéger, en nous appuyant sur des études menées dans l’ouest du Canada depuis 2016. Nous avons publié un rapport sur la santé des pompiers déployés lors d’un incendie de forêt intense centré sur Fort McMurray, dans le nord de l’Alberta, et conclu que les expositions massives pendant un incendie de forêt sont associées à des lésions des voies respiratoires non résolutives [1]. En outre, nous avons établi une cohorte de WLFF employés par le gouvernement de l’Alberta de 1998 à 2022 et lié leurs dossiers d’emploi aux conditions de santé enregistrées lors des visites chez le médecin, reflétant l’accès au soin en Alberta. Nous avons conclu que les WLFF présentaient un risque accru d’affections respiratoires non malignes (bronchite/COPD, pneumonie et asthme) en cas d’expositions répétées à la fumée des incendies de forêt [2]. Nous avons mené des interventions sur le terrain en 2019, 2021 et 2023, au cours desquels les WLFF ont été répartis de manière aléatoire pour porter une protection respiratoire et les effets ont été surveillés par des rapports sur les symptômes respiratoires et la concentration urinaire de 1-hydroxypyrène, un indicateur de l’exposition aux hydrocarbures polyaromatiques (HAP) [3], [4], [5], [6]. Nous avons constaté (sauf en 2023, globalement) que le port d’un masque réduisait l’irritation des voies respiratoires et l’absorption des HAP. Dans ces études, le port des masques était laissé à la liberté des WLFF : les personnes qui se voyaient attribuer un masque pouvaient choisir le moment où elles le portaient. Nous leur avons demandé d’évaluer l’intensité de la fumée, ce qu’ils ont bien fait, mais il y avait peu de relation entre l’intensité de la fumée et le port du masque [7]. Nous concluons qu’il est nécessaire d’obtenir davantage d’informations sur les tâches et les circonstances dans lesquelles des expositions élevées sont probables, afin qu’un programme puisse être mis au point pour aider la FMTF à choisir en toute connaissance de cause le moment où elle doit porter l’équipement de protection respiratoire.

OBJECTIVES:To determine the effects of work exposures on fertility in tradeswomen. METHODS:Women apprenticed in welding and electrical trades across Canada were recruited (2011-2017) to a prospective cohort and contacted every 6 months for up to 5 years. At each contact, participants provided information on conceptions, sexual activity, birth control and pregnancy attempts. Occupational exposures to ergonomic factors and, for welders, to metals and dust in welding fume were estimated from task-specific questionnaires. The OR of clinical infertility for work in welding was estimated. Time ratios (TR), relative times to conception, were estimated for first pregnancy in an accelerated failure time (AFT) regression with a log normal distribution of the hazard, to assess the relation of exposure to conception. RESULTS:885 women were recruited, 447 in welding and 438 in electrical trades. 96 reported a period of clinical infertility (prevalence 10.8%) with 70/96 infertile since joining the trade. There was no excess in welders (OR=0.81 95% CI 0.49 to 1.33). 372 women were nulliparous and met selection criteria for further analysis. In the final multivariable model for welders, TR was increased with working >8 days without a rest day (TR=3.06 95% CI 1.03 to 9.05), reporting hand-arm vibration for >1 h/day (TR=3.06 95% CI 1.13 to 8.34) and with increasing aluminium exposure (TR=1.38 95% CI 1.05 to 1.80). Among electrical workers, TR was increased in those working above shoulder height for ≥2 h/day (TR=1.88 95% CI 1.19 to 2.97). CONCLUSION:Work in welding did not increase the risk of clinical infertility, but time to first pregnancy reflected preventable work exposures.

OBJECTIVE:We aimed to estimate prevalence of post-COVID conditions (PCCs) among healthcare workers (HCWs) and to identify predisposing factors. METHODS:A cohort of Canadian HCWs completed four questionnaires during the pandemic. At the final questionnaire, HCWs reported conditions attributed to earlier COVID-19. The proportion developing a PCC was estimated. Risk factors were evaluated by logistic regression. RESULTS:Among 4964 HCWs, 995 had one positive COVID test >90 days before completing the final questionnaire. A total of 266 (27%) developed a PCC. Factors predisposing HCWs to a PCC included depression and increased alcohol consumption reported preinfection, chronic ill-health prepandemic, and a perception that the infection was work-related. PCCs were less likely following vaccination. Most HCWs (98%) returned to work within 30 days, with 8% reporting severe PCC (n = 80). CONCLUSIONS:Predisposing factors reflected poor health preinfection. Most conditions were mild.

A prospective cohort of 4964 HCWs from four Canadian provinces was established early in the COVID-19 pandemic. Participants were invited to comment about workplace mental health supports at three time points. We performed a thematic content analysis of responses from 1738 participants using the Social Support Behaviour Code framework to categorize barriers to support as informational, tangible, emotional, social, or expressing esteem. Themes were synthesized into suggestions for healthcare organizations to prepare for future crises. Formal and informal peer support, workplace mental health supports, and one-on-one counseling were most often mentioned as valued. Analysis suggested that workplace social networks as a source of support and mental health supports would have been appreciated. HCWs perceived that a lack of tangible workplace supports, such as staffing, compensation, and time off, were barriers to well-being. Medical workplaces could consider the availability of tangible supports in addition to developing formal mental health supports for healthcare workers.

Wildland firefighters are exposed to airborne particulates, polycyclic aromatic hydrocarbons (PAHs), and other hazardous substances. Respiratory protection is indicated, but information is lacking on the tasks and conditions for which mask wearing should be advised. Studies to assess respiratory protection in wildland firefighters were carried out in western Canada in 2021 and 2023. Sampling pumps measured airborne exposures and urinary 1-hydroxypyrene (1-HP) was assayed to indicate PAH absorption. Participants in 2021 reported the time for which they wore the mask during each task. In 2023, the use of masks was reported, and firefighters rated the smoke intensity. In 2021, 72 firefighters were monitored over 164 shifts and, in 2023, 89 firefighters were monitored for 263 shifts. In 2021, mask wearing was highest for those engaged in initial attack and hot spotting. Urinary 1-HP at the end of rotation was highest for those reporting initial attack, working on a prescribed fire and mop-up. In 2023, firefighter ratings of smoke intensity were strongly associated with measured particulate mass and with urinary 1-HP, but masks were not worn more often when there was higher smoke intensity. The data from the literature did not provide a clear indication of high-exposure tasks. Better task/exposure information is needed for firefighters to make informed decisions about mask wearing.

Abstract Introduction Definitions of ‘disaster’ focus on events causing great damage, loss, or destruction: and include both natural occurrences such as floods and volcanic eruptions and events resulting from man-made failures or conflicts. Some definitions emphasize also that the event is sudden and unexpected, others that the society’s response capacity is overwhelmed. While there has been a great increase in publications in the broad area of disaster research, not all consider health aspects, many are case studies with little epidemiological content and rather few (before COVID-19) were of those exposed to the health effects of disaster through their occupation. Major exceptions include the impact on health of response and clean-up workers after the Deepwater Horizon marine oil spill and on first responders after the collapse of the World Trade Center. It is all too easy to think of other disasters which would have warranted equally focused investigation of immediate and long-term health effects, and of ways to prevent recurrence, including the Bhopal gas escape in India and the Rana Plaza garment factory fire in Bangladesh. More generally, occupational disasters may include events without an abrupt onset with only retrospective recognition of the insidious harm done, for example exposure to silica in tunnelling or drought bringing economic and mental distress to farmers. Few such disasters are limited wholly to workers but spill out also into the community. Two ships colliding in the harbor of Halifax, Canada resulted in the deaths not only of the seamen but throughout the city. The gas escape in Bhopal killed thousands of residents as well as workers. Equally, community disasters put at risk frontline responders seeking to minimize harm to the population, or to rescue those trapped or damaged. This presentation considers factors critical to the conduct of epidemiological studies of workers exposed during such disasters. Materials and methods In considering barriers, facilitators, and best practice for occupational epidemiology in disasters we will draw on experiences from two such events in Canada. The first is of a wildfire that led to the evacuation of a town in the north of Alberta (known as the Fort McMurray fire). The study was set up, and data collection began, within 2 weeks of the fire overwhelming the community in May 2016. Over the following months we recruited 1234 firefighters deployed to the fire and followed them for five years with clinical assessment of respiratory and mental health. The second is a cohort study of healthcare workers during the COVID-19 pandemic. Again, we recruited the first cohort members very soon after the first COVID-19 infection was confirmed in Canada, and extended recruitment to four Canadian provinces with a total of 4964 healthcare workers followed up from the early weeks of the COVID-19 pandemic to the summer of 2022. The focus of interest in these studies was the occupation group, the firefighters and healthcare workers but always within the context of the communities in which they lived and worked. Results As occupational health epidemiologists, our basic mission is to investigate occupational causes of ill-health and to demonstrate how such ill-effects might be mitigated. In normal times, without incipient or actual disaster, we might choose to design and carry out intervention studies, randomizing some groups of workers to conditions where exposure to a risk is controlled and others to normal practice, and comparing changes in key health indicators. Such a design requires a hypothesis, planning, measurements before and after exposure, randomization of exposure groups, high compliance and near complete follow-up. Imagine in contrast setting up an epidemiological study in the immediate aftermath of a natural or manmade disaster. Unless you are from a wealthy country that has foreseen the need to support such disaster research, you are very likely to be on your own during the first few days, making decisions that may profoundly affect the viability of any study you hope to carry out. Unless the disaster is with a workforce whose culture you know well and in which you have useful contacts, the learning curve will be very steep. Research will be the last priority for those trying to contain the impact of the disaster and access may be barred to those wanting to measure exposure. Indeed, you may have rather little idea of the exposure parameters that will be key or of how to measure them. It is likely you will have no immediate record of who was present or where they were at the time of the catastrophic event. You will not know where they have fled to find refuge. If there are illegal immigrants among the work force or those whose papers are not in order, they will rapidly become untraceable. Research into workforces with formal structures may be less intimidating than with informal workers or those with low literacy. In the study we did of firefighters at the Fort McMurray fire we were able to access names and home fire services for those from Alberta who were deployed to the fire as structural, industrial or wildland firefighters. This meant that we had the huge advantage of a nominal list, although we could only contact them through their employer and collaboration was uncertain. Equally, for the study of COVID-19 in health care workers we were able to contact frontline workers through their professional organizations although for some of those less formally employed the official lists were incomplete and contact details less reliable. It is well recognized that estimation of relevant exposures is a central challenge for disaster epidemiology, but this is essential if we are to understand and apply new knowledge from the disaster to protect the health of future workers. For both studies described here, self-report of exposures was central but we were fortunate in being able to supplement this by collection of biological samples. For the firefighters we collected urine samples immediately after deployment, using urinary 1-hydroxypyrene as a marker of exposure to polycyclic aromatic hydrocarbons, together with inflammatory markers in plasma. In this study we were also able to estimate the concentration of particulate exposure from monitoring stations and satellite imagery. For health care workers we were able to use blood samples to confirm infection with the SARS-CoV-2 virus and their response to vaccination. The collection and preservation of environmental and biological samples for later analysis may be key to understanding the relationship between exposures and health effects caused by the disaster, and ways to do this must be considered and implemented as early as possible. Understanding of changes in health due to the disaster can be greatly helped by access to medical records both before and after the event. This may only be possible in societies with universal access to health care and with central records, but this allowed us to demonstrate increased medical consultations for asthma in firefighters and for mental distress in health care workers. Access to spirometry from routine firefighter medicals before and after the Fort McMurray fire was also helpful in demonstrating effects of exposure. A particular challenge arises when a new condition, such as Gulf Wat syndrome or Long Covid is associated with a disaster. In the absence of a clearly defined health outcome, a convincing demonstration of dose-response may be difficult. Conclusions Occupational health practitioners and epidemiologists have an obligation to study the effects of natural or man-made disasters on the workforce, either as leaders or collaborators. While we cannot necessarily prevent repetitions it behooves us to learn what we can from the chaos and distress implicit in the disaster. This will help prepare for the next calamitous event that may appear in different disguise but requires an immediate, appropriate, and thoughtful response, ideally with a team of experienced epidemiologists on standby, with seed funding and collaborations in place. There may be lessons to be learnt also for the improvement of working conditions during the more normal daily round. Mental health supports found to be effective in mitigating distress in healthcare workers during a pandemic may be of value in later times for healthcare workers struggling with manpower shortages. Data on the lack of access to respiratory protection for firefighters during a disaster may open the door to a change of culture going forward. Occupational health epidemiology in the face of disaster has many challenges, but special circumstances can bring about change, if the evidence is there.

Introduction: Respiratory ill-health in welders is well documented but without a clear indication of exposures responsible. Methods: In a Canadian cohort study of welders and electrical workers, we collected self-reports of asthma/wheeze and rhinitis at each 6-monthly contact for up to 5 years. Physician diagnoses of asthma and chronic obstructive pulmonary disease (COPD/bronchitis) were extracted from the Alberta administrative health database (AHDB). Welders provided task-specific information at each contact. Estimates were derived for cumulative exposure to particulates, chromium, and nickel. Factors associated with time to first and recurrent events were identified by proportional hazards regression, adjusting for sex, age, and smoking. Results: Of 1001 welders and 884 workers in electrical trades recruited, 1338 in Alberta were matched to the AHDB. Welders were more at risk of physician-diagnosed COPD/bronchitis than those in the electrical trades (HR for first report=1.87; 95% CI=1.27-2.77) but not of asthma. Times to first self-report of asthma/wheezing (HR=1.58; 95% CI=1.23-2.04) and rhinitis (HR=1.29; 95%CI=1.11-1.49) were shorter in welders. Among welders, time to physician-diagnosed asthma was weakly related to cumulative nickel exposure (mg/m(3)_h/100) (HR=1.08; 95% CI=1.00-1.17). COPD/bronchitis was related to cumulative exposure to total dust (g/m(3)_h) (HR=1.01; 95% CI=1.00-1.03) and to chromium (mg/m(3)_h/100) (HR=1.14; 95% CI=1.04-1.26). The risk of both asthma and COPD/bronchitis reduced with time using local exhaust ventilation. Self-reported rhinitis increased with cumulative nickel exposure (HR=1.00; 95% CI=1.00-1.01). Conclusions: Welders were at increased risk of COPD/bronchitis, with risk related to cumulative dust and chromium exposure. Nickel exposure increased the risk of asthma and rhinitis.

Abstract Wildland firefighters are repeatedly exposed to smoke and particles during increasingly long and fierce wildfire seasons with both inhalation and skin absorption of polycyclic aromatic hydrocarbons (PAHs). Wildfire firefighters do not habitually use respiratory protection and good skin hygiene to reduce exposure through contaminated clothing and equipment can be difficult for those living in camp. We introduced interventions to reduce exposures during the 2019, 2021 and 2023 fire seasons, with urinary 1-hydroxypyrene (1-HP), as the outcome marker for PAH absorption. Secondary outcomes included self-reports of mask wearing and post fire respiratory symptom. Sources of PAH exposure were evaluated by personal sampling pumps and skin wipes. A total of 281 firefighters from the western Canadian provinces of Alberta and British Columbia took part over the three fire seasons. Interventions in 2019 and 2021 addressed both skin hygiene and mask wearing: the 2023 intervention compares the effects of three types of mask, half-face with P100 cartridges fire mask and mesh mask. Data collection for the 2023 season has been completed and analysis is in progress, with results expected early in 2023. Data from previous seasons have shown a strong relation between ambient air and skin wipe PAHs and urinary 1-HP, with lower than predicted values in those randomly allocated to wear a mask. A minority of those allocated masks wore them little or not at all, citing discomfort and difficulties carrying out their tasks. The 2023 season data will give clearer indication of the type of mask most efficient and acceptable.

Abstract Introduction Few studies have reported stress factors in healthcare workers (HCW) using open-ended questions, which collect a higher diversity of respondent perceptions than anticipated by researchers. Our objective was to describe stress factors reported by HCW in open-ended questions during the four phases of a large cohort study in Canada. Methods A prospective cohort of 4964 HCW was assembled with physicians, nurses, healthcare aides and personal support workers recruited from Alberta, British Columbia, Ontario and Quebec. Participants completed 4 online questionnaires (phase 1 in spring/summer 2020, phase 2 in fall 2020, phase 3 in spring 2021, phase 4 in spring 2022). Each questionnaire included an open-ended question on stressful events since the start of the pandemic or since the previous questionnaire. Responses were classified into 29 categories. Results Eight stress categories were reported 1000 times or more among the 17,436 questionnaires from the 4 phases. Five categories showed a downward trend over time: fear of COVID-19, difficult access to personal protective equipment, changing guidelines, management of difficult cases, changes to work routine. An increasing trend was noted for volume of work, and poor behavior from the public or staff. Difficulties managing patients’ deaths remained quite steady. Discussion Reporting of most stressors has decreased over the pandemic. However, the volume of work and the poor behavior of the public, patients and coworkers were seen to increase, consistent with reports of overtime work late in the pandemic. Conclusion The expression of stressors in open-ended questions helps identify levers for reducing them.

PurposeTo determine the contribution of recall bias to the observed excess in mental ill-health in those reporting harassment at work.MethodsA prospective cohort of 1885 workers in welding and electrical trades was contacted every six months for up to 5 years, asking whether they were currently anxious or depressed and whether this was made worse by work. Only at the end of the study did we ask about any workplace harassment they had experienced at work. We elicited sensitivity and specificity of self-reported bullying from published reliability studies and formulated priors that reflect the possibility of over-reporting of workplace harassment (exposure) by those whose anxiety or depression was reported to be made worse by work (cases). We applied the resulting misclassification models to probabilistic bias analysis (PBA) of relative risks.ResultsWe observe that PBA implies that it is unlikely that biased misclassification due to the study subjects' states of mind could have caused the entire observed association. Indeed, the results demonstrated that doubling of risk of anxiety or depression following workplace harassment is plausible, with the unadjusted relative risk attenuated with understated uncertainty.ConclusionsIt seems unlikely that risk of anxiety or depression following workplace harassment can be explained by the form of recall bias that we proposed.

Introduction Wildland firefighters are exposed through the lungs and skin to particulate matter, fumes, and vapors containing polycyclic aromatic hydrocarbons (PAH). Wearing respiratory protection should reduce pulmonary exposure, but there is uncertainty about the most effective and acceptable type of mask.Methods Firefighters from 6 unit crews working with the British Columbia Wildfire Service were approached and those consenting were randomly allocated within each crew to a "no mask" control group or to use 1 of 3 types of masks: X, half-face respirator with P100/multi gas cartridge; Y, cloth with alpaca filter; Z mesh fabric with a carbon filter. Crews were followed for 3 consecutive firefighting days. The mask allocated was constant for each firefighter throughout. All participants completed a brief questionnaire at the start and end of each day, giving information on mask use, respiratory symptoms, and assessment of mask qualities. Spot urine samples were collected pre and post shift to assess 1-hydroxypyrene (1-HP) concentration as an indicator of total PAH absorption. Skin wipe samples from the hands and throat were collected pre and post shift and analyzed for PAH concentration. On each day monitored, 4 participants carried sampling pumps to measure total particulates and PAHs on particles and in vapor phase. The primary outcome was the concentration of urinary 1-HP at the end of the fire day. Secondary outcomes were changes in respiratory and eye symptoms during the course of the shift, reported mask use, and perception of mask qualities. The analysis used a 3-level random intercept regression model that clustered observations within individuals and crews. We aimed to detect any relation of allocated mask type to the 4 outcomes, having allowed for estimated exposure.Results Information was collected from 89 firefighters, including 14 women: 49% (37/75) of male firefighters were bearded. Nineteen fire days were monitored for a total of 263 firefighter x days, 64 to 68 for each intervention group. The end of shift 1-HP was higher than the start of the shift. Urinary 1-HP was more strongly related to PAHs on the skin than in the breathing zone. Men with beards had higher end-of-shift urinary log 1-HP/creat (ng/g) than other firefighters. None of the groups allocated a mask had lower 1-HP than the no-mask group, either in the study group overall or when stratified by beard-wearing. Among those without either beards or a failed fit-test, Mask Z reduced at the end of shift 1-HP where airborne PAH concentration was high. End-of-shift symptoms were related to particle mass in the breathing zone but was not mitigated by any of the masks. Hours electing not to wear a mask increased from the first to third shift for all mask types. Mask Z was rated as more comfortable than other types. Mask X was rated highest on fit and perceived protection. Mask Y gained the lowest ratings on fit, comfort and feelings of protection.Conclusions Allocated masks did not provide protection overall, but the results highlighted the need for a wider understanding of the circumstances in which wearing efficient protection is well-advised.

OBJECTIVES:Experience of psychosocial environments by workers entering trade apprenticeships may differ by gender. We aimed to document perceived harassment and to investigate whether this related to mental ill-health.METHODS:Cohorts of workers in welding and electrical trades were established, women recruited across Canada and men from Alberta. Participants were recontacted every 6 months for up to 3 years (men) or 5 years (women). At each contact, they were asked about symptoms of anxiety and depression made worse by work. After their last regular contact, participants received a "wrap-up" questionnaire that included questions on workplace harassment. In Alberta, respondents who consented were linked to the administrative health database that recorded diagnostic codes for each physician contact.RESULTS:One thousand eight hundred and eighty five workers were recruited, 1,001 in welding trades (447 women), and 884 in electrical trades (438 women). One thousand four hundred and nineteen (75.3%) completed a "wrap up" questionnaire, with 1,413 answering questions on harassment. Sixty percent of women and 32% of men reported that they had been harassed. Those who reported harassment had more frequently recorded episodes of anxiety and depression made worse by work in prospective data. In Alberta, 1,242 were successfully matched to administrative health records. Those who reported harassment were more likely to have a physician record of depression since starting their trade.CONCLUSIONS:Tradeswomen were much more likely than tradesmen to recall incidents of harassment. The results from record linkage, and from prospectively collected reports of anxiety and depression made worse by work, support a conclusion that harassment resulted in poorer mental health.

Objective The aim of the study was to identify determinants of mental health in healthcare workers (HCW) during the COVID-19 pandemic. Methods A cohort of Canadian HCW completed four questionnaires giving details of work with patients, ratings of workplace supports, a mental health questionnaire, and substance use. Principal components were extracted from 23 rating scales. Risk factors were examined by Poisson regression. Results A total of 4854 (97.8%) of 4964 participants completed ratings and mental health questionnaires. Healthcare workers working with patients with COVID-19 had high anxiety and depression scores. One of three extracted components, ‘poor support,’ was related to work with infected patients and to anxiety, depression, and substance use. Availability of online support was associated with feelings of better support and less mental ill-health. Conclusions Work with infected patients and perceived poor workplace support were related to anxiety and depression during the pandemic.

Objectives To investigate changes in risk of infection and mental distress in healthcare workers (HCWs) relative to the community as the COVID-19 pandemic progressed. Methods HCWs in Alberta, Canada, recruited to an interprovincial cohort, were asked consent to link to Alberta’s administrative health database (AHDB) and to information on COVID-19 immunization and polymerase chain reaction (PCR) testing. Those consenting were matched to records of up to five community referents (CRs). Physician diagnoses of COVID-19 were identified in the AHDB from the start of the pandemic to 31 March 2022. Physician consultations for mental health (MH) conditions (anxiety, stress/adjustment reaction, depressive) were identified from 1 April 2017 to 31 March 2022. Risks for HCW relative to CR were estimated by fitting wave-specific hazard ratios. Results Eighty percent (3050/3812) of HCWs consented to be linked to the AHDB; 97% (2959/3050) were matched to 14,546 CRs. HCWs were at greater risk of COVID-19 overall, with first infection defined from either PCR tests (OR=1.96, 95%CI 1.76–2.17) or physician records (OR=1.33, 95%CI 1.21–1.45). They were also at increased risk for each of the three MH diagnoses. In analyses adjusted for confounding, risk of COVID-19 infection was higher than for CRs early in the pandemic and during the fifth (Omicron) wave. The excess risk of stress/adjustment reactions (OR=1.52, 95%CI 1.35–1.71) and depressive conditions (OR=1.39, 95%CI 1.24–1.55) increased with successive waves during the epidemic, peaking in the fourth wave. Conclusion HCWs were at increased risk of both COVID-19 and mental ill-health with the excess risk continuing late in the pandemic.

We investigated the availability and use of workplace mental health (MH) supports during the COVID-19 pandemic in a Canadian cohort of healthcare workers (HCW) and measured anxiety and depression by the Hospital Anxiety and Depression Scale (HADS) completed at four contacts 2020-2022. Reports were available for 4400 HCW working with patients. Half the HCWs had a clinically significant HADS score at one or more contacts Access to MH supports increased during the pandemic, with 94% reporting access to some workplace support by 2022: 47% had made use of at least one support. 25% of those with high HADS scores used no support. Older women and men with depressive conditions were less likely to report use. Reported use of an Employee Assistance Program was associated with a reduction in HADS scores in the following months.

Introduction Healthcare workers (HCWs) from an interprovincial Canadian cohort were asked to give serial blood samples to identify factors associated with anti-receptor binding domain (anti-RBD) IgG response to the SARS-CoV-2 virus. Methods Members of the HCW cohort donated blood samples four months after their first SARS-CoV-2 immunization and again at 7, 10 and 13 months. Date and type of immunizations and dates of SARS-CoV-2 infection were collected at each of four contacts, together with information on immunologically-compromising conditions and current therapies. Blood samples were analyzed centrally for anti-RBD IgG and anti-nucleocapsid IgG (Abbott Architect, Abbott Diagnostics). Records of immunization and SARS-CoV-2 testing from public health agencies were used to assess the impact of reporting errors on estimates from the random-effects multivariable model fitted to the data. Results 2752 of 4567 vaccinated cohort participants agreed to donate at least one blood sample. Modelling of anti-RBD IgG titer from 8903 samples showed an increase in IgG with each vaccine dose and with first infection. A decrease in IgG titer was found with the number of months since vaccination or infection, with the sharpest decline after the third dose. An immunization regime that included mRNA1273 (Moderna) resulted in higher anti-RBD IgG. Participants reporting multiple sclerosis, rheumatoid arthritis or taking selective immunosuppressants, tumor necrosis factor inhibitors, calcineurin inhibitors and antineoplastic agents had lower anti-RBD IgG. Supplementary analyses showed higher anti-RBD IgG in those reporting side-effects of vaccination, no relation of anti-RBD IgG to obesity and lower titers in women immunized early in pregnancy. Sensitivity analysis results suggested no important bias in the self-report data. Conclusion Creation of a prospective cohort was central to the credibility of results presented here. Serial serology assessments, with longitudinal analysis, provided effect estimates with enhanced accuracy and a clearer understanding of medical and other factors affecting response to vaccination.