Explore the vast range of titles available.

Noise-induced hearing loss (NIHL) is the most prevalent occupational disease in the world and firefighters are at increased risk of NIHL due to their frequent exposure to hazardous levels of noise during service. Adverse effects of NIHL include acceleration of age-related hearing loss and an increased risk of cognitive decline. A critical challenge in addressing NIHL is the delayed clinical presentation of symptoms and lack of sensitive tools for early detection. To study the early clinical symptoms of NIHL in this high-risk group, we collected hearing function data including behavioral audiometric thresholds and distortion product otoacoustic emissions (DPOAEs) in 176 firefighters during annual physical assessments. Results revealed significant deficits in cochlear outer hair cell function in the presence of normal audiograms. Additionally, 55% of firefighters self-reported changes in hearing, while 20% self-reported concerns about their balance. This study is the first to characterize DPOAEs in firefighters who display decreased DPOAE amplitudes with increasing years in the fire service. These effects were observed even when controlling for hearing loss and age and are suggestive of a link between hearing loss and occupational exposure to hazardous noise.

Occupational exposures significantly contribute to the risk of adverse cancer outcomes, and firefighters face many carcinogenic exposures. Occupational research using cancer registry data, however, is limited by missing and inaccurate occupation-related fields. The objective of this study is to determine the frequency and predictors of missing and inaccurate occupation data for a cohort of career firefighters in a state cancer registry. We conducted a linkage between data from the Florida Cancer Data System (1981-2014) and the Florida State Fire Marshal's Office (1972-2012). The percentage and the odds of having a firefighting-related occupation code in the cancer record were calculated, adjusting for other occupation and cancer-related factors. Among 3,928 career firefighters, nearly half (47%) were missing a registry-dervived occupation code and only 17% had a firefighting-related code. Males were more likely to have a firefighting-related code (OR = 2.31;95%CI: 1.41-3.76), as were those with more recent diagnoses (OR1992-2002 = 2.98;95%CI: 1.57-5.67; OR2003-2014 = 11.40;95%CI: 6.17-21.03), and those of younger ages (OR45-64y = 1.26;95%CI: 1.03-1.54; OR20-44y = 2.26;95%CI: 1.73-2.95). Accurate occupation data is key for identifying increased risk of advserse cancer outcomes. Cancer registry occupation fields, however, are overwhelmingly missing for firefighters and are missing disproportionally by sociodemographic and diagnosis characteristics. This study highlights the lack of accurate occupation data available for hypothesis-driven cancer research. Cancer registry linkage with external occupational data sources represents an essential resource for conducting studies among at-risk populations such as firefighters.

Background: Firefighters are exposed to a unique set of carcinogens through their work environment that predispose them to several cancers, yet there is limited research related to cancer survivorship amongst this occupational group. Methods: A mixed-method approach was used to assess cancer survivorship amongst firefighters. Four focus groups and one in-depth interview were conducted with 29 active and retired firefighters who have been diagnosed with cancer to understand the experiences and challenges associated with cancer survivorship in the fire service and desired resources. Qualitative data were analyzed using Nvivo software. All participants completed the Functional Assessment of Cancer Therapy-General (FACT-G) survey to assess their quality of life. Results: The primary themes that emerged from the focus groups included managing health and well-being changes, navigating support systems in place, and accessing new resources. FACT-G scores (mean ± standard deviation) of the firefighter cancer survivor sample demonstrate relatively lower levels of emotional well-being (19.26 ± 4.67) and higher quality of life in the physical well-being (23.67 ± 5.08), social well-being (23.38 ± 4.16), and functional well-being (22.6 ± 4.966) domains. Conclusions: Firefighters requested curated resources, such as support groups and department training resources, supporting the need for more cancer survivorship resources specific to firefighters.

Firefighters are exposed to extensive hazardous noise while on the job, both during routine tasks at the station and when responding to calls. However, little is known about firefighters’ occupational noise hazards. This study employed mixed methods, including focus groups, a survey, and audiometric testing, to identify sources of noise in the firefighters’ work environment, determine hearing protective strategies, discern firefighters’ perceptions of occupational noise exposure and impacts to their health, and quantify the prevalence of hearing loss among South Florida firefighters. A total of 6 senior officers served in an expert panel, 12 participated in focus groups, 300 completed the survey, and 214 received audiometric tests. Most firefighters were unaware of the risk and their departments’ policies, and did not participate in hearing protection practices and avoided using hearing protection devices, which they believed impede team communication and situational awareness. Nearly 30% of participating firefighters showed mild to profound hearing loss, a prevalence that is considerably worse than expected by normal aging alone. Educating firefighters about noise-induced hearing loss early in their careers may have significant health implications for their future. These findings provide insights for developing technologies and programs to mitigate the effects of noise exposure in the firefighting population.

Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine. Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days. In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.

ObjectivesWe estimate the point seroprevalence of SARS-CoV-2 antibodies in the frontline firefighter/paramedic workforce of a South Florida fire department located in the epicentre of a State outbreak.MethodsA cross-sectional study design was used to estimate the point seroprevalence of SARS-CoV-2 antibodies using a rapid immunoglobulin (Ig)M-IgG combined point-of-care lateral flow immunoassay among frontline firefighters/paramedics collected over a 2-day period, 16–17 April 2020. Fire department personnel were emailed a survey link assessing COVID-19 symptoms and work exposures the day prior to the scheduled drive-through antibody testing at a designated fire station. Off-duty and on-duty firefighter/paramedic personnel drove through the fire station/training facility in their personal vehicles or on-duty engine/rescue trucks for SARS-CoV-2 antibody testing.ResultsAmong the 203 firefighters/paramedics that make up the fire department workforce, 18 firefighters/paramedics (8.9%) tested positive for SARS-CoV-2 antibodies, of which 8 firefighters/paramedics (3.9%) were IgG positive only, 8 (3.9%) were IgM positive only and 2 (0.1%) were IgG/IgM positive. The positive predictive value (PPV) of the serological test is estimated to be 33.2% and the negative predictive value is 99.3%. The average number of COVID-19 case contacts (ie, within 6 feet of an infected person (laboratory-confirmed or probable COVID-19 patient) for ≥15 min) experienced by firefighters/paramedics was higher for those with positive serology compared with those with negative (13.3 cases vs 7.31 cases; p=0.022). None of the antibody positive firefighters/paramedics reported receipt of the annual influenza vaccine compared with firefighters/paramedics who tested negative for SARS-CoV-2 antibodies (0.0% vs 21.0%; p=0.027).ConclusionRapid SARS-CoV-2 IgM-IgG antibody testing documented early-stage and late-stage infection in a firefighter workforce providing insight to a broader medical surveillance project on return to work for firefighters/paramedics. Given the relatively low PPV of the serological test used in this study back in April 2020, caution should be used in interpreting test results.

Hearing protection devices (HPDs) remain the first line of defense against hazardous noise exposure and noise-induced hearing loss (NIHL). Despite the increased awareness of NIHL as a major occupational health hazard, implementation of effective hearing protection interventions remains challenging in at-risk occupational groups including those in public safety that provide fire, emergency medical, or law enforcement services. A reduction of situational awareness has been reported as a primary barrier to including HPDs as routine personal protective equipment. This study examined the effects of hearing protection and simulated NIHL on spatial awareness in ten normal hearing subjects. In a sound-attenuating booth and using a head-orientation tracker, speech intelligibility and localization accuracy were collected from these subjects under multiple listening conditions. Results demonstrate that the use of HPDs disrupts spatial hearing as expected, specifically localization performance and monitoring of speech signals. There was a significant interaction between hemifield and signal-to-noise ratio (SNR), with speech intelligibility significantly affected when signals were presented from behind at reduced SNR. Results also suggest greater spatial hearing disruption using over-the-ear HPDs when compared to the removal of high frequency cues typically associated with NIHL through low-pass filtering. These results are consistent with reduced situational awareness as a self-reported barrier to routine HPD use, and was evidenced in our study by decreased ability to make accurate decisions about source location in a controlled dual-task localization experiment.

PurposeDespite life-saving potential, many women struggle to adhere to adjuvant endocrine therapy (AET) for their breast cancer (BCa). Prior research has demonstrated that emotional distress is a barrier to AET adherence. We followed women from a trial to test the long-term effects of two 5-week post-surgical group-based stress management interventions, cognitive behavioral therapy (CBT), and relaxation training versus an attention-matched health education control, on AET adherence.MethodsWe conducted a long-term follow-up (median = 8 years) of women randomized to CBT, relaxation training, or health education after surgery for stage 0–3 BCa. We measured adherence with the Endocrine Therapy Medication Usage Questionnaire (ETMUQ). First, we established factors on the ETMUQ via confirmatory factor analysis. We then used Bayesian structural equation modeling to regress these factors on study arm, controlling for age and treatments received.ResultsOf those who completed long-term follow-up (n = 59, 44.7%), over half (n = 33; 55.9%) reported problems with adherence generally. Women receiving relaxation training (n = 15) had better adherence than those receiving health education (n = 24) on the Forgetfulness/Inconsistency [B(SE) = 0.25(0.14), p = 0.049] and Intentional Nonadherence [B(SE) = 0.31(0.14), p = 0.018] factors of the ETMUQ. Similar results were observed for those receiving relaxation training compared to CBT (n = 20): Forgetfulness/Inconsistency [B(SE) = − 0.47(0.25), p = 0.031]; Intentional Nonadherence [B(SE) = − 0.31(0.15), p = 0.027].ConclusionWomen receiving relaxation training were less likely to (1) forget to take their AET and (2) intentionally miss doses of AET in the long term compared to women receiving health education or CBT. This is evidence for the need of randomized trials that aim to improve adherence by incorporating theoretically based behavioral change techniques.Trial registration and datesTrial 2R01-CA-064710 was registered March 26, 2006.

Occupational noise exposure and hearing loss are prominent in the fire service. Firefighters are routinely exposed to hazardous levels of noise arising from the tools and equipment they use, from sirens and alarm tones to the emergency response vehicles they drive. The present study utilized the Apple Watch to continuously measure environmental noise levels for on-duty firefighters. Participants included 15 firefighters from the metropolitan South Florida area, and 25 adult non-firefighter control subjects. Firefighters were recruited from a variety of roles across two stations to ensure noise exposure profiles were appropriately representative of exposures in the fire service. All participants wore an Apple Watch for up to three separate 24 h shifts and completed a post-shift survey self-reporting on perceived exposures over the 24 h study period. Cumulative exposures were calculated for each shift and noise dose was calculated relative to the NIOSH recommended exposure limit of 85 dBA as an 8 h time-weighted average. The maximum dBA recorded on the Apple Watches was statistically significant between groups, with firefighters experiencing a median of 87.79 dBA and controls a median of 77.27 dBA. Estimated Exposure Time at 85 dBA (EET-85) values were significantly higher for firefighters when compared to controls: 3.97 h (range: 1.20–14.7 h) versus 0.42 h (range: 0.05–8.21 h). Only 2 of 16 firefighters reported the use of hearing protection devices during their shifts. Overall, our results highlight the utility of a commonly used personal device to quantify noise exposure in an occupationally at-risk group.