Diana Jaramillo

Chronic kidney disease of unknown origin (CKDu) is a public health concern, particularly in agricultural communities, with multiple environmental exposures hypothesized as potential contributors. This study employed a targeted exposure assessment using personal silicone wristbands to characterize chemical exposures among women living and working in CKDu-affected regions of Guatemala. Participants wore wristbands for seven days, passively sampling air and dermal exposures. Overall, 45 wristbands were collected from 37 female participants (19 sugarcane workers and 18 community members). Of the 1530 chemicals measured using a single semi-quantitative method, 103 were detected, with an average of 27 chemicals per wristband (range: 16–40). Polycyclic aromatic hydrocarbon (PAH) levels were higher in community members’ wristbands, whereas workers exhibited higher exposure to pesticides (i.e., pendimethalin and fipronil). Workers had worse kidney function compared to community members, with almost half of the workers having an estimated glomerular filtration rate, eGFR, 2. Correlations were observed between kidney function markers and specific chemicals, with the strongest correlation between albumin-to-creatinine ratio and pyrene levels (ρ = 0.57, p < 0.01) among workers. Women in agricultural regions of Guatemala experience widespread exposure to diverse environmental chemicals, some of which may contribute to kidney function decline.

Objectives: This study evaluated training transfer after a Total Worker Health (TWH) training with Mexican safety engineers and occupational medicine physicians and residents. Methods: We used a mixed-methods analysis to assess responses before and after training and 3 months after. Results: Nearly three quarters (73%) of the participants applied a TWH concept from the course into their work. Over half (52%) of the participants worked to change the way they applied the TWH approach, and examples included broadened awareness of what health means at work and the need for workforce engagement. While changes in TWH practices occurred, gaps remained. Conclusions: The TWH training facilitated behavior changes, particularly in leadership for TWH practices. Factors supporting skill transfer included a national-level TWH-type program, positive mindsets, and willingness to implement change. Additional training is needed to address specific skills in TWH risk assessment and controls.

Total Worker Health® (TWH) leadership training, targeting organizational leaders who influence workplace safety, health, and well-being, offers a promising avenue for lasting positive change. However, the efficacy of such training in diverse communities, especially low- and middle-income countries (LMICs) such as Latin America, remains underexplored. We conducted a comprehensive evaluation of a TWH leadership training program within a major Latin American agribusiness operating in Guatemala, Nicaragua, and Mexico. The evaluation followed best practices, encompassing behavior change and outcome assessment, including a post-training evaluation measuring training reactions, TWH leadership practices, training transfer intentions, modifiable health indicators, training transfer facilitators and barriers, and goal setting. A follow-up evaluation occurred three months post-training to assess the sustainability of TWH leadership practices, intentions, and health indicators. Linear mixed effects models were employed for analyzing training reactions. A total of 121 leaders (61% of all leaders) participated in TWH leadership training. The findings indicated consistently high training ratings across countries. Leaders reported positive leadership practices immediately post-training, and these improvements persisted three months later. Health indicators among leaders in different countries suggested a reduction in home and work-related stress and overall improvement in well-being. Positive changes in leadership practices and notable health improvements were observed. No significant differences were found among countries. This study contributes to understanding TWH implementation in Latin America, emphasizing the importance of tailoring programs to address specific organizational and cultural needs.

High temperatures and air pollution exposure are individually known risks to human health, with amplifying adverse health effects during periods of co-exposure. This study compared co-occurring individual-level exposures to particulate matter (PM₅, aerodynamic diameter of ≤5 μm) and heat among women in residential and agricultural settings in Guatemala. We measured personal and ambient exposure to PM₅, temperature, and humidity among 21 female sugarcane workers in the fields and on their off days. We measured similar exposures among a group of 30 community members not involved in sugarcane work. We collected 171 personal PM₅ measurements across 18 sampling days. The median workday personal PM₅ concentration was 271 µg/m³, which was 3.6-fold higher than ambient area levels in the fields. The median personal PM₅ concentration was 95.8 µg/m³ for off-work days and 83.5 µg/m³ for community days. The average workday individual-level temperature and humidity were 39.4 °C and 82.4%, respectively, with significantly lower temperatures on off-work and community days. The women workers and community members were exposed to high levels of PM₅ and heat in both occupational and residential settings. Research needs to consider individual-level exposures at both work and home to help tailor more effective comprehensive prevention efforts to reduce risks.

With chronic disease prevalence on the rise globally, surveillance and monitoring are critical to improving health outcomes. Point-of-care (POC) testing can facilitate epidemiological research and enhance surveillance systems in limited resource settings, but previous research has identified bias between POC devices and laboratory testing. We compared the performance of two POC blood analyzers, the iSTAT handheld (Abbott, Princeton, NJ, USA) and the StatSensor Creatinine (Nova Biomedical, Waltham, MA, USA) to concurrent blood samples analyzed at a local laboratory that were collected from 89 agricultural workers in Guatemala. We measured creatinine and other measures of underlying health status with the POC and the lab blood samples. Pearson correlation coefficients, Bland-Altman plots, no intercept linear regression models and two-sample t-tests were used to evaluate the agreement between the POC and lab values collected across three study days and to assess differences by study day in a field setting. On average there was no observed difference between the iSTAT and lab creatinine measurements (p = 0.91), regardless of study day. Using lab creatinine as the gold standard, iSTAT creatinine results were more accurate compared to the Statsensor, which showed some bias, especially at higher values. The iSTAT had good agreement with the lab for sodium and blood urea nitrogen (BUN), but showed differences for potassium, anion gap, bicarbonate (TCO2), glucose, and hematocrit. In this tropical field setting, the research team devised a protocol to prevent the devices from overheating. In limited resource settings, POC devices carry advantages compared to traditional lab analyses, providing timely results to patients, researchers, and healthcare systems to better evaluate chronic health conditions. Technical challenges due to use of POC devices in high heat and humidity environments can be addressed using a standard protocol for transporting and operating the devices.

Objective: We sought to test whether a 2-week Total Worker Health (TWH) training mapped to TWH education competencies could be administered to a Mexican audience of occupational safety and health professionals and could lead to positive changes to knowledge and behaviors. Methods: This study used robust program evaluation methods collected before and after each of the nine training days and at the end of the course. Results: Overall course quality received a mean score of 4.6 (SD = 0.6) and 98.8% of participants agreed that their TWH knowledge increased. All participants intended to make at least one change to their professional practice, most frequently helping companies assess their organizational culture to support health, safety, and well-being. Conclusions: This TWH training was well received and led to positive self-reported increase in knowledge and abilities to influence workers’ health, safety, and well-being.

Rates of anemia among agricultural workers, who are also at risk for kidney injury and chronic kidney disease of unknown cause (CKDu), are unknown. We evaluated body composition through the sum of three skinfolds among 203 male sugarcane cutters and assessed the relationship of variables related to nutrition, anemia (hemoglobin < 13 g/dL), and elevated hemoglobin A1c (HbA1c ≥ 5.7%) with estimated glomerular filtration rate (eGFR) using linear regression. Eleven percent of workers were at the level of essential body fat (2–5%). Anemia was present among 13% of workers, 70% of which were normochromic normocytic, a type of anemia suggesting potential underlying chronic disease. Anemia was more common among those with lower BMI and fat free mass. The prevalence of elevated HbA1c was 21%. A moderate negative correlation was found between hemoglobin and HbA1c (Pearson’s r = −0.32, p < 0.01) which suggests that HbA1c values should be interpreted with caution in populations that have high rates of anemia. Twelve percent of workers had reduced kidney function with an eGFR < 90 mL/min/1.73 m². On average, the eGFR was 18 mL/min per 1.73 m² lower [(95% CI:−24, −12), p < 0.01)] for those with anemia than those without, and 8 mL/min per 1.73 m² lower among those with elevated HbA1c [(95% CI: −13, −2), p < 0.01]. Results will inform future studies examining the role of anemia in the evaluation of CKDu and interventions to improve nutrition for workers in low-resource settings.

Total Worker Health^® (TWH) is a framework for integrating worker and workplace safety, health, and well-being, which has achieved success in European and US settings. However, the framework has not been implemented in Latin America or in agricultural sectors, leaving large and vulnerable populations underrepresented in the implementation and evaluation of these strategies to improve safety and promote health and well-being. This study presents a case study of how a TWH approach can be applied to a multinational Latin American agribusiness. We describe the process and adaptation strategy for conducting a TWH assessment at multiple organizational levels and in multiple countries. We follow this with a description of a TWH leadership training that was conducted based on the results of the assessment. Finally, we describe our methods to make corporate recommendations for TWH policies and programs that were informed by the TWH assessment and leadership trainings. With this case study we aim to demonstrate the importance and feasibility of conducting TWH in Latin America.

As global temperatures continue to rise it is imperative to understand the adverse effects this will pose to workers laboring outdoors. The purpose of this study was to investigate the relationship between increases in wet bulb globe temperature (WBGT) and risk of occupational injury or dehydration among agricultural workers. We used data collected by an agribusiness in Southwest Guatemala over the course of four harvest seasons and Poisson generalized linear modelling for this analysis. Our analyses suggest a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30 °C (95% CI: −6%, 14%). Additionally, these data suggest that the relationship between WBGT and injury risk is non-linear with an additional 4% acceleration in risk for every degree increase in WBGT above 30 °C (95% CI: 0%, 8%). No relationship was found between daily average WBGT and risk of dehydration. Our results indicate that agricultural workers are at an increased risk of occupational injury in humid and hot environments and that businesses need to plan and adapt to increasing global temperatures by implementing and evaluating effective occupational safety and health programs to protect the health, safety, and well-being of their workers.