Understanding Occupational Injury and Substance Use Issues among Workers in the Shellfish and Lobster Industries

In 2022, American lobster (Homarus americanus) and softshell clam (Mya arenaria) harvests contributed $283 million to Downeast Maine’s economy, employing thousands of harvesters. Harvesting is grueling work. Pain from work-related injuries precedes most opioid deaths, and workers in fisheries are disproportionately at risk. Harvesters are typically self-employed and often uninsured or underinsured, complicating access to care. Prior studies have focused on injury risk or drug use among harvesters without revealing how injury, pain and substance use intertwine with cultural, social and regulatory factors. This study examined the socio-ecologically embedded injury/ pain/ substance use process with surveys of harvesters (n=106) and healthcare providers and advocates (n=31) followed by interviews of harvesters (n=13) and providers (n=8). We found that harvesters are extremely prone to injury from myriad causes. Shellfish harvesters were more injury-prone and socially vulnerable than lobster harvesters. Deferral of care, problems with healthcare access, age, lack of cultural competency among healthcare providers, and challenges with financial stability were linked to poor outcomes. Interviewees shared many anecdotes of addiction and overdose stemming from injury. Self-medication with substances other than opioids was also prevalent, indicating widespread pain-related challenges. Participants reported family disruption and incarceration related to substance use disorder, and common comorbidities included hepatitis-C, HIV and organ failure. Consultation with community partners yielded recommendations to support health and keep Maine\u27s fisheries afloat, including community-embedded healthcare services, fisheries policy arrangements that reduce injury risk and incentivize health, financial education for managing boom and bust cycles, and expanded insurance programs

How Do Women in Prek Toal Village (Tonle Sap Biosphere Reserve, Cambodia) Participate in and Benefit From Ecotourism?

Abstract This study assesses how women in the floating village of Prek Toal in the Tonle Sap Biosphere Reserve, participate and benefit from the ecotourism activities in their area. The study also investigates women’s perspective on ecotourism within their community, how it affects their lives, and if they have expectations of current and future benefits or changes resulting from ecotourism. This study is conducted in the context of current studies on livelihoods in the Tonle Sap region, including the recent technical report, “Influence of Built Structures on Local Livelihoods: Case Studies of Road Development, Irrigation, and Fishing Lots,”(ADB, 2007a) identifying ecotourism as one of the recommended livelihood options for villagers in fishing villages of the Tonle Sap. The study findings indicate that while fishing remains the main source of income, an overall decline in fish catch per household makes the people of these fishing communities particularly vulnerable. Promoting rural development that enables new livelihood alternatives is seen as a means to improve people’s livelihoods while reducing competition and pressure on the natural resource base, such as fisheries. Focusing on women’s experience with ecotourism, this study is sensitive to the local context of a riparian community in the Tonle Sap region, and specifically in a fishing village, where women traditionally exercise diverging roles and appreciate different responsibilities from men. (FAO, 2003) Studies in the Tonle Sap region such as “Gender Roles in Natural Resource Management in the Tonle Sap Region”(1998) identify that current gender dynamics, which frame the control of resources and benefits can undermine women’s involvement in development activities. This study considers the influence of current ecotourism activities upon women living in Prek Toal floating village located within the Tonle Sap Biosphere Reserve. Research for this report was conducted in three locations, Phnom Pen, Siem Reap and Prek Toal village, Cambodia. Literature review and key informant interviews and discussions were conducted in Phnom Penh and fieldwork using participatory assessment tools was conducted in Prek Toal village

Abstract 12067: Prospective Utility of ST2 in Patients Hospitalized With Acute Decompensated Heart Failure

Introduction: The soluble ST2 (sST2) biomarker is upregulated in response to myocardial strain, remodeling and fibrosis, and may play a role in risk stratification of patients with decompensated Heart Failure with a Reduced Ejection Fraction (HFrEF). The widely accepted prognostic sST2 cut-off for chronic HF is 35ng/ml. What this value would be for acute HF is debated. Objectives: To determine the prognostic value of sST2 in patients admitted with acute decompensated HFrEF. Methods: Between January 2020 and June 2021, consecutive patients hospitalized with HFrEF had sST2 measured at admission (within 24 hours) and at recompensation, as part of the INST2ANT-HF study (UK REC no:19/EE/0269). To determine an appropriate prognostic cut-off, we evaluated the median sST2 in our group as a potential threshold. The primary outcome was mortality at one year. Cumulative incidences, and the relationship between several clinical variables were tested in a Cox multivariate model for the primary outcome and comparisons between groups for events was performed using the χ2 test. Results: In the first 34 consecutive patients (Male 64%, AF 38%) with complete follow up (FU) data, median (IQR) FU was 405 (262-438)days. Median (IQR) age, 77 (60-85)years, mean (SD) EF, 27.9(±12.1). Median (IQR) eGFR, 62 (50-83)ml/min/1.73m 2 . Median (IQR) admission sST2 was 68 (43-91)ng/ml and admission NTproBNP was 7307 (5019-12809)ng/L. The primary endpoint occurred more frequently in patients with admission sST2>68ng/ml (p<0.01) (Fig.1). Conclusion: Our data suggests that in an unselected population of patients admitted with acute decompensated HFrEF, an admission sST2 value >68ng/ml has important prognostic value. Patients with high sST2 values on presentation require close follow up and a lower threshold for consideration of advanced HF therapies. A higher sST2 prognostic cut-off compared to CHF patients may hence be required for risk stratification