Laura Kochevar

Machinery-related injuries:: Regional Rural Injury Study—I (RRIS—I)

Although it is known that farm machinery is a source of serious and catastrophic farm work-related injuries, little is known about the magnitude of, and potential risk factors for, this problem. The study population is from the five-state Regional Rural Injury Study--I (RRIS--I) that included 3,939 farm households and 13,144 persons who were interviewed about their injury experience and farming operation-related exposures during 1990. Rates were calculated for sociodemographic variables and various exposures pertinent to large farm machinery (excluding tractors). Multivariate analyses were conducted using logistic regression, based on a model developed a priori and further confirmed using backward stepwise logistic regression. Among the total farming-related injury events (n = 764), 151 (20%) were related to large machinery use (1,127 injured persons per 100,000 persons per year). Through multivariate analyses, several variables were associated with elevated rate ratios that were important in both models: hours worked per week on the farm (40-59, 60-79, 80+); operation of an auger; field crops as the enterprise requiring the most time; and male gender. In addition, in the backward stepwise model, certain marital status categories (married; separated/widowed/divorced) were also associated with elevated rate ratios that were important. The majority of injury events occurred while persons were lifting, pushing, or pulling (21%), adjusting a machine (20%), or repairing a machine (17%). While only 5% of the cases were hospitalized, 79% required some type of health care. Among all injured persons, 34% were restricted from regular activities for 1 week or more and 19% were restricted for 1 month or more; 25% continued to have persistent problems. In summary, the RRIS-I permitted one of the most comprehensive studies of agricultural machinery-related injuries, to date. The findings indicate that these injuries represent a significant problem, based on the relevant rates, potential risk factors, and consequences from trauma.

Understanding variation in chronic disease outcomes.

We propose an explanation for variation in disease outcomes based on patient adaptation to the conditions of chronic disease. We develop a model of patient adaptation using the example of Type 2 diabetes mellitus and assumptions about the process entailed in transforming self-care behaviors of compliance with treatment, compliance with glucose monitoring, and patients knowledge seeking behavior into health outcomes of glycemic control and patient satisfaction. Using data from 609 adults with diagnosed Type 2 diabetes we develop an efficiency (fitness) frontier in order to identify best practice (maximally adapted) patients and forms (archetypes) of patient inefficiency. Outcomes of frontier patients are partitioned by categories of returns to scale. Outcomes for off-frontier patients are associated with disease severity and patient archetype. The model implicates strategies for improved health outcomes based on fitness and self-care behaviors.

The Determinants of Time off Work after Childbirth

Relatively little is known about the role that leave policies--family, parental, or maternity-leave policies--play in facilitating time off work after childbirth. Yet time off is a critical element of leave policies, as it facilitates the mothers recovery from childbirth and promotes maternal-infant attachment. Using data from Minnesota, the state with the highest rate of female labor force participation, we examine the extent to which policies, relative to personal, job, and workplace characteristics, determine the duration of womens childbirth-related leaves from work. A random sample of women identified from vital statistics records is used to estimate the relationship between leave policies and time off work after childbirth. Of our sample 85 percent had access to some paid leave benefits, although only 46 percent had paid maternity leave benefits. The difference in duration of leave between women with and without paid leave policies was approximately four weeks, a substantial difference for most women and their infants. Paid leave policies and spousal earnings as primary determinants of maternal time off work, suggest problems in the use of unpaid leave for economically vulnerable women.

Factors affecting universal precautions compliance

This study characterizes levels of self-reported compliance with Universal Precautions (UP) among health care workers (HCWs) at risk of bloodborne exposure. A convenience survey was conducted of 1135 health care workers, expected to be at high risk for transmission of bloodborne pathogens. Using a cross-sectional design and a theoretical model by Gershon et al. (1995) data were analyzed with logistic regression. Factors associated with at least one of the two measures of HCW compliance with UP included longer tenure in ones job, increased knowledge of human immunodeficiency virus (HIV) transmission, a conservative attitude toward risky behaviors, a perception of a strong organizational safety climate, and having had some training in the use of personal protective equipment. Knowledge of factors associated with compliance helps to explain why health care workers sometimes exhibit poor compliance despite the real occupational hazard posed by exposure to bloodborne pathogens.

Out-of-hospital Violence Injury surveillance : Quality of data collection

STUDY OBJECTIVE The recognized need to improve data collection for violence prevention may be met, in part, by using out-of-hospital data for injury surveillance. The purpose of the Prehospital Violence Injury Surveillance project was to examine the extent to which paramedics can adequately collect information about injuries, particularly intentional injuries, at emergency scenes. METHODS Paramedics in a large Midwestern metropolitan area were trained to assess violence-related events and collect relevant data using a modified ambulance run report form. Data collected from 8 violence-related training scenarios and from 13 ride-along observations were analyzed to estimate paramedic interrater reliability using the kappa statistic. Data from 7,363 run report forms, filed during a 3-month study period, were abstracted and analyzed for completeness and quality. RESULTS Paramedics demonstrated fair to good, and sometimes excellent, interrater agreement when documenting the training scenarios. Paramedics revealed barriers to collecting violence-related out-of-hospital data. The paramedics and the observer disagreed in documenting 77% of the ride-along observations. Overall, 73% of abstracted run report forms showed documentation errors, with more than 99% of these reports containing errors of omission and 29% showing internal documentation inconsistencies. Despite the emphasis on violence-related data, documentation of domestic abuse screening was missing from more than 99% of run reports from female patients. CONCLUSION Significant barriers to quality out-of-hospital data collection were identified during study implementation and in abstracted run reports. These barriers included the following: lack of organizational support; characteristics of the violence-related data elements; design of the ambulance run report form; and paramedic knowledge, attitudes, and behaviors regarding data collection.

Preplacement assessments. Impact on injury outcomes

Evaluation of the impact of preplacement assessments is important given the resources companies and occupational health nurses allocate to screening and the ambiguity of the literature about the effectiveness of such assessments. This study examined the effects of preplacement assessments on employee injuries. All individuals screened by an occupational health clinic in the upper Midwest and given work restrictions during a 3 year period were identified as cases (n=67). Cases were matched with controls without work restrictions (n=264) on the basis of employer, gender, and job. Age was controlled for statistically. Chi-square analysis, used to test differences in percent distribution of injuries between cases and controls, found no statistically significant differences in musculoskeletal injuries between the groups. Work restrictions recommended as a result of preplacement assessments appear to protect vulnerable workers.

A survey of community-based violence prevention and control efforts in Minnesota.

Rates of interpersonal violence at the national level in the United States exceed those of other industrialized nations; evidence of violence exists at the state level as well. Yet, data that identify the magnitude of the problem, pertinent risk factors, and efficacy of intervention efforts are limited. Faculty at the University of Minnesota School of Public Health conducted a survey to assess the extent to which violence prevention research and programmatic efforts exist statewide. Study findings served as a basis for developing a relevant research agenda and prioritizing limited academic resources. This paper describes the survey and development of an academic-community partnership that fosters collaborative research on violence prevention that will hopefully contribute to control of the violence epidemic.

Role function and mental health in postpartum working women: a pilot study.

1. Postpartum women have unique needs warranting study due to competing perspectives on the duration and time needed for recovery after childbirth. 2. This pilot study tests measures of role function and mental health in a sample of 26 women returning to work within 6 months of childbirth. 3. The study did not reveal decrements in mental health among subjects, but did reveal limitations to functional status. The results also suggested that the adapted measure of role function, and the measure of mental health, are reliable and have some preliminary evidence of construct validity in this population. 4. The results of the study have implications for occupational health nursing practice, including worker assessment and family policy development, and serve as a resource for measuring health outcomes in workers.

Form follows function: Occupational health nursing as a member of the management team

Role, often designated by a given title, e.g., manager, has been one of the most common means of defining occupational health nursing practice. A function based model provides an opportunity to reframe the occupational health nurse as a member of the management team. This descriptive study characterized the functions of a random sample (40%) of members of the American Association of Occupational Health Nurses from eight Midwestern states (463) in 1994. With a 78% response rate, the most frequently performed function for all respondents was “evaluate status of employees returning to work after absence” (68%). The relative frequencies for functions performed by the associates degree nurses were very similar to those for diploma nurses (r=.889 based on a perfect relationship value of 1). Subjects with baccalaureates in nursing performed more educational programming than subjects with non-nursing baccalaureates who performed more frequently in a policy area. Type of masters preparation represented different functional activities. The department to which the respondent reported affected functions. Reviewing function by salary level revealed a linear relationship with certain functions by frequency. To facilitate the investigation of the role construct based on functions, the researchers conducted a principle components analysis of the data. Four principle components were found representing groups of functions that tended to be performed by the same sets of respondents. The functions in each component tended to cluster around common skills as defined by Hersey (1988).

The impact of educational research centers on occupational health and safety alumni competence. A program evaluation.

1. A 10 step method for program evaluation can be used to evaluate the success of a program in meeting its major goals and objectives. This evaluation examined the 20 year impact of the Midwest Center for Occupational Health and Safety, a NIOSH supported Educational Research Center, on its alumni. 2. The majority of alumni (89%) reported the primary focus of their work after graduation was the provision of occupational and environmental health and safety products and services--consistent with the legislative intent of Educational Research Centers (ERC). 3. Alumni reported the most highly valued ERC products and services included interdisciplinary interactions during and after graduate school, research training, and the presence of the ERC as a regional focal point for occupational health and safety graduate and continuing education. 4. The program evaluation design and survey instrument employed in this study are recommended for adaptation by other ERCs or educational programs faced with the challenge of providing evaluation data with minimal resources.