Lisa A. Pompeii

Occupational Safety and Health Interventions to Reduce Musculoskeletal Symptoms in the Health Care Sector

Introduction Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards. Methods A systematic review of the literature used a best evidence synthesis approach to address the general question “Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?” This was followed by an evaluation of the effectiveness of specific interventions. Results The initial search identified 8,465 articles, for the period 1980–2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006–2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health. Conclusions The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.

Physical exertion at work and the risk of preterm delivery and small-for-gestational-age birth.

OBJECTIVE: To assess whether exposure to standing, lifting, night work, or long work hours during 3 periods of pregnancy are associated with an increased risk of preterm or small-for-gestational-age birth. METHODS: The Pregnancy, Infection and Nutrition study is a prospective cohort with a nested case–control component that was conducted through clinic and hospital settings in Central North Carolina. A total of 1,908 women pregnant with a singleton gestation were recruited during prenatal visits from January 1995 through April 2000 and provided information during telephone and face-to-face interviews about physical exertion for the 2 longest-held jobs during pregnancy. RESULTS: No significant elevations in preterm delivery were observed among women who lifted repeatedly or stood at least 30 hours per week, with no changes in risk estimates over the course of pregnancy. A 50% elevation in the risk of preterm delivery (relative risk 1.5, 95% confidence interval 1.0–2.0; first trimester) was observed among women who reported working at night (10:00 PM to 7:00 AM), whereas a 40% reduction in risk was observed among women working at least 46 hours per week (relative risk 0.6, 95% confidence interval 0.4–0.9; first trimester), regardless of period of exposure. No elevations in small-for-gestational-age birth were observed among women exposed to any of the 4 types of occupational exertion. CONCLUSION: Physically demanding work does not seem to be associated with adverse pregnancy outcomes, whereas working at night during pregnancy may increase the risk of preterm delivery. Studies to examine the effect of shift work on uterine activity would help to clarify the possibility of a causal effect on preterm birth. LEVEL OF EVIDENCE: II-2

Prevalence of Asthma among Adult Females and Males in the United States: Results from the National Health and Nutrition Examination Survey (NHANES), 2001–2004

BACKGROUND The prevalence of asthma has increased over the last three decades with females exhibiting a higher prevalence of asthma than males. The objective of this study was to obtain gender-specific estimates of the prevalence of current and ever asthma and describe the relationships between risk factors and asthma by gender in US men and women ages 20 to 85. METHODS Data for this study came from two cycles (2001-2002 and 2003-2004) of National Health and Nutrition Examination Survey (NHANES) and included 9,243 eligible adults: 4,589 females and 4,654 males. Multiple logistic regression was used to investigate gender-specific associations between race/ethnicity, body mass index (BMI), sociodemographic characteristics, and smoking habits for current asthma and ever asthma. RESULTS The prevalence of current asthma was 8.8% for women and 5.8% for men, while the prevalence of ever having been diagnosed with asthma was higher (13.7% and 10.4% for women and men, respectively). Current asthma was less prevalent in Mexican American women (1.9%) and men (0.9%) born in Mexico as compared to Mexican Americans born in the U.S. (8.7% and 5.2% for women and men, respectively) or for any other ethnic group. Approximately 20% of extremely obese women and men had ever been diagnosed with asthma; among this group, 15% reported they had current asthma. Results from multiple logistic regression models indicate that extreme obesity and living in poverty were strongly associated with current and ever asthma for both women and men, as was former smoking and ever asthma for men. CONCLUSION As compared to previous NHANES reports, our results indicate that the prevalence of asthma among U.S. adults continues to increase. Further, our findings of marked differences among subgroups of the population suggest asthma-related disparities for impoverished persons and greater prevalence of asthma among obese and extremely obese US adults.

Measures of Physical and Cognitive Function and Work Status Among Individuals with Multiple Sclerosis: A Review of the Literature

The purpose of this review was to critically evaluate the multiple sclerosis (MS) literature that has examined physical and cognitive function in relation to ability to work. Although numerous factors may be considered when determining work ability, physical and/or cognitive functional limitations associated with MS are presumably the primary determinants of work capacity. An exhaustive search of the literature produced 20 research articles that described 18 studies. Findings from these studies support that limitations in physical or cognitive function can hinder one’s ability to work; however, ability to work could not be based solely on these measures of function. Work ability among individuals extended beyond measures of impairment to include level of education, job characteristics, and disease symptoms such as fatigue. In summary, measures of physical and cognitive function can guide physicians when clinically evaluating an individual with MS, but are poor indicators for precluding an individual from working.

Perpetrator, worker and workplace characteristics associated with patient and visitor perpetrated violence (Type II) on hospital workers: A review of the literature and existing occupational injury data

PROBLEM Non-fatal type II violence experienced by hospital workers (patient/visitor-on-worker violence) is not well described. METHODS Hospital administration data (2004-2009) were examined for purposes of calculating rates of type II violent events experienced by workers. We also conducted a review of the hospital-based literature (2000-2010) and summarized findings associated with type II violence. RESULTS 484 physical assaults were identified in the data, with a rate of 1.75 events/100 full-time equivalents. Only few details about events were captured, while non-physical events were not captured. The literature yielded 17 studies, with a range proportion of verbal abuse (22%-90%), physical threats (12%-64%) and assaults (2%-32%) reported. The literature lacked rigorous methods for examining incidence and circumstances surrounding events or rates of events over time. DISCUSSION For purposes of examining the impact of type II violence on worker safety, satisfaction and retention, rigorous surveillance efforts by hospital employers and researchers are warranted.

Obstetrician practice patterns and recommendations for physical activity during pregnancy

BACKGROUND AND METHODS Many women do not attain minimum American College of Obstetricians and Gynecologists (ACOG) recommendations for physical activity during pregnancy. This study assessed the self-reported practice patterns and recommendations of 384 obstetricians working in Texas through a mailed survey on physical activity during pregnancy. RESULTS The most common exercise elements routinely collected from pregnant women included types of exercise (81%), history of exercise before pregnancy (79%), and frequency of exercise (76%). Fewer obstetricians collected duration (68%) or intensity (69%) of exercise. The percentage of obstetricians recommending avoidance of nine household activities and exercises (including lifting groceries, starting a new exercise program, or participating in walking, jogging, or bicycling) was significantly higher with each successive trimester. Most obstetricians agreed that pregnant women would gain some benefit from mild exercise (99.5%), but fewer agreed that moderate (74%) or vigorous exercise (6%) would be beneficial. Sixty-two percent of obstetricians reported that women who have never exercised could begin an exercise program during pregnancy. Almost all participants agreed that physical activity might make a woman feel more energetic (98%) and improve her labor and delivery (89%), but fewer agreed that exercise during pregnancy causes lower weight babies (23%) or could trigger labor (18%). CONCLUSIONS Dissemination of current recommendations and discussion about the benefits and risks of physical activity during pregnancy, such as through continuing education, appear warranted. Future research could address the causes of disparities between self-reported practice patterns and current ACOG guidelines.

Relation of Cholesterol and Lipoprotein Parameters with Carotid Artery Plaque Characteristics: the Atherosclerosis Risk in Communities (ARIC) Carotid MRI Study

OBJECTIVE There is a paucity of data regarding relations of apolipoproteins (apolipoprotein B [ApoB] and apolipoprotein A-1 [Apo A-1]), lipoprotein particle measures (low-density lipoprotein particle concentration [LDLp] and high-density lipoprotein particle concentration [HDLp]), and lipoprotein cholesterol measures (low-density lipoprotein cholesterol [LDL-C], non-high-density lipoprotein cholesterol [non-HDL-C], and high-density lipoprotein cholesterol [HDL-C]) with atherosclerotic plaque burden, plaque eccentricity, and lipid-rich core presence as a marker of high-risk plaques. METHODS Carotid artery magnetic resonance imaging was performed in 1670 Atherosclerosis Risk in Communities study participants. Vessel wall and lipid cores were measured; normalized wall index (NWI), standard deviation (SD) of wall thickness (measure of plaque eccentricity) were calculated; and lipid cores were detected in vessels with ≥ 1.5mm thickness. Fasting concentrations of cholesterol, ApoB and Apo A-1, and LDLp and HDLp were measured. RESULTS Measures of plaque burden (carotid wall volume, wall thickness, and NWI) were positively associated with atherogenic cholesterol and lipoproteins (p < 0.05 for total cholesterol, LDL-C, non-HDL-C, ApoB, and LDLp), but not with HDL-C, Apo A-1, or HDLp. SD of wall thickness was associated with total cholesterol (p 0.01) and non-HDL-C (p 0.02). Although measures of atherogenic or anti-atherogenic cholesterol or lipoprotein were not individually associated with detection of a lipid-rich core, their ratios (total cholesterol/HDL-C, non-HDL-C/HDL-C, and LDLp/HDLp) were associated with lipid-rich core presence (p ≤ 0.05). CONCLUSION Extent of carotid atherosclerosis is associated with atherogenic cholesterol and lipoproteins. Atherogenic/anti-atherogenic cholesterol or particle ratios were associated with presence of a detectable lipid-rich core.

Cancer incidence among union carpenters in New Jersey.

A cohort of 13,354 male union carpenters in New Jersey was linked to cancer registry data to investigate cancer incidence during 1979 through 2000. Surveillance, Epidemiology and End Results data were used to calculate standardized incidence ratios (SIRs). A total of 592 incident cancers were observed among this cohort (SIR = 1.07), which was not statistically in excess. However, significant excesses were observed for cancers of the digestive system and peritoneum (SIR = 1.24) and the respiratory system (SIR = 1.52). Workers in the union more than 30 years were at significant risk for cancers of the digestive organs and peritoneum (SIR = 3.98), rectum (SIR = 4.85), trachea, bronchus, and lung (SIR = 4.56), and other parts of the respiratory system (SIR = 11.00). Testicular cancer was significantly in excess (SIR = 2.48) in analyses that lagged results 15 years from initial union membership. Additional etiologic research is needed to evaluate possible occupational and nonoccupational risk factors for testicular cancer.

Accuracy of self-reports of fecal occult blood tests and test results among individuals in the carpentry trade

BACKGROUND Inaccuracy in self-reports of colorectal cancer (CRC) screening procedures (e.g., over- or underreporting) may interfere with individuals adhering to appropriate screening intervals, and can blur the true effects of physician recommendations to screen and the effects of interventions designed to promote screening. We assessed accuracy of self-report of having a fecal occult blood test (FOBT) within a 1-year window based on receipt of FOBT kits among individuals aged 50 and older in the carpentry trade (N = 658) who were off-schedule for having had a FOBT. METHOD Indices of evaluating accuracy of self-reports (concordance, specificity, false-positive and false-negative rates) were calculated relative to receipt of a mailed FOBT. Among those who mailed a completed FOBT, we assessed accuracy of reporting the test result. RESULTS Participants underestimated having performed a FOBT (false-negative rate of 44%). Accuracy was unrelated to perceptions of getting or worrying about CRC or family history. Self-reports of having a negative FOBT result more consistently matched the laboratory result (specificity 98%) than having a positive test result (sensitivity 63%). CONCLUSIONS Contrary to other findings, participants under- rather than over reported FOBT screening. Results suggest greater efforts are needed to enhance accurate recall of FOBT screening.

Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six U.S. hospitals

BACKGROUND An elevated risk of patient/visitor perpetrated violence (type II) against hospital nurses and physicians have been reported, while little is known about type II violence among other hospital workers, and circumstances surrounding these events. METHODS Hospital workers (n = 11,000) in different geographic areas were invited to participate in an anonymous survey. RESULTS Twelve-month prevalence of type II violence was 39%; 2,098 of 5,385 workers experienced 1,180 physical assaults, 2,260 physical threats, and 5,576 incidents of verbal abuse. Direct care providers were at significant risk, as well as some workers that do not provide direct care. Perpetrator circumstances attributed to violent events included altered mental status, behavioral issues, pain/medication withdrawal, dissatisfaction with care. Fear for safety was common among worker victims (38%). Only 19% of events were reported into official reporting systems. CONCLUSIONS This pervasive occupational safety issue is of great concern and likely extends to patients for whom these workers care for.