Nancy Lightfoot

Occupational Stress Management and Burnout Interventions in Nursing and Their Implications for Healthy Work Environments: A Literature Review.

This article reports on a literature review of workplace interventions (i.e., creating healthy work environments and improving nurses’ quality of work life [QWL]) aimed at managing occupational stress and burnout for nurses. A literature search was conducted using the keywords nursing, nurses, stress, distress, stress management, burnout, and intervention. All the intervention studies included in this review reported on workplace intervention strategies, mainly individual stress management and burnout interventions. Recommendations are provided to improve nurses’ QWL in health care organizations through workplace health promotion programs so that nurses can be recruited and retained in rural and northern regions of Ontario. These regions have unique human resources needs due to the shortage of nurses working in primary care.

Interviewing in situ: employing the guided walk as a dynamic form of qualitative inquiry

The purpose of this paper is to provide a critical analysis of a mobile research method, the guided walk, and its potential suitability in medical education research.

Mortality and cancer incidence in a nickel cohort

BACKGROUND Previous studies of nickel workers have primarily noted significant early increases in lung and nasal cancers and for various types of accidents. AIMS To examine cancer incidence and mortality, concurrently, for a cohort of male nickel workers at a major nickel and copper producer in Sudbury, Ontario, Canada. METHODS From January 1964 to December 2001, nominal roll and work history information were linked to Ontario health data and mortality and cancer incidence were compared to the Ontario population. RESULTS There were 1984 (19%) deaths and 1127 (11%) incident cancers (n = 10,253). Significant elevations in mortality were observed for accidents, poisoning and violence; for possibly job-related accidents among those with <15 years since first hire [standardized mortality ratio (SMR) = 133, 95% CI: 111-158; SMR = 241, 95% CI: 159-351, respectively] and for accidents in those with > or =15 years since first hire (SMR = 123, 95% CI: 104-144). Significant elevations were also observed for accidents, poisoning and violence for those with 6 months to 14 years work experience and for lung cancer incidence and mortality for those with 15-29 years work experience (SMR = 128, 95% CI: 107-153). Incident lung cancers were significantly elevated for those hired in the 1940s and 1960s. CONCLUSIONS Significant lung cancer mortality and incidence elevations were observed for the cohort and underground workers with increased time since first hire, for those hired during early periods of operation and for those with longer durations of employment. Further aetiological study is required as occupational aetiology could not be ascertained.

Transition processes through a longitudinal integrated clerkship: a qualitative study of medical students' experiences.

This paper describes the transition processes experienced by Year 3 medical students during their longitudinal integrated clerkship (LIC). The authors conceptualise the stages that encompass the transition through a LIC.

Mortality and cancer incidence in a copper-zinc cohort.

Previous studies of copper-zinc workers have primarily observed significant increases in lung and other respiratory cancers. This study concurrently examined cancer incidence and cause-specific mortality for a cohort of workers at a copper-zinc producer in Ontario, Canada, from 1964 to 2005. Significant elevations in lung cancer incidence were observed for males in the overall cohort (standardized incidence ratio [SIR] = 124, 95% confidence interval [CI] = 102–150) and for surface mine (SIR = 272, 95% CI = 124–517), concentrator (SIR = 191, 95% CI = 102–327), and central maintenance (SIR = 214, 95% CI = 125–343) employees. Significant elevations of non-Hodgkins lymphoma incidence were observed for male underground mine employees (SIR = 232, 95% CI = 111–426). Occupational etiology cannot be ascertained with the current exploratory study design. Future studies could (1) incorporate exposure assessment for subgroups within the existing cohort and (2) determine the efficacy of wellness programs in partnership with the local health unit.

The Lost Creek Fire: managing social relations under disaster conditions.

This paper examines some of the social processes associated with disaster conditions. Utilising an asset-based perspective of community capacity, it focuses on four types of normative systems to interpret the ability of communities to manage disasters through market-, bureaucratic-, associative-, and communal-based norms. Drawing on experience of a wildfire in the Crowsnest Pass region of southwest Alberta, Canada, in 2003, the tensions and compatibilities among these normative systems are evaluated through interviews with 30 community leaders. The results confirm the contributions of all types of social capital to resiliency, the necessity for rapid use of place-based knowledge, and the importance of communication among all types and levels of agents. In addition, they point to the value of identifying and managing potential conflicts among the normative systems as a means to maximising their contributions. The integration of local networks and groups into the more general disaster response minimised the impacts on health and property.

Natural resource-based industries and prostate cancer risk in Northeastern Ontario: a case-control study.

Objective Prostate cancer continues to be the most commonly diagnosed cancer in men, and there is limited knowledge on its preventable risk factors. A number of occupational exposures in natural resource-based industries are suspected to be related to prostate cancer risk. This study investigates associations between employment in these industries and prostate cancer. Methods Data were from a population-based, case–control study previously conducted in Northeastern Ontario. Incident cases (N=760) aged 45–85 years and diagnosed with prostate cancer between 1995 and 1998 were identified from the Ontario Cancer Registry. Controls (N=1632) were recruited using telephone listings, and were frequency matched to cases by age. Lifetime occupational history was collected for all participants. Logistic regression was used to estimate ORs and their associated 95% CIs. Results Elevated risks were observed for employment in forestry and logging industries (OR=1.87, 95% CI 1.32 to 2.73) and occupations (OR=1.71, 95% CI 1.24 to 2.35), and these risks increased with duration of employment for ≥10 years. Elevated risks were also found for employment in wood products industries (OR=1.45, 95% CI 1.07 to 1.97), and paper and allied products industries (OR=1.43, 95% CI 1.03 to 2.00), and when duration of employment was ≥10 years. There were also elevated risks in agriculture and mining-related work; however, these findings were not consistent across industry and occupation categories. Conclusions Prostate cancer risk may be associated with work in several natural resource industries, primarily in the forest industries. To further evaluate observed associations, studies should focus on natural resource-based exposures in larger populations with improved exposure assessment.

The impact of cocaine use in patients enrolled in opioid agonist therapy in Ontario, Canada

BACKGROUND Opioid agonist therapy is the gold standard of care for opioid use disorder; however, the efficacy of this treatment may be hindered by concurrent drug use, including the use of cocaine. This study examines the impact of cocaine use on treatment retention, while accounting for various risk factors, including geographic location, age, gender, and first-month cocaine use. METHODS We conducted a retrospective cohort study using anonymized electronic medical records from 58 opioid agonist therapy clinics in Ontario between 2011 and 2013. One-year treatment retention was the primary outcome of interest and was measured by differing frequencies of cocaine use - as well as baseline use - with an additional focus on geographic location (Northern Ontario vs. Southern Ontario). RESULTS Our cohort consisted of 3835 patients, with the average retention rate of 44%. Baseline cocaine users had a retention rate of 39% and non-users had a retention rate of 46%. Patients who were cocaine-negative on admission benefited from an increased median days retained (302 vs. 212 days). Patients who used cocaine at higher frequencies had decreased retention rates compared to those who used less often. Despite increased levels of cocaine use, Northern patients were better retained than Southern patients. CONCLUSION Northern patients and patients from urban communities are more likely to be baseline cocaine users. Both baseline and continued cocaine use is predictive of treatment dropout in Northern and Southern patients. The higher the frequency of cocaine use, the more likely a patient is to terminate treatment. Patients in Northern Ontario are retained in treatment at higher rates than their Southern counterparts.

Evaluation of Cancer Patient Education and Services

On their first visit to the Regional Cancer Program, all patients are provided with the “Information for Patients and Families” binder that was designed by an interdisciplinary cancer patient education team. Patients were asked to complete a survey to evaluate the usefulness of this binder. Timely delivery of the “Information for Patients and Families” binder validates a higher level of satisfaction with oncology services because patients are better informed and this translates into a reduction of psychosocial problems. As a result of this study, a decision was made to provide the binder earlier in the patient’s journey (e.g., post surgery for thoracic and brain tumor patients).

From awareness to action: Sudbury, mining and occupational disease in a time of change

BACKGROUND: Miners work in highly hazardous environments, but surprisingly, there are more fatalities from occupational diseases, including cancers, than from fatalities from injuries. Over the last few decades, the mining environment has become safer with fewer injuries and less exposure to the toxins that lead to occupational disease. There have been improvements in working conditions, and a reduction in the number of workers exposed, together with an overall improvement in the health of miners. OBJECTIVES: This study attempted to gain a deeper understanding of the impetus for change to reduce occupational exposures or toxins at the industry level. It focuses on one mining community in Sudbury, Ontario, with a high cancer rate, and its reduction in occupational exposures. It explored the level of awareness of occupational exposures from the perspective of industry and worker representatives in some of the deepest mines in the world. Although awareness may be necessary, it is often not a sufficient impetus for change, and it is this gap between awareness and change that this study explored. It examined the awareness of occupational disease as an impetus to reducing toxic exposures in the mining sector, and explores other forces of change at the industrial and global levels that have led to an impact on occupational exposures in mining. METHODS: From 2014 and 2016, 60 interviews were conducted with individuals who were part of, or witness to the changes in mining in Sudbury. From these, 12 labour and 10 industry interviews and four focus groups were chosen for further analysis to gain a deeper understanding of industry and labour’s views on the changes in mining and the impact on miners’ health from occupational exposures. The results from this subsection of the data is the focus for this paper. RESULTS: The themes that emerged told a story about Sudbury. There is awareness of occupational exposures, but this awareness is dwarfed in comparison to the attention that is given to the tragic fatal injuries from injuries and accidents. The mines are now owned by foreign multinationals with a change from an engaged, albeit paternalistic sense of responsibility for the health of the miners, to a less responsive or sympathetic workplace culture. Modernization has led to the elimination, substitution, or reduction of some of the worst toxins, and hence present-day miners are less exposed to hazards that lead to occupational disease than they were in the past. However, modernization and the drop in the price of nickel has also led to a precipitous reduction in the number of unionized miners, a decline in union power, a decline in the monitoring of present-day exposures, and an increase in non-unionized contract workers. The impact has been that miners have lost their solidarity and power to investigate, monitor or object to present-day exposures. CONCLUSIONS: Although an increase in the awareness of occupational hazards has made a contribution to the reduction in occupational exposures, the improvement in health of miners may be considered more as a “collateral benefit” of the changes in the mining sector. Multiple forces at the industrial and global level have differentially led to an improvement in the working and living environment. However, with the loss of union power, the miners have lost their major advocate for miner health.