Susan Goodwin Gerberich

An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses' Study

Aims: To identify the magnitude of and potential risk factors for violence within a major occupational population. Methods: Comprehensive surveys were sent to 6300 Minnesota licensed registered (RNs) and practical (LPNs) nurses to collect data on physical and non-physical violence for the prior 12 months. Re-weighting enabled adjustment for potential biases associated with non-response, accounting for unknown eligibility. Results: From the 78% responding, combined with non-response rate information, respective adjusted rates per 100 persons per year (95% CI) for physical and non-physical violence were 13.2 (12.2 to 14.3) and 38.8 (37.4 to 40.4); assault rates were increased, respectively, for LPNs versus RNs (16.4 and 12.0) and males versus females (19.4 and 12.9). Perpetrators of physical and non-physical events were patients/clients (97% and 67%, respectively). Consequences appeared greater for non-physical than physical violence. Multivariate modelling identified increased rates for both physical and non-physical violence for working: in a nursing home/long term care facility; in intensive care, psychiatric/behavioural or emergency departments; and with geriatric patients. Conclusions: Results show that non-fatal physical assault and non-physical forms of violence, and relevant consequences, are frequent among both RNs and LPNs; such violence is mostly perpetrated by patients or clients; and certain environmental factors appear to affect the risk of violence. This serves as the basis for further analytical studies that can enable the development of appropriate prevention and control efforts.

Concussion incidences and severity in secondary school varsity football players.

The head coaches and players of 103 secondary school football teams in Minnesota were asked to respond to mail questionnaires. Information about injury incidence and concomitant health care provision was elicited. Responses from 3,063 players (81 per cent) yielded a total injury rate of 78 injuries/100 players; 19/100 players reported a concussion experience characterized by loss of consciousness and/or loss of awareness. Of the players who experienced a loss of consciousness, 69 per cent were returned to play the same day. Persistent concussion symptoms were reported as long as six to nine months following the end of the season; six cases involved permanent disabilities. Continued use of illegal techniques of butt-blocking and face-tackling by as many as 40 per cent of the players was associated with apparent increased risks of concussions and concussion symptoms. Players with a prior history of loss of consciousness had a risk of loss of consciousness four times that of the player without a prior history.

Risk factors for work-related assaults on nurses

Background: Work-related homicides have been the subject of considerable study, but little is known about nonfatal violence and relevant risk factors. Methods: We surveyed 6300 Minnesota nurses who were selected randomly from the 1998 licensing database and determined their employment and occupational violence experience. In a nested case–control study, we examined environmental exposures and physical assault. Cases of assault in the previous 12 months and controls randomly selected from assault-free months were surveyed about prior-month exposures. Results: After adjustment by multiple logistic regression, incidence of physical assault was 13.2 per 100 persons per year (95% confidence interval = 12.2–14.3). Among 310 cases and 946 control subjects, odds ratios for assault were increased: in nursing homes or long-term care facilities (2.6; 1.9–3.6), emergency departments (4.2; 1.3–12.8), and psychiatric departments (2.0; 1.1–3.7); in environments not “bright as daylight” (2.2; 1.6–2.8); and for each additional hour of shift duration (1.05; 0.99–1.11). Risks were decreased when carrying cellular telephones or personal alarms (0.3; 0.2–0.7). Conclusions: These results may guide in-depth investigation of ways protective and risk factors can control violence against nurses.

An epidemiological study of high school ice hockey injuries.

Between 1976 and 1983, 42 spinal cord injuries among ice hockey participants were documented in Canada; within a recent 3-week period, three cases involving fractured necks were reported in a metropolitan area of Minnesota. The purpose of this comprehensive epidemiological study was to document rates, types, and severities of injuries incurred among high school varsity hockey players in Minnesota, as a result of participation in the 1982–1983 season, and to determine the variables associated with these injuries. Within a 30-mile radius of the states major metropolitan area, 12 high school varsity hockey teams were selected for participation. Specific techniques were used to ensure confidentiality, high response rates, and validation of information. Among the players an injury rate of 75 injuries per 100 players was documented. Head and neck injuries accounted for 22% of the total injuries. Increased risks of injury were associated with multiple health-care provision variables and equipment utilized. Potential strategies are identified as a result of these findings.

Analysis of severe injuries associated with volleyball activities

In brief: Volleyball has rarely been studied with regard to injuries. However, recent identification of severe knee injuries incurred as a result of participation in volleyball has prompted an investigation of injuries associated with this sport. Among 7,490 persons referred to a major metropolitan outpatient sports medicine clinic for rehabilitation, 106 were treated for injuries related to volleyball. Nearly 90% of the injuries were concentrated in the lower extremities. In particular, knee injuries accounted for 59% of the injuries in both males and females, while ankle injuries accounted for 22% and 24%, respectively. The mechanism of jumping, landing, and twisting upon impact with the ground or floor was associated with 63% of all the injuries, including 61% of the knee injuries and 92% of the ankle injuries. The costs associated with these injuries indicate a significant problem. Directions for future research are identified so that the most appropriate strategies for prevention and control can be d...

Risk factors for injury among veterinarians

Work-related injuries among veterinarians are a major problem, but little is known of the specific risk factors involved. The purpose of this nested case-control study, conducted from a comprehensive population-based study of practicing Minnesota veterinarians, was to identify risk factors for job-related injuries. We questioned cases (N = 193) on exposures occurring in the month before their injury, and we questioned controls (N = 495) on exposures occurring in a randomly selected month. We used logistic regression to model the dependence of veterinary work-related injury on each exposure of interest and associated confounders. We observed increased rates for prior injuries (RR = 1.7, 95% CI = 1.1–2.6), participation in sports (RR = 1.7, 95% CI = 1.05–2.6), no sharps boxes present (RR = 1.8, 95% CI = 1.01–3.2), current smoking (RR = 4.1, 95% CI = 1.8–9.1), and 6 or fewer hours of sleep (RR = 1.8, 95% CI = 1.0–3.3). We identified a dose response for lifting patients, as follows: lifting 41–75 lb (RR = 3.1, 95% CI = 1.6–5.9), lifting 76–100 lb (RR = 3.2, 95% CI = 1.6–5.9), and lifting more than 100 lb (RR = 6.1, 95% CI = 2.5–15.0). Decreased rates were observed for participation in aerobic activities (RR = 0.6, 95% CI = 0.4–0.99), perception of lower risk (RR = 0.4, 95% CI = 0.2–0.9), and experience (RR = 0.6, 95% CI = 0.4–0.9).

Risk factors for work related violence in a health care organization

Objective: Identify the exposure effects of job family, patient contact, and supervisor support on physical and non-physical work related violence. Design: Cross sectional study of employees in a Midwest health care organization, utilizing a specially designed mailed questionnaire and employer secondary data. Subjects: Respondents included 1751 current and former employees (42% response rate). Results: Physical and non-physical violence was experienced by 127 (7.2%) and 536 (30.6%) of the respondents, respectively. Multivariate analyses of physical violence identified increased odds for patient care assistants (odds ratio (OR) 2.5, 95% confidence interval (CI) 1. 1 to 6.1) and decreased odds for clerical workers (OR 0.1, 95% CI 0.03 to 0.5). Adjusted for job family, increased odds of physical violence were identified for moderate (OR 5.9, 95% CI 2.1 to 16.0) and high (OR 7.8, 95% CI 2.9 to 20.8) patient contact. Similar trends were identified for non-physical violence (OR 1.4, 95% CI 1.1 to 2.0 and OR 1.7, 95% CI 1.3 to 2.3). Increased supervisor support decreased the odds of both physical (OR 0.7, 95% CI 0.6 to 0.95) and non-physical violence (OR 0.5, 95% CI 0.4 to 0.6), adjusting for job family and demographic characteristics. Conclusions: Increased odds of physical violence were identified for the job family of nurses, even when adjusted for patient contact. Increased patient contact resulted in increased physical and non-physical violence, independent of job family, while supervisor support resulted in decreased odds of physical and non-physical violence.

Injury from dairy cattle activities.

Animals have been implicated as an important source of injury for farm household members. Little is known, however, about the specific activities associated with the animal/livestock operations that place a person at increased or decreased risk for injuries. The primary aim of this case‐control study was to identify which dairy cattle operation activities (that is, milking, feeding, cleaning barns, trimming and treating feet, dehorning, assisting with difficult calvings, and doing treatments) were associated with an increased or decreased risk of injury. We found milking to have the greatest increase in risk for injury. The ratios for increasing hours per week spent at milking (0, 1–10, 11–20, 21–30, 31–63) were 1.0, 2.3, 5.5, 10.9, and 20.6, respectively. We also found an increased rate ratio associated with trimming or treating hooves (rate ratio = 4.2).

Identification of differences between rural and urban safety cultures

The prevailing risk of traffic fatalities is much larger in rural areas compared to urban areas. A number of explanations have been offered to explain this including road design, emergency medical service proximity, and human factors. This research explored the potential contribution of rural driver attitudes that may underlie the increased fatal crash risk in rural environments. This analysis examined differences between rural and urban drivers in terms of self-reported risk taking for driving behaviors associated with fatal crashes and attitudes toward safety interventions using a large-scale survey. The results suggested that rural drivers engage in riskier behavior, such as not wearing seatbelts, because they have lower perceptions of the risks associated with such behaviors. Results also suggested that vehicle type (e.g., pickup trucks versus passenger vehicles) may be related to seatbelt compliance and frequency of driving under the influence of alcohol. Rural drivers perceived the utility of government-sponsored traffic safety interventions to be lower than their urban counterparts. This study provides insights into the role of the human factor in rural fatal crashes and provides policy suggestions for developing safety interventions that are designed with respect to the psychosocial factors that define the rural culture.

Marijuana use and injury events resulting in hospitalization

PURPOSE Information on the potential relation between marijuana use and the incidence of hospitalized injury is extremely limited. The purpose of this effort was to investigate the potential for this association. METHODS A retrospective study was conducted in a large prepaid Northern California health care program cohort (n = 64,657) that completed baseline questionnaires about health behaviors, including marijuana use, and health status between 1979 and 1985. All injury hospitalizations through December 31, 1991, (n = 965) were identified and validated. RESULTS Using Poisson regression modeling, increased rate-ratios and 95% confidence intervals were identified for all-cause injury hospitalizations for both men and women among current users (1.28; 1.01 to 1.61 and 1.37; 1.04 to 1.79, respectively) relative to nonusers, adjusted for age, cigarette and alcohol use, and other potential confounders. Increased rates of motor vehicle (1.96; 1.23 to 3.14), and assault (1.90, 1.16 to 3.15), injuries were identified among men who were current users; an increased rate of assault was suggestive in women (2.21; 0.92 to 5.19). CONCLUSIONS Though the results must be viewed cautiously, they suggest that marijuana use may be independently associated with increased risk of hospitalized injury. Further study of the physiological and behavioral mechanisms is warranted [corrected].