Allergic reactions and adverse events associated with administration of mRNA-based vaccines. A health-care system experience.

Background: Adverse reactions, including anaphylaxis, to messenger RNA coronavirus disease 2019 (COVID-19) vaccines rarely occur. Because of the need to administer a timely second dose in subjects who reported a reaction to their first dose, a panel of health-care professionals developed a safe triage of the employees and health care providers (EHCP) at a large health-care system to consider administration of future dosing. Methods: There were 28,544 EHCPs who received their first dose of COVID-19 vaccines between December 15, 2020, and March 8, 2021. The EHCPs self-reported adverse reactions to a centralized COVID-19 command center (CCC). The CCC screened and collected information on the quality of reaction, symptoms, and timing of the onset of the reaction. Results: Of 1253 calls to the CCC, 113 were identified as requiring consideration by a panel of three (American Board of Allergy and Immunology) ABAI-certified allergists for future dosing or formal in-person assessment. Of the 113 EHCPs, 94 (83.2%) were recommended to get their second dose. Eighty of 94 received their second planned dose without a severe or immediate reaction. Of the 14 of 113 identified as needing further evaluation, 6 were evaluated by a physician and subsequently received their second dose without a serious adverse reaction. Eight of 14 did not receive their second dose. Only 5 of the 113 EHCPs reported reactions (4.4%) were recommended to not take the second dose: 3 (2.6%) because of symptoms consistent with anaphylaxis, and 2 because of neurologic complications (seizure, stroke). Conclusion: The panel demonstrated that, by consideration of reaction history alone, the ECHPs could be appropriately triaged to receive scheduled second dosing of COVID-19 vaccines without delays for in-person evaluation and allergy testing.

The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures.

INTRODUCTION: The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures. METHODS: We evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12-item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. RESULTS: In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (-0.50 point; 95% confidence interval [CI], -0.89 to -0.12) and functional impairment (-0.42 point; 95% CI, -0.78 to -0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. DISCUSSION: Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.

Peer review audit of non-specialist occupational physician reports.

BACKGROUND: With declining specialist occupational physician (OP) numbers, there is increasing recognition of the importance of non-specialist physicians in occupational health (OH) service delivery, yet to date, this physician group remains understudied and their competency requirements poorly understood. AIMS: To evaluate the quality of a sample of non-specialist OH reports and compare these with specialist reports. METHODS: A retrospective peer review audit of a convenience sample of 200 consecutive non-specialist and specialist OH reports from an Irish OH service using an assessment form based on the modified Sheffield Assessment Instrument for Letters SAIL(OH)1. RESULTS: Of the 200 peer reviewed OH reports, 159 (80%) were from non-specialists. For all questions, 87% and above of non-specialist reports were 'satisfactory' or 'above expected'. On the overall assessment, out of 10, the mean non-specialist report score was 6.8 (standard deviation (SD) 3-10) and the specialist score was 7.3 (SD 3-10). Comparatively, non-specialist reports highlighted legal/ethical issues marginally more and adhered slightly better to contractual/ethical/legal boundaries, while specialist reports fared better in addressing manager's questions, in their structure and clarity and in covering all significant aspects of the case, particularly if the case was complex. CONCLUSIONS: Our findings demonstrate a high standard of OH report quality in this sample of non-specialist OPs that is consistent across all key OH report components. Potential development areas are also identified that can inform education/training tailored to this physician group and assist in competency standard-setting.

Experiences and outcomes of nurses referred to a peer health assistance program: Recommendations for nursing management.

AIM: To provide recommendations for nursing management based on the experiences of current and former nurses who were served by a peer health assistance program (PHAP). BACKGROUND: Providing help for nurses with impaired practice is critical to their health and well-being, assuring patient safety and public trust, as well as returning competent nurses to the healthcare workforce. METHODS: Nurses (n = 268) who were current clients or former clients of a PHAP were surveyed about their experiences. RESULTS: Nearly half of nurses were referred by the board of nursing with 69% reporting the referral was due to substance use, alcohol being the most common. Most (62%) did not believe that their substance use affected their practice yet relayed that recognition of their emotional or physical condition could have led to earlier identification. Key barriers to seeking assistance were fear and embarrassment, along with concerns about losing their nursing license. CONCLUSIONS: Nurses in management are in key roles to identify and intervene with nurses who are at risk for impaired practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses in management and nurse colleagues would benefit from workplace education on the warning signs of impaired nursing practice and how to address it.

Limitations of periodical health examinations in detecting occupational chronic solvent encephalopathy.

OBJECTIVES: Occupational diseases (ODs) are globally underdetected, and chronic solvent encephalopathy (CSE) is no exception. The aim was to study how the recommended policies and protocols were followed in occupational health services (OHS) periodical health examinations where symptomatic CSE cases have remained undetected. METHODS: We retrospectively studied the medical records of occupational CSE cases (n=18) found in a screening project, which had not been detected in preceding OHS health examinations. We collected data from three sources: OHS units, the screening project and the Finnish Institute of Occupational Health. We analysed the health examinations conducted between symptom onset and the detection of CSE: regularity, content, use of recommended screening tools, exposure estimation and whether a physician was involved in the examinations, as recommended. RESULTS: The mean duration of symptoms before OD identification was 7.3 years (range 3-13), and 36 health examinations had been conducted. Fifteen workers had attended these (1-9 times each) while suffering from CSE symptoms, and two before symptoms. Only one had not had access to OHS. The recommended symptom screening questionnaire, Euroquest, was used in five (14%) examinations, and previous solvent exposure inquired once. A physician was involved in 24 (67%) examinations, whereas the rest were carried out by a nurse. CONCLUSIONS: Although health examinations are conducted, guidelines are not followed. This may be due to a lack of awareness concerning CSE, and may apply to other ODs. In addition to legislation and policies, OH professionals must be continuously educated to improve awareness, prevention and detection of ODs.

Effectiveness of a tailored implementation strategy to improve adherence to a guideline on mental health problems in occupational health care.

BACKGROUND: As compliance to guidelines is generally low among health care providers, little is known about the impact of guidelines on the quality of delivery of care. To improve adherence to guideline recommendations on mental health problems, an implementation strategy was developed for Dutch occupational physicians (OPs). The aims were 1) to assess adherence to a mental health guideline in occupational health care and 2) to evaluate the effect of a tailored implementation strategy on guideline adherence compared to traditional guideline dissemination. METHODS: An audit of medical records was conducted as part of a larger RCT study. Participants were 66 OPs (32 intervention and 34 control) employed at one of six sites of an Occupational Health Service in southern Netherlands. OPs in the intervention group received multiple-session peer group training which focused on identifying and addressing barriers to using the guideline, using a Plan-Do-Check-Act approach. The control group did not receive training. Medical records of 114 workers sick-listed with mental health problems were assessed (56 intervention and 58 control). Guideline adherence was determined by auditing the records using 12 guideline-based performance indicators (PI), grouped into 5 PIs: process diagnosis, problem orientation, interventions/treatment, relapse prevention, and continuity of care. Differences in performance rates of the PIs between the intervention and control groups were analyzed, taking into account the cluster study design. RESULTS: OPs who received the training showed significantly greater adherence compared to the controls (p < .028) in 4 out of 5 grouped PIs, i.e. process diagnosis, problem orientation, interventions/treatment and relapse prevention. In one out of 12 PIs adherence was found adequate (53% of the medical records), in 6 PIs adherence was found minimal, and in 5 PIs the majority of the records showed no adherence. CONCLUSIONS: An implementation strategy which addressed key barriers for change and tailor-made interventions improves adherence to an occupational health guideline for mental health problems compared to traditional guideline dissemination. However, adherence to the guideline recommendations is still far from optimal. To optimize adherence, it is recommended that implementation strategies focus on the workers level, organizational level, and the professional level. TRIAL REGISTRATION: ISRCTN86605310 . Registered 30 June 2010.

Development of hearing standards for Ontario's Constable Selection System.

Objective: Develop valid and defensible hearing standards for Ontario constables to ensure safe and efficient operations. Design: Research involved three steps: (1) identification of hearing critical (HC) tasks, (2) characterisation of real-world noise environments where these tasks are performed (3) and establishment of screening criteria and protocols for determining fitness for duty. Study sample: Three panels of subject matter experts (SMEs) from different Ontario police services participated in Steps 1 and 3. Result: Fifty-one HC tasks conducted in 25 different environments were identified. Acceptable levels of speech communication in noise were based on environments with the highest frequency, importance and difficulty ratings. The ability to understand soft speech was also deemed critical. These translated into a 2 dB maximum elevation in the Noise Composite speech recognition threshold (SRT) with the Hearing-In-Noise-Test and a threshold in quiet of 35 dBA or better. Conclusions: Speech communication modelling methodology greatly facilitates the task of developing fitness for duty hearing standards, but participation of SMEs is crucial for face validity.

Inequities in occupational diseases recognition in France.

BACKGROUND: In France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases. METHODS: Three experienced occupational physicians specialized in OD were asked to develop 28 clinical cases representative of claims for compensation usually seen in these committees. The cases, in the form of short vignettes, were submitted to the 18 French regional committees, asking if they would recognise each case as an OD. RESULTS: All committees participated. The acceptance rate (recognition of the case as an OD) varied, ranging from 18% to 70%. All the committees took the same decision for only 7 out of the 28 cases, but half accepted and half refused for 3 cases. For 10 cases, one quarter of the committees gave a decision different than the other 75%. The highest discordance rates were observed for the cases concerning musculoskeletal disorders and asbestos related diseases. CONCLUSION: The committees take very different decisions in terms of recognition of OD, especially for the most frequently compensated OD in France, i.e. musculoskeletal disorders and asbestos related diseases. This is a major source of injustice for the employees who seek compensation and there is a need to develop methods to harmonize decisions between committees.

A study of leading indicators for occupational health and safety management systems in healthcare.

BACKGROUND: In Ontario, Canada, approximately $2.5 billion is spent yearly on occupational injuries in the healthcare sector. The healthcare sector has been ranked second highest for lost-time injury rates among 16 Ontario sectors since 2009 with female healthcare workers ranked the highest among all occupations for lost-time claims. There is a great deal of focus in Ontario's occupational health and safety system on compliance and fines, however despite this increased focus, the injury statistics are not significantly improving. One of the keys to changing this trend is the development of a culture of healthy and safe workplaces including the effective utilization of leading indicators within Occupational Health and Safety Management Systems (OHSMSs). In contrast to lagging indicators, which focus on outcomes retrospectively, a leading indicator is associated with proactive activities and consists of selected OHSMSs program elements. Using leading indicators to measure health and safety has been common practice in high-risk industries; however, this shift has not occurred in healthcare. The aim of this project is to conduct a longitudinal study implementing six elements of the Ontario Safety Association for Community and Healthcare (OSACH) system identified as leading indicators and evaluating the effectiveness of this intervention on improving selected health and safety workplace indicators. METHODS: A quasi-experimental longitudinal research design will be used within two Ontario acute care hospitals. The first phase of the study will focus on assessing current OHSMSs using the leading indicators, determining potential facilitators and barriers to changing current OHSMSs, and identifying the leading indicators that could be added or changed to the existing OHSMS in place. Phase I will conclude with the development of an intervention designed to support optimizing current OHSMSs in participating hospitals based on identified gaps. Phase II will pilot test and evaluate the tailored intervention. DISCUSSION: By implementing specific elements to test leading indicators, this project will examine a novel approach to strengthening the occupational health and safety system. Results will guide healthcare organizations in setting priorities for their OHSMSs and thereby improve health and safety outcomes.

Using the CDC's Worksite Health ScoreCard as a Framework to Examine Worksite Health Promotion and Physical Activity.

INTRODUCTION: Worksite health promotion programs are emerging as an effective approach for addressing the adult obesity epidemic and improving the overall health of employees. METHODS: We conducted a scoping review to identify articles that described a physical activity component (eg, promoted increased physical or reduced sitting time) of a worksite health promotion intervention. Our search specified full-length articles published in English from January 2000 through July 2015. We used the Centers for Disease Control and Prevention's Worksite Health ScoreCard, a validated tool, as a framework to summarize information on organizational supports strategies (18 questions) and physical activity strategies (9 questions) implemented by worksite health promotion programs. We also determined whether or not the included studies reported significant (P < .05) improvements in physical activity. RESULTS: We identified 18 worksite health promotion programs; 11 produced significant improvements in physical activity. Incentives, health risk assessments, health promotion committees, leadership support, marketing, and subsidies or discounts for use of exercise facilities were the most effective organizational supports strategies cited, and physical activity seminars, classes, and workshops were the most effective physical activity strategies cited. CONCLUSION: The use of the Health ScoreCard allowed for a practical interpretation of our findings, which can inform next steps for the field. Future research should explore the relationships between components of worksite health promotion programs and their outcomes to further develop best practices that can improve worker health and promote physical activity.

[Role of the occupational health nurse]. / Rôle de l'infirmier de santé au travail.

The missions of occupational health nurses are exclusively preventive, except in the event of emergency situations. They are involved in the prevention of occupational stress, the assessment of psychosocial risks and the improvement of quality of life at work.

Evaluating the Effectiveness of New York City Health Policy Initiatives in Reducing Cardiovascular Disease Mortality, 1990-2011.

Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality.

Do Hospitals Support Second Victims? Collective Insights From Patient Safety Leaders in Maryland.

BACKGROUND: Second victims-defined as health care providers who are emotionally traumatized after a patient adverse event-may not receive needed emotional support. Although most health care organizations have an employee assistance program (EAP), second victims may be reluctant to access this service because of worries about confidentiality. A study was conducted to describe the extent to which organizational support for second victims is perceived as desirable by patient safety officers in acute care hospitals in Maryland and to identify existing support programs. METHODS: Semistructured interviews (using existing and newly developed questions) were conducted with 43 patient safety representatives from 38 of the 46 acute care hospitals in Maryland (83% response rate). RESULTS: All but one of the responding hospitals offered EAP services to their employees, but there were gaps in the services provided related to timeliness, EAP staff's ability to relate to clinical providers, and physical accessibility. There were no valid measures in place to assess the effectiveness of EAP services. Participants identified a need for peer support, both for the second victim and potentially for individuals who provide that support. Six (16%) of the 38 hospitals had second victim support programs, which varied in structure, accessibility, and outcomes, while an additional 5 hospitals (13%) were developing such a program. CONCLUSION: Patient safety officers thought their organizations should reevaluate the support currently provided by their EAPs, and consider additional peer support mechanisms. Future research is needed to evaluate the effectiveness of these programs.

Effectiveness of an Intervention to Enhance Occupational Physicians' Guideline Adherence on Sickness Absence Duration in Workers with Common Mental Disorders: A Cluster-Randomized Controlled Trial.

Purpose Evidence-based guidelines in occupational health care improve the quality of care and may reduce sickness absence duration. Notwithstanding that, guideline adherence of occupational physicians (OPs) is limited. Based on the literature on guideline implementation, an intervention was developed that was shown to effectively improve self-reported adherence in OPs. The aim of present study was to evaluate whether this intervention leads to earlier return to work (RTW) in workers with common mental disorders (CMD). Methods In a two-armed cluster randomized controlled trial, 66 OPs were randomized. The trial included 3379 workers, with 1493 in the intervention group and 1886 in the control group. The outcome measures were: time to full RTW, time to first RTW, and total hours of sickness absence. Cox regression analyses and generalized linear mixed model analyses were used for the evaluations. Results The median time to RTW was 154 days among the 3228 workers with CMD. No significant differences occurred in (time to) full RTW between intervention and control group HR 0.96 (95% CI 0.81-1.15) nor for first RTW HR 0.96 (95% CI 0.80-1.15). The mean total hours of sickness absence was 478 h in the intervention group and 483 h in the control group. Conclusions The intervention to enhance OPs' guideline adherence did not lead to earlier RTW in workers with CMD guided by the OPs. Possible explanations are the remaining external barriers for guideline use, and that perceived guideline adherence might not represent actual guideline adherence and improved care.Trail registration: ISRCTN86605310.

Human rights in occupational therapy education: A step towards a more occupationally just global society.

BACKGROUND/AIM: Education on human rights will place occupational therapists in a strong position to address societal inequities that limit occupational engagement for many client groups. The imminent changes to the Minimum Standard for the Education of Occupational Therapists engender efforts towards social change and will require university-level human rights education. This education might enhance the profession's influence on disadvantaging social structures in order to effect social change. To contribute to the evidence base for social change education in occupational therapy, this research aims to understand the knowledge, skills, confidence and learning experiences of occupational therapy students who completed a human rights course. METHODS: Final year occupational therapy students responded to questionnaires which included listing human rights, a human rights scale measuring knowledge and confidence for working towards human rights, and open questions. Numbers of rights listed, knowledge scores and confidence scores were calculated. Responses to the open questions were thematically analysed. RESULTS: After completing a human rights course, students had good knowledge and moderate confidence to work with human rights. Three themes were identified including 'learning about human rights', 'learning about structural, societal and global perspectives on occupational engagement' and 'learning how occupational therapists can work with groups, communities and populations: becoming articulate and empowered'. CONCLUSIONS: Human rights education fosters the development of occupational therapists who are skilled, knowledgeable, confident and empowered to address occupational injustices, according to these research findings. To develop a more occupationally just global society, education that considers iniquitous social structures and human rights is necessary.

[Investigation on the application of GBZ/T 229.2-2010--classification of occupational hazards at workplaces Part 2: occupational exposure to chemicals].

Objective: To investigate the application and effectiveness evaluation of the standard of GBZ/T 229.2-2010 in practice, and to explore the applicability, aiming to provide technical evidence for the re-vision of GBZ/T 229.2-2010. Methods: There were 2 questionnaire surveys carried out in the study, including general survey and specific survey. Databases were established and data were input with Excel 2010 and Epi-data version 3.1 software. SPSS version 19.0 software was used for data cleaning and statistical analysis. Results: In total, the general survey received 100 questionnaires, with 59 from occupational health technical ser-vice organizations held by government, and 11 from colleges and universities. The leading three jobs using GBZ/T 229.2-2010 were the occupational hazards evaluation for constructive project (65.0%), lecturing/train-ing (50.0%), occupational hazards monitoring (43.0%), respectively. In the results of feasibility, scores of the fourth part "classification" , the fifth part "the principles of classification management" , annex A "the correct use instructions" were 3.4, 3.3, 3.5 respectively. In total, the specific survey received 27 questionnaires, with 18 from the employers and 9 from occupational health technical service organizations. The awareness rate of GBZ/T 229.2-2010 among occupational health professionals was 72.2%. In the results of feasibility, scores of the level of chemical hazards, occupational exposure ratio, physical labor intensity level, classification of expo-sure to industrial toxicants, principles of classification management, annex A "the correct use instructions" were 3.2, 3.7, 4.3, 4.1, 3.2, 3.2, respectively Conclusions: The results indicates that each part of GBZ/T 229.2-2010 is feasible and practical. But there are still some problems, such as classification of different kinds of chemicals at workplace, and the interaction of occupational exposure to chemicals and other hazards at work-place, etc. We suggest that in the revision of GBZ/T 229.2-2010, the action level of hazards should be clear.

[Investigation on standard application of industrial dust hazard classification].

Objective: To investigate the application and effectiveness evaluation of the standard of GBZ/T 229.1-2010 in practice, and to explore the applicability, aiming to provide technical evidence for the revision of GBZ/T 229.1-2010. Methods: There were 2 questionnaire surveys carried out in the study, including general survey and specific survey. Databases were established and data were input with Excel 2010 and Epidata version 3.1 software. SPSS version 19.0 software was used for data cleaning and statistical analysis. Results: The general survey received 100 questionnaires, with 43 from facilities and 57 from professional expertise. There were 59 questionnaires from occupational health technical service organizations held by government, and 11 from colleges and universities. The leading three jobs using GBZ/T 229.1-2010 were the occupational hazards evaluation for constructive project (69.0%) , lecturing/training (55.0%) , occupational hazards monitoring (50.0%) , respectively. The high frequency used contents of GBZ/T 229.1-2010 were the fourth part "classification" (67.0%) , the fifth part "the principles of classification management" (59.0%) , annex A "the correct use instructions" (52.0%) , respectively. In the results of feasibility, scores of the fourth part "classification" , the fifth part "the principles of classification management" , annex A "the correct use instructions" were 3.07, 3.03, 3.23, respectively. The parts needed to be modified as priories were the fourth part "classification" (22.0%) , the fifth part "the principles of classification management" (13.0%) , annex A "the correct use instructions" (12.0%) . The specific survey received 15 questionnaires, with 12 from the employers and 3 from occupational health technical service organizations. The awareness rate of GBZ/T 229.1-2010 among occupational health professionals was 83.3%. Classification results in the employers were used for guidance on improvement measures (66.7%) , health surveillance and monitoring (58.3%) , certification for occupational health and safety management system (33.3%) , occupational disease diagnosis (33.3%) , and personal protective equipment issued (33.3%) , etc. In the results of feasibility, scores of the content of free SiO(2), occupational exposure ratio, physical labor intensity level, classification of industrial dust, principles of classification management, annex A "the correct use instructions" were 5.00, 4.33, 5.00, 5.00, 3.67, 3.67, respectively. Conclusion: GBZ/T 229.1-2010 indicates that the standard is feasible and practical. But there are still some problems, such as classification of different kinds of industrial dusts at workplace, and the interaction of occupational exposure to industrial dusts and other hazards at workplace, etc.

Evaluation of a fitness intervention for new firefighters: injury reduction and economic benefits.

BACKGROUND: Firefighting is a hazardous profession and firefighters suffer workplace injury at a higher rate than most US workers. Decreased physical fitness is associated with injury in firefighters. A physical fitness intervention was implemented among Tucson Fire Department recruit firefighters with the goals of decreasing injury and compensation claims frequency and costs during the recruit academy, and over the subsequent probationary year. METHODS: Department injury records were analysed and described by body part, injury type and mechanism of injury. Injury and workers' compensation claims outcomes from the recruit academy initiation through the 12-month probationary period for the intervention recruit class were compared with controls from three historical classes. RESULTS: The majority of injuries were sprains and strains (65.4%), the most common mechanism of injury was acute overexertion (67.9%) and the lower extremity was the most commonly affected body region (61.7%). The intervention class experienced significantly fewer injuries overall and during the probationary year (p=0.009), filed fewer claims (p=0.028) and experienced claims cost savings of approximately US$33 000 (2013) from avoided injury and reduced claims costs. The estimated costs for programme implementation were $32 192 leading to a 1-year return on investment of 2.4%. CONCLUSIONS: We observed reductions in injury occurrence and compensation costs among Probationary Firefighter Fitness (PFF-Fit) programme participants compared with historical controls. The initiation of the PFF-Fit programme has demonstrated promise in reducing injury and claims costs; however, continued research is needed to better understand the programme's potential effectiveness with additional recruit classes and carryover effects into the recruit's career injury potential.

Healthy and productive workers: using intervention mapping to design a workplace health promotion and wellness program to improve presenteeism.

BACKGROUND: Presenteeism is a growing problem in developed countries mostly due to an aging workforce. The economic costs related to presenteeism exceed those of absenteeism and employer health costs. Employers are implementing workplace health promotion and wellness programs to improve health among workers and reduce presenteeism. How best to design, integrate and deliver these programs are unknown. The main purpose of this study was to use an intervention mapping approach to develop a workplace health promotion and wellness program aimed at reducing presenteeism. METHODS: We partnered with a large international financial services company and used a qualitative synthesis based on an intervention mapping methodology. Evidence from systematic reviews and key articles on reducing presenteeism and implementing health promotion programs was combined with theoretical models for changing behavior and stakeholder experience. This was then systematically operationalized into a program using discussion groups and consensus among experts and stakeholders. RESULTS: The top health problem impacting our workplace partner was mental health. Depression and stress were the first and second highest cause of productivity loss respectively. A multi-pronged program with detailed action steps was developed and directed at key stakeholders and health conditions. For mental health, regular sharing focus groups, social networking, monthly personal stories from leadership using webinars and multi-media communications, expert-led workshops, lunch and learn sessions and manager and employee training were part of a comprehensive program. Comprehensive, specific and multi-pronged strategies were developed and aimed at encouraging healthy behaviours that impact presenteeism such as regular exercise, proper nutrition, adequate sleep, smoking cessation, socialization and work-life balance. Limitations of the intervention mapping process included high resource and time requirements, the lack of external input and viewpoints skewed towards middle and upper management, and using secondary workplace data of unknown validity and reliability. CONCLUSIONS: In general, intervention mapping was a useful method to develop a workplace health promotion and wellness program aimed at reducing presenteeism. The methodology provided a step-by-step process to unravel a complex problem. The process compelled participants to think critically, collaboratively and in nontraditional ways.

Process Evaluation of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis.

Purpose To perform a process evaluation of the implementation of a workplace integrated care intervention for workers with rheumatoid arthritis to maintain and improve work productivity. The intervention consisted of integrated care and a participatory workplace intervention with the aim to make adaptations at the workplace. Methods The implementation of the workplace integrated care intervention was evaluated with the framework of Linnan and Steckler. We used the concepts recruitment, reach, dose delivered, dose received, fidelity and satisfaction with the intervention. Data collection occurred through patient questionnaires and medical records. Results Participants were recruited by sending a letter including a reply card from their own rheumatologist. In total, we invited 1973 patients to participate. We received 1184 reply cards, and of these, 150 patients eventually participated in the study. Integrated care was delivered according to protocol for 46.7 %, while the participatory workplace intervention was delivered for 80.6 %. Dose received was nearly 70 %, which means that participants implemented 70 % of the workplace adaptations proposed during the participatory workplace intervention. The fidelity score for both integrated care and the participatory workplace intervention was sufficient, although communication between members of the multidisciplinary team was limited. Participants were generally satisfied with the intervention. Conclusions This process evaluation shows that our intervention was not entirely implemented as intended. The integrated care was not delivered to enough participants, but for the intervention components that were delivered, the fidelity was good. Communication between members of the multidisciplinary team was limited. However, the participatory workplace intervention was implemented successfully, and participants indicated that they were satisfied with the intervention.