Industrialization and food safety for the Tsleil-Waututh Nation: An analysis of chemical levels in shellfish in Burrard Inlet.

While Indigenous food systems remain critical for community well-being, traditionally harvested foods are a potential source of toxic exposures. The Tsleil-Waututh Nation (TWN) is seeking to restore shellfish harvesting in Burrard Inlet (British Columbia [BC], Canada), where the cumulative effects of industrial activity have nearly eliminated safe harvesting. The Trans Mountain Expansion project would triple the capacity to transport oil through the inlet, threatening TWN's progress to restore shellfish harvesting. To inform ongoing efforts we assessed contamination by heavy metals (arsenic, cadmium, lead, and mercury) and 48 polycyclic aromatic hydrocarbons (PAHs) congeners in different shellfish species (Softshell clams, Varnish clams, and Dungeness crab) in three areas. We compared our results against local screening values (SVs) established by the TWN and BC Ministry of Environment and Climate Change Strategy, as well as provincial and national benchmarks. In total, we analyzed 18 composite samples of Softshell clams and Varnish clams (5 individuals per sample), as well as 17 individual crabs. We found chemical contamination in all species at all sites. PAHs were most frequently detected in Softshell clams, highest in the site closest to the pipeline terminus. Clams presented higher levels of contamination than crabs for PAHs, but not for heavy metals. For Softshell and Varnish clams, all heavy metals across study sites exceeded at least one of the population-specific SVs. Of the 14 PAHs detected, benzo(a)pyrene presented a median concentration in Softshell clams of 3.25 µ/kg, exceeding local SV for subsistence fisher. Our results call for further assessment of human health impacts related to food harvesting within Burrard Inlet and establishing a long-term coordinated program co-led by the TWN to monitor contamination and inform future harvesting programs. The study draws attention to the need to consider locally-relevant toxicity benchmarks, and include potential health impacts of food contamination in appraising development project proposals.

Reforming the workers' compensation process for occupational lung disease among miners in South Africa: an efficiency study of claims assessment.

PURPOSE: The large burden of silicosis and tuberculosis (TB) in the South African mining industry, coupled with an under-resourcing of the compensation agencies responsible for certifying occupational lung disease, have resulted in serious backlogs. This work aimed to measure the efficiency gains from triaging occupational lung disease claims using claim type, years of mining exposure and computer aided detection (CAD) to save on scarce medical adjudicators. METHODS: During 2020, the compensation authority started to triage claims for TB and those of miners with < 10 years of service to two-person panels instead of the four-person panel plus radiologist used previously. Efficiency gain was calculated in medical person-units saved and reduction in delays. Different service thresholds predictive of silicosis were simulated, as well as the impact of pre-classification of chest X-rays with CAD using different combinations of sensitivity and specificity. RESULTS: The new triage system saved 20.3% in person-time units and reduced delays by 10-20 days. Without CAD the greatest efficiency gain (28%) was projected from dispensing with a mining service threshold and routing all non-TB claims to the small panels at the outset. Simulation of four different CAD sensitivity/specificity combinations yielded efficiency gains of 18.2-36.1%, with 31.1% judged the most realistic. Use of sensitivity of close to 100% would not be feasible because of the very low resulting specificity. CONCLUSION: Pre-adjudication triage of claims at the compensation agency is capable of saving a substantial proportion of adjudicator time and reducing certification delays. Additional efficiency gains are achievable by referring all claims to small panels to begin with and improvement of CAD performance for this ex-miner population.

Effect of effort-reward imbalance and burnout on infection control among Ecuadorian nurses.

BACKGROUND: Nurses are frequently exposed to transmissible infections, yet adherence to infection control measures is suboptimal. There has been inadequate research into how the psychosocial work environment affects compliance with infection control measures, especially in low- and middle-income countries. AIM: To examine the association between effort-reward imbalance, burnout and adherence to infection control measures among nurses in Ecuador. INTRODUCTION: A cross-sectional study linking psychosocial work environment indicators to infection control adherence. METHODS: The study was conducted among 333 nurses in four Ecuadorian hospitals. Self-administered questionnaires assessed demographic variables, perceived infection risk, effort-reward imbalance, burnout and infection control adherence. RESULTS: Increased effort-reward imbalance was found to be a unique incremental predictor of exposure to burnout, and burnout was a negative unique incremental predictor of nurses' self-reported adherence with infection control measures. DISCUSSION: Results suggest an effort-reward imbalance-burnout continuum, which, at higher levels, contributes to reduce adherence to infection control. The Ecuadorean government has made large efforts to improve universal access to health care, yet this study suggests that workplace demands on nurses remain problematic. CONCLUSION: This study highlights the contribution of effort-reward-imbalance-burnout continuum to the chain of infection by decreased adherence to infection control of nurses. IMPLICATIONS FOR NURSING POLICY: Health authorities should closely monitor the effect of new policies on psychosocial work environment, especially when expanding services and increasing public accessibility with limited resources. Additionally, organizational and psychosocial interventions targeting effort-reward imbalance and burnout in nurses should be considered part of a complete infection prevention and control strategy. Further study is warranted to identify interventions that best ameliorate effort-reward imbalance and burnout in low- and middle-income settings.

Workers' compensation claims for occupational tuberculosis in South African health workers: Outcomes and workers' experiences.

BACKGROUND: Given the elevated risk of tuberculosis (TB), including drug-resistant disease, experienced by health workers in South Africa (SA), effective workers' compensation for occupational TB is a legal right and an essential social benefit. OBJECTIVES: To investigate the experience of the workers' compensation system among health workers who suffered from TB while working in public service facilities in Western Cape Province, SA. METHODS: In this case series with a qualitative component, 300 claims for occupational TB in health workers were sampled from the provincial health department database of claims submitted. Claim status for each case was ascertained. An attempt was made to contact each health worker for a telephonic interview consisting of both closed- and open-ended (qualitative) questions. Fifty-one interviews were completed. RESULTS: In nearly half of the cases, there was no record of claim status on the state Compensation Fund website. Of the 51 interviewees, only one had received all the compensation benefits for their particular claim circumstances. Health workers' experience of having their cases reported for compensation purposes was marred by perception of poor communication and administration. The experience of contracting TB was further characterised by surprise, perceptions of stigma, financial burden and ongoing ill-health. CONCLUSIONS: Affected health workers' experience of the workers' compensation system was mostly negative, adding to the burden of being ill with TB. Education of management and clinicians, improvement in communication, and timeous and regular checking of claim status and of payment of applicable compensation are required at the provincial level. Dedicated facility-based occupational health units are needed, with a staff complement of knowledgeable persons trusted by their colleagues. However, the effectiveness of the system is ultimately dependent on the ability of the Compensation Fund to register and display claims timeously and administer compensation expeditiously.

Computer-aided detection for tuberculosis and silicosis in chest radiographs of gold miners of South Africa.

BACKGROUND: For over one hundred years, the gold mining sector has been a considerable source of tuberculosis (TB) and silicosis disease burden across Southern Africa. Reading chest radiographs (CXRs) is an expert and time-intensive process necessary for the screening and diagnosis of lung disease and the provision of evidence for compensation claims. Our study explores the use of computer-aided detection (CAD) of TB and silicosis in CXRs of a population with a high incidence of both diseases.METHODS: A set of 330 CXRs with human expert-determined classifications of silicosis, TB, silcotuberculosis and normal were provided to four health technology companies. The ability of each of their respective CAD systems to predict disease was assessed using receiver operating characteristic curve analysis of the under the curve metric.RESULTS: Three of the four systems differentiated accurately between TB and normal images, while two differentiated accurately between silicosis and normal images. Inclusion of silicotuberculosis images reduced each system's ability to detect either disease. In differentiating between any abnormal from normal CXR, the most accurate system achieved both a sensitivity and specificity of 98.2%.CONCLUSION: The current ability of CAD to differentiate between TB and silicosis is limited, but its use as a mass screening tool for both diseases shows considerable promise.

Are you prepared? Defining occupational health resource needs to prevent infectious disease transmission in the health care sector.

This article discusses the extent of resource allocation to Occupational Health (OH) to prevent infectious disease exposure and transmission in British Columbia (B.C.). It also characterizes the delineation of roles and responsibilities within OH services in B.C. health care settings and highlights areas where improvements to current OH programs could be made to prevent and control occupational infections. Given the breadth of OH responsibilities, resource allocation in many health care institutions for these services is inadequate and roles and responsibilities may not be clearly delineated.

Social transformation, collective health and community-based arts: 'Buen Vivir' and Ecuador's social circus programme.

Worldwide, interest is increasing in community-based arts to promote social transformation. This study analyzes one such case. Ecuador's government, elected in 2006 after decades of neoliberalism, introduced Buen Vivir ('good living' derived from the Kichwan sumak kawsay), to guide development. Plans included launching a countrywide programme using circus arts as a sociocultural intervention for street-involved youth and other marginalised groups. To examine the complex ways by which such interventions intercede in 'ways of being' at the individual and collective level, we integrated qualitative and quantitative methods to document relationships between programme policies over a 5-year period and transformations in personal growth, social inclusion, social engagement and health-related lifestyles of social circus participants. We also conducted comparisons across programmes and with youth in other community arts. While programmes emphasising social, collective and inclusive pedagogy generated significantly better wellbeing outcomes, economic pressures led to prioritising productive skill-building and performing. Critiques of the government's operationalisation of Buen Vivir, including its ambitious technical goals and pragmatic economic compromising, were mirrored in social circus programmes. However, the programme seeded a grassroots social circus movement. Our study suggests that creative programmes introduced to promote social transformation can indeed contribute significantly to nurturing a culture of collective wellbeing.

Staff perception and institutional reporting: two views of infection control compliance in British Columbia and Ontario three years after an outbreak of severe acute respiratory syndrome.

Few studies have audited the resources available to infection control (IC) and occupational health (OH) to promote safe work behaviour, whilst comparing audited findings with perceptions by healthcare workers (HCWs). We aimed to determine the IC and OH resources available and compare this with HCWs' perception of resources, following an outbreak of severe acute respiratory syndrome (SARS). A survey of IC and OH resources and a questionnaire completed by HCWs were compared with on-site observational audits. HCWs believed that plans were available to protect against future SARS-like events but audits revealed that these did not exist in many facilities. Both OH and IC were under-resourced post-SARS, with OH professionals particularly lacking in British Columbia. There is a discrepancy between HCWs' perception of what is available and what is actually accessible in facilities. Experts in IC and OH need to focus on communication.

Promoting health in response to global tourism expansion in Cuba.

The ability of communities to respond to the pressures of globalization is an important determinant of community health. Tourism is a rapidly growing industry and there is an increasing concern about its health impact on local communities. Nonetheless, little research has been conducted to identify potential mitigating measures. We therefore took advantage of the 'natural experiment' provided by the expansion of tourism in Cuba, and conducted four focus groups and key informants interviews in each of two coastal communities. Participants expressed concerns about psycho-social impacts as well as occupational and environmental concerns, and both infectious and chronic diseases. A wide array of programs that had been developed to mitigate potential negative were described. Some of the programs were national in scope and others were locally developed. The programs particularly targeted youth as the most vulnerable population at risk of addictions and sexually transmitted infections. Occupational health concerns for workers in the tourism sector were also addressed, with many of the measures implemented protecting tourists as well. The health promotion and various other participatory action initiatives implemented showed a strong commitment to address the impacts of tourism and also contributed to building capacity in the two communities. Although longitudinal studies are needed to assess the sustainability of these programs and to evaluate their long-term impact in protecting health, other communities can learn from the initiatives taken.

Participatory theatre and tuberculosis: a feasibility study with South African health care workers.

SETTING: Health care workers (HCWs) in South Africa have a risk of acquiring tuberculosis (TB) that is twice that of the general population. Nonetheless, adherence to infection control and TB disclosure requirements remain problematic. OBJECTIVE: To gain insight into the feasibility of an educational participatory theatre intervention to reduce the risk of occupational TB. DESIGN: An intervention using participatory theatre was developed progressively over six consecutive sessions with different groups of HCWs, totalling 83 participants. Videos of the sessions, field notes, observations, interviews and a post-experience survey were analysed to ascertain feasibility. RESULTS: The intervention was acceptable to participants, met a defined demand, proved adaptable to the target group and was practical if done during working hours or if integrated into already existing training sessions. The theatre work shed light on where to focus educational interventions. Preliminary efficacy outcomes included strengthened social cohesion via group work and reports of subsequent greater vigilance regarding occupational TB. CONCLUSION: Participatory theatre techniques may offer a useful, culturally appropriate supplement to existing educational approaches to the prevention and management of occupational TB. Given the limitations in resources and our assessment of feasibility, training existing health care educators in such techniques would be a promising next step.

Infection control and tuberculosis in health care workers: an assessment of 28 hospitals in South Africa.

SETTING: Twenty-eight public hospitals in the Free State Province, South Africa. OBJECTIVE: To examine the association between tuberculosis (TB) infection control (IC) scores in Free State hospitals and the incidence of TB disease among health care workers (HCWs) in 2012. DESIGN: A cross-sectional survey and mixed-methods analysis of TB IC policies, practices and infrastructure using a comprehensive, 83-item IC audit and observation tool. RESULTS: As the total IC score increased, the probability of TB in an HCW at that hospital decreased. When adjusted for other covariates in multivariate analysis, if the total score of a hospital increased by one unit, the odds of an HCW having TB decreased by 4.9% (95%CI 0.9-8.8). Significant associations were also seen for the personal protective equipment (PPE) score, where odds decreased by 11.5% (95%CI 1.8-20.1) for each unit increase in score. Administrative score, environmental score and miscellaneous score were not statistically significant in the multivariate model. CONCLUSIONS: These findings reaffirm that overall IC and PPE are essential to protect HCWs from acquiring TB. More attention to TB IC is required to protect the health care workforce and to stop the South African TB epidemic.

Occupational tuberculosis in South Africa: are health care workers adequately protected?

Setting: A provincial tertiary hospital in Gauteng province, South Africa, with a high burden of tuberculosis (TB) patients and high risk of TB exposure among health care workers (HCWs). Objective: To determine HCWs' adherence to recommended TB infection prevention and control practices, TB training and access to health services and HCW TB rates. Design: Interviews with 285 HCWs using a structured questionnaire as part of a large, international mixed-methods study. Results: Despite 10 HCWs (including seven support HCWs) acquiring clinical TB during their period of employment, 62.8% of interviewees were unaware of the hospital's TB management protocol. Receipt of training was low (34.5% of all HCWs and <5% of support HCWs trained on TB transmission; 27.5% of nurses trained on respirator use), as was use of respiratory protection (44.5% of HCWs trained on managing TB patients). Support HCWs were over 36 times more likely to use respiratory protection if trained; nurses who were trained were approximately 40 times more likely to use respirators if they were readily available. Conclusion: Improved coordination and uptake of TB infection prevention training is urgently needed, especially for non-clinical HCWs in settings of regular exposure to TB patients. Adequate supplies of appropriate respiratory protection must be made available.

Contexte : Un hôpital provincial de niveau tertiaire dans la province de Gauteng, Afrique du Sud avec de très nombreux patients avec tuberculose (TB) et un risque élevé d'exposition à la TB parmi les travailleurs de santé (HCW).Objectif : Déterminer l'observance des HCW vis-à-vis des pratiques recommandées de prévention de l'infection et de lutte contre la TB, la formation en matière de TB et l'accès aux services de santé, et le taux de TB chez les HCW.Schéma : Entretiens avec 285 HCW, basés sur un questionnaire structuré, dans le cadre d'une vaste étude internationale à multiples méthodes.Résultats : Bien que 10 HCW (dont sept personnels de soutien) aient eu une TB pendant leur période de travail, 62,8% des répondants n'étaient pas au courant du protocole de prise en charge de la TB dans l'hôpital. La couverture de la formation a été faible (34,5% de tous les HCW et moins de 5% des HCW de soutien sur la transmission de la TB ; 27,5% des infirmiers sur l'utilisation d'un masque respiratoire), tout comme l'utilisation d'une protection respiratoire (44,5% des HCW prenant en charge des patients TB). Les HCW de soutien ont été 36 fois plus susceptibles d'utiliser une protection respiratoire s'ils avaient été formés ; les infirmiers qui avaient été formés ont été environ 40 fois plus susceptibles d'utiliser des masques respiratoires s'ils étaient facilement disponibles.Conclusion : Une amélioration de la coordination et de la couverture de la formation à la prévention de l'infection TB est requise d'urgence, surtout pour les HCW de soutien dans les contextes d'exposition régulière aux patients TB. Des stocks suffisants de protection respiratoire doivent être disponibles.

Marco de referencia: Un hospital provincial de atención terciaria en la provincia de Gauteng de Suráfrica, donde se observa una alta carga de morbilidad por tuberculosis (TB) y un alto riesgo de exposición de los profesionales de salud (HCW) a la enfermedad.Objetivo: Evaluar la observancia de las prácticas de prevención y control de la infección tuberculosa, la capacitación en materia de TB y el acceso de los HCW a los servicios de atención y calcular la tasa de TB en este tipo personal.Método: Se entrevistaron 285 HCW mediante un cuestionario estructurado, en el marco de un extenso estudio internacional por métodos mixtos.Resultados: Pese a que 10 HCW (incluidos siete miembros del personal auxiliar) habían adquirido la enfermedad tuberculosa durante el período de su empleo, el 62,8% de los entrevistados no conocía el protocolo de manejo de la TB del hospital. La tasa de capacitación era baja (34,5% de todos los HCW y menos de 5% del personal auxiliar sobre la transmisión de la TB y 27,5% del HCW sobre la utilización de mascarillas respiratorias) y asimismo la utilización de la protección respiratoria (el 44,5% de los HCW que se ocupaban de pacientes con TB). La probabilidad de que personal auxiliar utilizara la protección respiratoria era 36 veces mayor al haber recibido capacitación; el personal de enfermería tenía una probabilidad 40 veces mayor de utilizar las mascarillas respiratorias cuando había sido formado y el material estaba al alcance.Conclusión: Se precisa con urgencia una mejor coordinación y una utilización más amplia de la formación sobre la prevención de la infección tuberculosa, sobre todo dirigida a los HCW auxiliares, en los entornos donde es corriente la exposición a pacientes tuberculosos. Es necesario contar con los suministros adecuados de protección respiratoria al alcance del personal.

Health promotion in the workplace--the merging of the paradigms.

PURPOSE: To synthesize the lessons from both occupational health and health promotion, to improve workplace health. APPROACH: This article briefly outlines the evolution in defining and understanding health promotion as well as current thinking in occupational health and safety. It also discusses an approach taken in the healthcare sector in British Columbia, Canada, where evidence-based practices and collaboration became the cornerstones to bringing about change and achieve impressive cost-beneficial results in healthcare workforce health. CONCLUSION: Traditionally, workplace health promotion and occupational health and safety have been two solitudes. Workplace health promotion is rooted in "wellness" and healthy lifestyle choices, while occupational health is heavily dictated by workplace health and safety requirements and legislation. Recently however, there has been increasing recognition of the need for a more holistic approach that focusses on workplace culture, addressing both primary and secondary prevention [1], as well as interventions aimed both at the individual as well as the organisation [2].

Electromyography as a measure of peak and cumulative workload in intermediate care and its relationship to musculoskeletal injury: an exploratory ergonomic study.

Injury rates in Intermediate Care (IC) facilities are high and the factors related to these injuries are unclear. The objectives of this exploratory sub-study, which is part of a large multi-faceted study in 8 IC facilities are to: (1) evaluate EMG measured over a full-shift in the back and shoulders of 32 care aides (CAs) as an indicator of peak and cumulative workload (n = 4 x 8 facilities); investigate the relationship between EMG measures and injury indicators; and explore the relationship between EMG measures and other workload measurements. Lumbar EMG was converted to predicted cumulative spinal compression and ranged in CAs from 11.7 to 22.8 MNs with a mean of 16.4 MNs. Average compression was significantly different during different periods of the day (p < 0.001) with highest compression during pre-breakfast when CAs assist most with activities of daily living. Significant differences were found in average compression between low and high injury facilities for 3 of 5 periods of the day (p < 0.010). Peak compressions exceeding 3400 N occurred for very little of the workday (e.g. 11.25s during the 75 min period pre-breakfast). Peak neck/shoulder muscle activity is low (99% APDF ranged from 8.33% to 28% MVC). Peak and cumulative spinal compression were significantly correlated with lost-time and musculoskeletal injury rates as well as with total tasks observed in the CAs (p < 0.01). Perceived exertion was only correlated with peak compressions (p < 0.01). Facilities with low injury rates provided significantly more CAs (p < 0.01) to meet resident needs, and subsequently CAs performed fewer tasks, resulting in less peak and cumulative spinal loading over the day.

Pilot study to detect airborne Mycobacterium tuberculosis exposure in a South African public healthcare facility outpatient clinic.

BACKGROUND: Airborne transmission of Mycobacterium tuberculosis remains an occupational health hazard, particularly in crowded and resource-limited healthcare settings. AIM: To quantify airborne M. tuberculosis in a busy outpatient clinic in Gauteng, South Africa. METHODS: Stationary air samples and samples from healthcare workers (HCWs) were collected in the polyclinic and administrative block. Quantitative real-time polymerase chain reaction (PCR) was used to detect airborne M. tuberculosis. Walkthrough observations and work practices of HCWs were also recorded. FINDINGS: In total, M. tuberculosis was detected in 11 of 49 (22.4%) samples: nine of 25 (36%) HCW samples and two of 24 (8.3%) stationary air samples. Samples from five of 10 medical officers (50%) and three of 13 nurses (23%) were positive. Repeat measurements on different days showed variable results. Most of the HCWs (87.5%) with positive results had been in contact with coughing patients and had not worn respiratory masks despite training. CONCLUSION: The use of air sampling coupled with quantitative real-time PCR is a simple and effective tool to demonstrate the risk of M. tuberculosis exposure. The findings provide an impetus for hospital management to strengthen infection prevention and control measures for tuberculosis.

Determinants of blood and body fluid exposure in a large teaching hospital: hazards of the intermittent intravenous procedure.

Determinants of staff exposure to blood and body fluids in a 1100-bed hospital were examined over a 2-year period. Eighty-two percent of the 799 reported accidental exposures were needlestick injuries, and 18% were cutaneous or mucous membrane splashes. Nurses and nursing students incurred 78.8% of the exposures; respiratory technologists and laboratory personnel, 9.2%; medical personnel, 7.5%; and support staff, 4.2%. Rate of exposure per 100,000 hours worked showed nursing students to be at particularly high risk, highlighting the need for specific instruction. Analysis of events leading to needlestick-related exposures revealed that the heparin lock intermittent intravenous procedure was involved in 26%; recapping accounted for 17%; improper disposal, 15%; manipulating equipment, 14%; phlebotomy, 12%; and other needlestick events, 16%. Ocular splashes and spills onto nonintact skin each accounted for 50% of the total number of non-needlestick-related exposures. This study revealed the hazardous nature of the intermittent intravenous procedure, prompting specific revisions in this procedure as well as promoting point-of-use sharps disposal and other preventive measures.

Efficacy and cost-effectiveness of a needleless intravenous access system.

BACKGROUND: Needlestick injury has been identified as a major cause of exposure to blood and body fluids. The heparin-lock intermittent intravenous procedure was implicated in the largest number of needlestick-related exposures (26%) at this 1100-bed tertiary care hospital, and replacement of this system was imperative. Cost concerns, however, necessitated that replacement products not increase overall hospital costs. METHODS: A needleless intravenous access system (Interlink i.v. Access System; Baxter Healthcare Corp., Parenterals Division, Deerfield, Ill.) was introduced. Effectiveness and cost-benefit of this system were analyzed by comparing needlestick injuries and their associated costs, as well as costs of relevant products and procedures, for the year before introduction of the new product with those for 1 year after implementation of the new system. RESULTS: During the study period, the needleless access system was 78.7% effective in reducing intravenous line-related needlestick injuries. There was an overall reduction of 43.4% in total needlestick injuries from all procedures and events. The incremental cost to this hospital ranged from a 5.3% additional cost to a 5.7% savings, without even considering the less quantifiable benefits associated with avoidance of needlestick injury, time saved by using this product, and decreased infection rate. CONCLUSION: When used as intended, this system was extremely effective in reducing intravenous line-related needlestick injuries, and the system does pay for itself.

Predictors of time loss after back injury in nurses.

STUDY DESIGN: A 2-year prospective inception cohort study of back injury in nurses. OBJECTIVES: To determine the extent to which characteristics of nurses, of the injury, and of the workplace predict occurrence and duration of time loss from work after back injury. SUMMARY OF BACKGROUND DATA: During 2 years, 320 nurses incurred 416 back injuries at a large teaching hospital in Winnipeg, Canada. Nurses injured on preselected wards were targeted for early intervention, including provision of modified work, whereas nurses injured on other wards received the usual care. METHODS: Time loss attributable to the back injury during the 6 months after injury was analyzed. Three statistical models were used to examine occurrence of time loss (logistic regression), duration of time loss (Tobit regression), and duration of time loss once an injury incurring time loss had been documented (least-squares regression). RESULTS: In 218 of the 416 injuries, the injured nurse consented to interview. Whereas perceived disability was related to whether a time loss injury would ensue, self-reported pain was strongly related to the duration of time loss once an injury had become a time loss injury. Duration of time loss was reduced by participation in the return-to-work program. Mechanism of injury, specifically injury occurring while lifting patients, resulted in greater time loss. CONCLUSIONS: Focusing on reducing the perception of disability at the time of injury is critical to preventing time loss, but once time loss has occurred, offer of modified work and attention to pain reduction are warranted. The findings add to the evidence that workplace-based intervention programs can be effective in reducing the morbidity resulting from back injury.

Components of initial and residual disability after back injury in nurses.

STUDY DESIGN: A pre- versus postintervention with concurrent control group design was used to investigate the effect of a workplace-based early intervention program on perception of disability in nurses with low back injury. OBJECTIVES: This report examines changes over time in the components of the Oswestry Low Back Pain and Disability Questionnaire in two groups of back-injured nurses-those who received the early intervention program (study) and those who were not offered the program (control). SUMMARY OF BACKGROUND DATA: Early intervention programs can decrease morbidity, time lost from work, and compensation costs. Although perception of disability decreases, some residual disability remains, the nature of which is not clear. METHODS: The Oswestry Low Back Pain and Disability Questionnaire scores of 40 study nurses and 118 control nurses at time of injury and at 6 months after injury were examined. Analysis of variance was used to compare changes in mean overall scores over time. The proportion of nurses reporting disability on individual components of the Oswestry Low Back Pain and Disability Questionnaire at each time period was compared with the results of a chi-square test. RESULTS: Overall Oswestry Low Back Pain and Disability Questionnaire scores were similar between study and control nurses at time of injury, but were significantly lower in study nurses at 6 months after injury. However, scores of individual Oswestry Low Back Pain and Disability Questionnaire components that related to job demands increased over time; this was most apparent in lifting, particularly in study nurses. CONCLUSIONS: Although overall perception of disability decreased 6 months after injury, particularly in study nurses, disability in job-related activities persisted. Residual disability after back injury should be addressed in workplace-based prevention programs.

Effect of an early intervention program on the relationship between subjective pain and disability measures in nurses with low back injury.

STUDY DESIGN: The effect of a workplace-based early intervention program on perceptions of pain and disability in nurses with low back injury was studied using a preintervention versus postintervention design with concurrent control group. OBJECTIVES: To examine the relationship and changes over time between pain and disability measures in two groups of back-injured nurses--those who received the early intervention program (study) and those who were not offered the program (control). SUMMARY OF BACKGROUND DATA: The relationship between back pain and disability is not straightforward. The effects of an intervention program on changes in perceptions of pain and disability over time have not been widely reported. METHODS: The Oswestry Low Back Disability Questionnaire and a visual analog pain scale were administered to 46 study nurses and 137 control nurses at time of injury and at 6 months after injury. Correlation and regression analyses were used to explore the relationships between the two measures. Changes over time were compared with analyses of variance. RESULTS: Pain and disability were positively correlated in both groups at time of injury and at follow-up evaluation. Mean scores for pain and disability were lower at follow-up evaluation than at initial injury in both groups; study nurses had significantly (P < 0.01) lower scores at 6 months than nurses in the control group. Disability at time of injury predicted disability at 6 months only for nurses in the control group. CONCLUSIONS: This workplace-based early intervention program decreased levels of pain and disability in back-injured nurses and altered the relationship between these two variables over a 6-month time interval.