Barriers and Facilitators of Implementing Injury Prevention Practices by Massage Therapists.

OBJECTIVE: Massage therapy involves pervasive ergonomic hazards with the majority of massage therapists (MTs) experiencing adverse musculoskeletal health issues. A variety of barriers and facilitators exist that can impact the efficacy of safety programs. METHODS: A longitudinal study to characterize individual and organizational barriers and facilitators that influence the implementation of self-care techniques designed to reduce musculoskeletal health issues. RESULTS: MTs who reported time as abarrier implemented 0.9 fewer selfcare items despite wanting to make these changes (P  = 0.003) and 1.4 fewer self-care items when management was identified as a barrier (P < 0.001). Almost 20% of the MTs reported switching jobs which was associated with implementing 1.1 fewer self-care items (P = 0.002). CONCLUSIONS: Our findings show that organizational factors plays a critical role in workplace safety which can be used to improve working conditions faced by MTs.

Attitudes and behaviors of chiropractic interns toward occupational history taking.

OBJECTIVE: This study uses a pre- and post-training program evaluation of chiropractic interns to (1) describe changes in their frequency of occupational history taking before and after a 1-hour training and (2) to document the attitudes and beliefs regarding occupational health and history taking. METHODS: All chiropractic interns at 1 clinic location completed questionnaires assessing their attitudes and perceptions regarding documenting the occupational history of their patients each trimester they were enrolled in the study. Each intern enrolled in the study for 2 or more trimesters participated in a 1-hour-long training session on taking an occupational history. The supervising clinician independently evaluated charting behaviors of interns for the duration of the study. RESULTS: The supervising clinician assessed 20 interns' level of documenting occupational history for 202 new patient or reexamination visits. A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was "very important." Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%). CONCLUSION: Chiropractic interns and clinicians should be adequately trained in occupational health history documentation practices as they are likely to care for work-related injuries. Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking.

Anthropometric, environmental, and dietary predictors of elevated blood cadmium levels in Ukrainian children: Ukraine ELSPAC group.

No comprehensive data on sources or risk factors of cadmium exposure in Ukrainian children are available. In this we measured the blood levels of cadmium among 80 Ukrainian children and evaluated sources of exposure. A nested case-control study from a prospective cohort of Ukrainian 3-year-old children was conducted. We evaluated predictors of elevated blood cadmium using a multivariable logistic regression model. The model included socioeconomic data, parent occupation, environmental tobacco smoke, hygiene, body-mass index, and diet. Dietary habits were evaluated using the 1992 Block-NCI-HHHQ Dietary Food Frequency survey. Elevated cadmium was defined as blood levels in the upper quartile (0.25 microg/L). The mean age for all 80 children was 36.6 months. Geometric mean cadmium level was 0.21 microg/L (range = 0.11-0.42 microg/L; SD = 0.05). Blood cadmium levels were higher among children taking zinc supplements (0.25 vs 0.21 microg/L; P = 0.032), children who ate sausage more than once per week (0.23 vs 0.20; P = 0.007) and children whose fathers worked in a by-product coking industry (0.25 vs 0.21; P = 0.056). In the multivariable model, predictors of elevated blood cadmium levels included zinc supplementation (adjusted OR = 14.16; P < 0.01), father working in a by-product coking industry (adjusted OR = 8.50; P = 0.03), and low body mass index (<14.5; adjusted OR = 5.67; P = 0.03). This is the first study to indicate a strong association between elevated blood cadmium levels and zinc supplementation in young children. Whole-blood cadmium levels observed in this group of Ukrainian children appear to be similar to those reported in other Eastern European countries.

Conflicts of interest and scientific integrity.

The encroachment of conflicts of interest on the peer-review process of scientific journals is discussed, with particular reference to a current example. The authors stress the need for transparency of the connections among authors, reviewers, publishers, editors, and sources of funding to prevent erosion of trust in the scientific integrity of such publications.