Are medical students in prehospital care at risk of moral injury?

BACKGROUND: The term 'moral injury' may be useful in conceptualising the negative psychological effects of delivering emergency and prehospital medicine as it provides a non-pathological framework for understanding these effects. This is in contrast to concepts such as burnout and post-traumatic stress disorder which suggest practitioners have reached a crisis point. We conducted an exploratory, pilot study to determine whether the concept of moral injury resonated with medical students working in emergency medicine and what might mitigate that injury for them. METHODS: Structured interviews and focus groups were carried out with medical students involved in the delivery of prehospital and emergency medicine. The study was carried out at Barts and the London School of Medicine and Dentistry in May and June 2017. The data were analysed using theoretically driven thematic analysis. RESULTS: Concepts of moral injury such as witnessing events which contravene one's moral code, especially those involving children, or acts of violence, resonated with the experiences of medical students in this study. Participants stated that having more medical knowledge and a clear sense of a job to do on scene helped reduce their distress at the time. While social support was a protective factor, not all students found the process of debrief easy to access or undergo, those with more established relationships with colleagues fared better in this regard. CONCLUSIONS: The term moral injury is useful in exploring the experience of medical students in emergency medicine. More effort should be made to ensure that students effectively access debrief and other support opportunities. It is hoped that future work will be undertaken with different professional groups and explore the potential psychological and neuropsychological impact of witnessing trauma.

[Comparative hygienic evaluation of work conditions in sulphate cellulose production, with consideration of modern mechanization].

Comparative evaluation covered work conditions in contemporary sulphate cellulose productions with various levels of mechanization and automation. Findings are that major work hazards for cellulose production workers are: polluted workplace air with chemical complex (methylsulphurous compounds, chlorine, chlorine dioxide, alkaline aerosol) in concentrations exceeding MAC, heating microclimate, noise. Levels of workplace air pollution with chemical hazards and transitory disablement morbidity parameters are considerably lower in highly automated production.

[Industrial medicine in production and processing of alloys based on copper].

In copper alloys production, workers engaged into the process are exposed to occupational hazards with leading one being high-dispersed dust of complex chemical composition. The workers of main occupations demonstrate increased prevalence of respiratory diseases, digestive diseases, peripheral nervous system disorders - that necessitates implementation of complex measures both in improvement of work conditions and in medical prophylaxis.

[OCCUPATIONAL RISK ASSESSMENT IN MODERN CONDITIONS OF EXPLOITATION OF POLYURETHANEFOAM INDUSTRIES].

In the article there are presented data on the evaluation of occupational risk on two types of modern production of polyurethane foam (PUF), one of which is a large-tonnage fast-growth production, the 2nd type is semidomestic industry being different in small volume of output products. An analysis and evaluation of occupational exposure to large-scale production was performed patient-specifically with the use of elaborated individual cards, where there was introduced information about occupational route, the level of harmful factors of the working environment in all the years of work, the duration of exposure. The research results allowed to establish that the occupational risk in representatives of the main professions in the large-scale production (operators and handlers) is referred to a class of working conditions 3.2, which corresponds to the risk categories--moderate (Important), and demonstrates the need for further improvement of the system of preventive measures. At the small production working conditions were characterized by the presence of a large number of manual operations and comply with Class 3.3--category of professional risk-high (Unbearable). To reduce the risk to the health of workers of this type of production it is necessary to develop documents, that will increase the responsibility of employers to ensure safe working conditions.

[Hygienic assessment of working conditions in the production of ferro-alloys].

This work is devoted to the study of conditions of the work of employees of the modern ferro-alloy production, which was performed in the framework of the evaluation of working places at the Open Joint-Stock Company «Ferrokhrom¼, which is part of Joint-Stock Transnational Company "Kazchrom". The studies were performed with account of the full range of the list of working places, both in the main and auxiliary shops. The work activity of the workers from leading professional groups was established to be conjugate of the impact of the complex of unfavorable factors of occupational environment and labor process. There are given comprehensive measures to improve working conditions and health maintenance in workers from leading professional groups.

[Ergonomic movement in dentistry]. / Gezond bewegen in de tandheelkunde.

'Ergonomic movement in dentistry' is a recently developed ergonomic programme for dental healthcare professionals which is intended to prevent work-related complaints and assist in recovering from them. The programme is recommended by disability insurers in cases of specific physical complaints, limitations or disability, as a consequence of which a dental healthcare professional is unable to carry out his or her work. In a four-day training programme, in one's own workplace, skills are taught in the areas of work organization, work attitude and movement. These skills are directly applied in the treatment ofpatients and, if necessary, further improved. In this way, one advances step by step to an ergonomic way of working. Evaluations have shown that the programme is advantageous for the attitude toward work, the workplace and the work organization as well as the reduction of disability.

[Contemporary state of work conditions and occupational morbidity of workers engaged into rubber, mechanical rubber and tire industries].

Based on analysis of materials provided by occupational safety department PC "UZEMiK" and JSC "Kauchuk", the authors evaluate contemporary work conditions and occupational morbidity in workers engaged into rubber, mechanical rubber and tyre industries.

[Evaluation of aerogenic occupational health risk for workers engaged into periclase-carbon refractories production].

The work is aimed to evaluate aerogenic occupational health risk for workers engaged into preparation and formation of technologic mass in periclase-carbon refractories production, using organic binding agent according to criteria R 2.2.2006-05 and R 2.2.1716-03. Occupational dust is a complicated chemical mixture containing manganum oxide, phenol, formaldehyde, aerosols containing silicon, benzpyrene (if "Carbores" binding agent used). Hygienic evaluation revealed occupational health risk due to occupational dust at workplaces of runners operator, press operator, batching feeder, crane operator. Aerogenic occupational risk at workplace of grinder operator is assessed as negligibly small (tolerable). Experimental and epidemiologic studies prove probable (proof category 1B) occupational risk of respiratory disease at the studied production.

[Occupational hygiene topics in ferroalloys production].

Hygienic evaluation covered work conditions of main occupations in ferroalloys production on a plant in Ural regions. The occupations are: ferroalloy furnace operator, ferroalloy furnace worker and crane operator. The findings proved that the workers are exposed to a complex of occupational hazards among which dust and unfavorable microclimate play major role. At the enterprise, occupational dust disease cases (silicosis from exposure to silicon-containing dust) are registered, with average development duration of 28.7 +/- 6.2 years.

[Individual and group occupational risk evaluation in metallizers in the process of covering titanium half-finished products with aluminum].

A purpose of this research is individual and group occupational risk evaluation at metallizers workplaces of titanium alloys production in the process of covering the titanium half-finished products with aluminum. The occupational risk has been estimated according to the hygienic criteria of Guide "P 2.2.2006-05", "P 2.2.1766-03", the individual occupational risk has been estimated according to the method, elaborated in Research Institute for Occupational Medicine of Russian Academy of Medical Sciences and Klin Institute of Work Conditions and Safety. The authors have established that the labor conditions correspond to the classes 2-3.1 in respect of air temperature, class 3.1--illumination, classes 3.3-3.4--noise. Assessing in general, with account of combined influence of the occupational hazards, the conditions have been attributed to 3-4 degrees of 3 class of harmful working conditions, that conform to the high and very high occupational risk levels. The individual occupational risk of the metallizers is characterized by the gradations from the average to very high one, the integral individual occupational risk for the group of metallizers as a whole has been estimated as the high one. Essential distinctions in the individual occupational risks should be considered while working out improving and rehabilitation actions.

[Quality of life in cryolite production workers depending on length of service].

Federal budgetary establishment of a science "the Ekaterinburg medical centre of science of preventive maintenance and health protection of workers industrial plants". Findings are that adaptation level and life quality parameters progressively decrease with longer length of service. The most unfavorable parameters are seen in cryolite production workers with length of service over 20 years and in age group of 45-55 years. Conclusion is that treatment and prevention are necessary.

Characterizing workplace exposures in Vietnamese women working in California nail salons.

OBJECTIVES: We engaged Vietnamese nail salon workers in a community-based participatory research (CBPR) study to measure personal and area concentrations of solvents in their workplace. METHODS: We measured average work-shift concentrations of toluene, ethyl acetate, and isopropyl acetate among 80 workers from 20 salons using personal air monitors. We also collected area samples from 3 salons using summa canisters. RESULTS: For personal measurements, the arithmetic mean was 0.53 parts per million (range = 0.02-5.50) for ethyl acetate, 0.04 parts per million (range = 0.02-0.15) for isopropyl acetate, and 0.15 parts per million (range = 0.02-1.0) for toluene. Area measurements were lower in comparison, but we detected notable levels of methyl methacrylate, a compound long banned from nail products. Predictors of solvent levels included different forms of ventilation and whether the salon was located in an enclosed building. CONCLUSIONS: Using a CBPR approach that engaged community members in the research process contributed to the successful recruitment of salon workers. Measured levels of toluene, methyl methacrylate, and total volatile organic compounds were higher than recommended guidelines to prevent health symptoms such as headaches, irritations, and breathing problems, which were frequently reported in this workforce.

Occupational exposures to styrene vapor in a manufacturing plant for fiber-reinforced composite wind turbine blades.

OBJECTIVES: A utility-scale wind turbine blade manufacturing plant requested assistance from the National Institute for Occupational Safety and Health (NIOSH) in controlling worker exposures to styrene at a plant that produced 37 and 42 m long fiber-reinforced wind turbine blades. The plant requested NIOSH assistance because previous air sampling conducted by the company indicated concerns about peak styrene concentrations when workers entered the confined space inside of the wind turbine blade. NIOSH researchers conducted two site visits and collected personal breathing zone and area air samples while workers performed the wind turbine blade manufacturing tasks of vacuum-assisted resin transfer molding (VARTM), gelcoating, glue wiping, and installing the safety platform. METHODS: All samples were collected during the course of normal employee work activities and analyzed for styrene using NIOSH Method 1501. All sampling was task based since full-shift sampling from a prior Occupational Safety and Health Administration (OSHA) compliance inspection did not show any exposures to styrene above the OSHA permissible exposure limit. During the initial NIOSH site visit, 67 personal breathing zone and 18 area air samples were collected while workers performed tasks of VARTM, gelcoating, glue wipe, and installation of a safety platform. After the initial site visit, the company made changes to the glue wipe task that eliminated the need for workers to enter the confined space inside of the wind turbine blade. During the follow-up site visit, 12 personal breathing zone and 8 area air samples were collected from workers performing the modified glue wipe task. RESULTS: During the initial site visit, the geometric means of the personal breathing zone styrene air samples were 1.8 p.p.m. (n = 21) for workers performing the VARTM task, 68 p.p.m. (n = 5) for workers installing a safety platform, and 340 p.p.m. (n = 14) for workers performing the glue wipe task, where n is the number of workers sampled for a given mean result. Gelcoating workers included job categories of millers, gelcoat machine operators, and gelcoaters. Geometric mean personal breathing zone styrene air samples were 150 p.p.m. (n = 6) for millers, 87 p.p.m. (n = 2) for the gelcoat machine operators, and 66 p.p.m. (n = 19) for gelcoaters. The geometric mean of the personal breathing zone styrene air samples from the glue wipe task measured during the follow-up site visit was 31 p.p.m. (n = 12). CONCLUSIONS: The closed molding VARTM process was very effective at controlling worker exposures to styrene. Personal breathing zone styrene air samples were reduced by an order of magnitude after changes were made to the glue wipe task. The company used chemical substitution to eliminate styrene exposure during the installation of the safety platform. Recommendations were provided to reduce styrene concentrations during gelcoating.

Airborne particulate metals in the New York City subway: a pilot study to assess the potential for health impacts.

A prior study in New York City observed that airborne concentrations of three metals found in steel - iron, manganese, and chromium - are more than 100 times higher in the subway system than in aboveground air. To investigate the potential for health effects of exposure at these levels, we conducted a pilot study of subway workers comparing personal exposures to steel dust with biomarkers of metal exposure, oxidative stress, and DNA damage in blood and urine samples. Workers wore a personal air sampler operating at 4L/m for one to three work shifts with blood and urine samples collected at the end of the final shift. We found that PM(2.5) exposures varied among subway workers on the basis of job title and job activity. The subway workers' mean time-weighted PM(2.5) exposure was 52 microg/m3, with a median of 27 microg/m3, and a range of 6-469 microg/m3. The observed concentrations of PM(2.5), iron, manganese, and chromium fell well below occupational standards. Biomarker concentrations among the 39 subway workers were compared with a group of 11 bus drivers, and a group of 25 suburban office workers. Concentrations of DNA-protein crosslinks and chromium in plasma were significantly higher in subway workers than in bus drivers, but no significant difference was observed for these biomarkers between subway workers and office workers. Urinary isoprostane concentrations were significantly correlated with the number of years working in the subway system, and were detected at higher, though not significantly higher, concentrations in subway workers than in bus drivers or office workers. At the group level, there was no consistent pattern of biomarker concentrations among subway workers significantly exceeding those of the bus drivers and office workers. At the individual level, steel dust exposure was not correlated with any of the biomarkers measured.

Oral health professionals: An exploration of the physical and psychosocial working environment.

BACKGROUND: Musculoskeletal disorders (MSD) are a significant problem in the oral health profession. This study explores oral health professionals' physical and psychosocial working environments in Australian workplaces. METHOD: Twelve oral health professionals from the public and private dental sectors participated in semi-structured interviews. Interviews were recorded and transcribed. Themes were identified and a coding framework developed which was refined and clarified during analysis. RESULTS: Participants reported a range of physical and psychosocial experiences in their work environment. Three major categories of themes were identified: Job Characteristics - particularly equipment unsuited for task and time constraints; Job Satisfaction - support from management and colleagues was valued, as was the significance of providing oral health care, particularly to children and minority groups; and Individual Factors - MSD and fatigue were reported by most participants. CONCLUSION: Oral health professionals are exposed to a range of workplace physical and psychosocial hazards associated with the development of MSDs. Risk management programs for the prevention of MSDs should take into account the range of physical and psychosocial hazards that oral health professionals are exposed to.

Quality management and work environment in Swedish oral and maxillofacial surgery.

This thesis attempts to describe the opinion of the work with quality, quality management, and work environment among the employees at Oral and Maxillofacial Surgery (OMFS) clinics in Sweden. THIS THESIS AIMED TO: Analyse if the OMFS clinics in Sweden actively work with quality development and if so which systems they use. Explore the opinion of the employees about quality work. Describe how the employees of OMFS clinics in Sweden perceive good work, i.e., their image of the dimensions that the profession should contain to be really good work. Investigate whether there is a discrepancy between ideal and reality for this group. Describe how the employees of OMFS clinics in Sweden perceive their health. Analyse how work environment influenced attitudes to and knowledge of quality among employees of OMFS clinics in Sweden. The study was based on self-report questionnaires which in 2003 were sent to all OMFS clinics in Sweden. The response rate was 86%. Only at two clinics did all the respondents agree on their system. Surgeons rated intellectually stimulating work as most important, and the hazard-free work environment as least important. The nurses rated stimulating fellowship as most important, and the opportunity for career advancement as least important. The percentage unit differences between the ideal and the reality were largest for the item the work provides opportunities to have an influence on important decisions. There were significant differences between maxillofacial. surgeons and dental nurses and assistant nurses as to muscle- and joint trouble. The differences were also significant between men and women both as to muscle- and joint troubles and somatic trouble. Only work environment was significant for attitude towards quality work. Profession, gender, clinic size, and a factor for hard demand had significant associations to quality management system used or not. IN CONCLUSION: More than half of the respondents stated that they worked with a quality system. The dental nurses and assistant nurses had a much more positive view on the potential of quality work as a means to improve their work than had the maxillo-facial surgeons. For a majority of the dental nurses the working situation concerning the physical environment was more important than for the maxillo-facial surgeons. The employees emphasized free, influential, and intellectually stimulating work, but the dissonance between ideal and reality was rather wide concerning good work. OMFS employees are feeling unhealthy, but no worse than other high-risk-groups in human service working and better than female general practice dentists. The women of OMFS employees feel worse than the men.

Formal and Informal Work-Life Balance Practices of Athletic Trainers in Collegiate and University Settings.

CONTEXT: Organizational policies for work-life balance exist, but little is known about athletic trainers' (ATs') awareness of and willingness to use them. OBJECTIVE: To explore ATs' formal and informal work-life balance policies in the collegiate and university athletic training setting. DESIGN: Sequential mixed-methods study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: We sent 4673 e-mails to National Athletic Trainers' Association ATs (full-time employment for at least 1 year, nonacademic appointment); 1221 participants began our survey (access rate = 26.1%), and 783 completed the survey (64.1% completion rate). Demographics were as follows: men = 375 (48.0%) and women = 404 (51.7%); age = 36 ± 10 years; experience = 13 ± 9 years; years at current place of employment = 8 ± 8 years; and participants with children or minor dependents = 262 (33.5%). MAIN OUTCOME MEASURE(S): We created a 17-item instrument from an earlier qualitative study. A panel of experts (n = 3; employer, employee, and researcher) completed a content analysis. Variables of interest were confidence (scale = 1-4) and satisfaction (scale = 1-5) with policies. We used Pearson χ2 analyses to compare the effect of undergoing an orientation and the presence or absence of children on the main outcome measures. RESULTS: A majority of participants had experienced formal orientation through the human resources department (n = 522, 66.8%), the direct supervisor (n = 240, 30.7%), or a colleague (n = 114, 14.6%). However, many had received no orientation (n = 184, 23.6%). Those who had undergone orientation indicated greater confidence in knowing about (P < .001) and greater satisfaction with (P < .001) formal workplace policies and benefits. Those with children stated that they had greater confidence in knowing about (P < .001) and greater satisfaction with (P = .013) formal workplace policies and benefits. Those who had been oriented felt greater confidence in knowing about (P = .009) but no difference in satisfaction with (P = .060) informal workplace policies and benefits. We did not identify differences between those with and those without children regarding their confidence in knowing about (P = .653) or satisfaction with (P = .150) informal workplace policies and benefits. CONCLUSIONS: Athletic trainers in the collegiate and university setting were not confident in their knowledge of formal or informal work-life balance policies.

Complying with the Occupational Safety and Health Administration: guidelines for the dental office.

This article outlines Occupational Safety and Health Administration (OSHA) guidelines for maintaining a safe dental practice workplace and covers requirements, such as education and protection for dental health care personnel. OSHA regulations aim to reduce exposure to blood-borne pathogens. Environmental infection control in dental offices and operatories is the goal of enforcement of OSHA codes of practice. Universal precautions reduce the risk for infectious disease. OSHA has a mandate to protect workers in the United States from potential workplace injuries. OSHA standards are available through online and print publications and owners of dental practices must meet OSHA standards for the workplace.

Work environment factors affecting quality work in Swedish oral and maxillofacial surgery.

The aim of this study was to investigate how work environment influenced attitudes to and knowledge of quality among employees of Oral and Maxillofacial Surgery (OMFS) clinics in Sweden. Data were collected with a questionnaire of 67 questions, related to quality management at the clinic, working situation, content of "good work", physical environment and health. 22 clinics with 297 employees responded, 65% of the clinics and 86% of the employees. A multiple regression analysis with the dependent variable "Attitude towards quality work" showed that only "work environment" (p = 0.010) revealed a significant association (p < 0.05). The personnel will have a more favourable attitude to quality work if they regard work environment to be important. Dental nurses and assistant nurses had more than four times more knowledge of the used quality management system than had the maxillo-facial surgeons. Women had nearly four times more knowledge of quality management than men. Clinic size was important, with better knowledge of quality management in bigger clinics. Soft demands were defined as demands for "flexibility, creativity, quality, service, engagement/commitment and ability to work together, and competence". Hard demands included economy as important, and emphasis on efficiency and productivity. There was a weak association with knowledge of quality management systems if soft demands increased, but negative if hard demands increased. In conclusion, mainly work environment was of significance for the attitude towards quality work among the employees of OMFS clinics in Sweden. Profession, gender, clinic size, and the hard demands were significantly associated with knowledge of the quality management system used.

Variability and Determinants of Occupational Noise Exposure Among Iron and Steel Factory Workers in Tanzania.

Background: Machines, processes, and tasks in the iron and steel factories may produce noise levels that are harmful to hearing if not properly controlled. Studies documenting noise exposure levels and related determinants in sub-Saharan Africa, including Tanzania are lacking. The aim of this study was to document noise exposure and to identify determinants of noise exposure with a view to establishing an effective hearing conservation programme. Methods: A walk-through survey was conducted to describe the working environment in terms of noise sources in four metal factories (A-D) in Tanzania. Noise measurements were conducted by both personal, full-shift noise measurements (8 h) using dosimeters and area measurements (10-s measurements) using a sound level meter. A total of 163 participants had repeated personal noise measurements (Factory A: 46 participants, B: 43, C: 34, and D: 40). Workers were randomly selected and categorized into 13 exposure groups according to their job. Linear mixed effects models were used to identify significant determinants of noise exposure in the furnace section and the rolling mill section. Results: The average personal noise exposure in the four factories was 92.0 dB(A) (range of job group means; 85.4-96.2 dB(A)) (n = 326). Personal exposure was significantly higher in the rolling mill section (93.0 dB(A)) than in the furnace section (89.6 dB(A)). Among the job groups, the cutters located in the rolling mill section had the highest noise exposure (96.2 dB(A)). In the furnace section, furnace installation (below the ground floor), manual handling of raw materials/billets/crowbars, and billet weighing/transfer were significant determinants explaining 40% of the total variance in personal noise exposure. In the rolling mill section, the size of the cutting machine, steel billet weight and feeding re-heating furnace explained 46% of the total variance in personal noise exposure. The mean noise level of the area measurements was 90.5 dB(A) (n = 376). Conclusion: Workers in the four iron and steel factories in Tanzania were exposed to average noise of 92.0 dB(A), without using hearing protection, implying a high risk of developing hearing loss. Task and factory level determinants were identified in the furnace and the rolling mill sections of the plant, which can inform noise control in factories with similar characteristics.