Promoting Evidence-Based Practice for Improved Occupational Safety and Health at Workplaces in Sweden. Report on a Practice-Based Research Network Approach.

Despite the rapid growth in research and R&D expenditures, the translation of research into practice is limited. One approach to increase the translation and utilization of research is practice based research networks. With the aim of strengthening evidence-based practice (EBP) within occupational health services in Sweden (OH-Services), a practice-based research network (PBRN-OSH) was developed. The PBRN-OSH includes researchers and representatives from end-users. This paper reports on the development, outputs and lessons learned in the PBRN-OSH. The PBRN-OSH resulted in several practice-based research projects as well as different measures to ensure EBP in OSH such as the governmentally sanctioned national guidelines for the OH-services. Moreover, results show that the competence in EBP increased among practitioners at the OH-services. Conducting research in a PBRN is more resource demanding; however, this does not imply that it is less cost effective. To succeed in increasing the utility of research findings via PBRN, resources must be invested into an infrastructure that supports collaboration in the PBRN, including costs for a variety of means of dissemination. Further, translation activities need to be included in academic career paths and reward systems if a major improvement in the impact and return of investments from research is to be expected.

Sleep debt, sleepiness and accidents among males in the general population and male professional drivers.

Men from the general population and male professional lorry and bus drivers were surveyed with regard to sleep habits and motor vehicle and other types of accidents. A random sample of 4000 men in the general population of Dalarna County in mid-Sweden were mailed a questionnaire and served as referents. A total of 1389 male professional lorry and bus drivers from this county responded to the same questionnaire. A total of 161 of the drivers also underwent a sleep study in their homes. The proportion of total accidents was higher among the professional drivers as compared with the males in the population, P=0.03. Reports on traffic accidents were the same in both groups, but the professional drivers reported more accidents at leisure compared with referents, P<0.0001. Accidents of any kind, traffic accidents included, among those affected by both snoring and apneas, were not reported more in either of the groups. At the sleep study, 17% of those examined received the diagnosis of obstructive sleep-apnea syndrome (OSAS). The professional drivers reported proportionally more sleep debt than the referents, P<0.001. Among referents, traffic accidents at leisure, traffic accidents while commuting and accidents at work increased in proportion to sleep debt (P<0.001, 0.006 and 0.002, respectively). The finding that self-perceived sleep debt may have an adverse effect on males in the general population and male professional drivers concerning accident likelihood should have an impact on prevention. These results stress the need to educate the general population on the importance of complying with our biological need of sleep.

EUROQUEST--a questionnaire for solvent related symptoms: factor structure, item analysis and predictive validity.

The study evaluates the factor structure and predictive validity of the symptom questionnaire EUROQUEST (EQ) that had been developed with the goal of simplifying the evaluation of health effects associated with long-term solvent exposure. The EQ was added to the normal evaluation procedures for 118 male patients with suspected solvent-induced toxic encephalopathy (TE) referred to seven Swedish clinics of occupational medicine during an 18-month period. EQ was also completed by 239 males from a random sample of 400 Swedish males aged 25-64 years selected from the general population and a sample of 559 occupationally active male spray painters aged 25-64 years. Factor and item analyses of EQ responses were performed. Ordinary least square regression analysis was used to evaluate sensitivity and correlation to evaluate the specificity of EQ and the separate components. Questions concerning memory and concentration symptoms alone showed better sensitivity than the other five EQ dimensions singly or combined for the entire EQ and for a subset of questions approximating Q16, a widely used organic solvent symptom screening questionnaire. However, the diagnosis of TE required information in addition to exposure and responses to EQ and Q16-like questions. The results indicate that the subset of EQ questions concerning memory and concentration might replace the more cumbersome EQ and less sensitive Q16 in screening for TE, although none of the screening instruments alone replaces current clinical diagnostic procedures.

Violence towards caregivers of persons with developmental disabilities.

OBJECTIVE: Violent and disruptive acts committed by persons with developmental disabilities are a potential work environment problem for caregivers. This study developed and tested an instrument for describing and analyzing violence among persons with developmental disabilities. METHODS: Personnel from four units of one facility recorded daily on a simple form all violent and disruptive acts occurring in a limited range of situations. RESULTS: Acts of violence were associated with a small minority of individuals, but grossly underreported and unrecognized in formal reporting systems. None of the nearly 3000 incidents recorded during the six-week study required sick leave. Violent and disruptive acts occurred most often when an individual was requested to do something he or she did not want to do, when the individual was denied the opportunity to do something they did want to do and when waiting or under-stimulated. Personnel used the data in discussing countermeasures that could be integrated with the care and treatment of the individual. CONCLUSION: Hitting, kicking, pinching etc. of personnel are a work environment problem due to their high frequency and effects upon employee morale. The instrument and procedures can be used to reduce incidents of violence, which would improve the working environment of employees and assist persons with developmental disabilities as they move from institutional environments.

Measures to prevent portable ladder accidents in the construction industry.

Ladder accidents account for nearly 5% of all reported occupational accidents in the Swedish construction industry. Eighty-five ladder accident victims were interviewed to obtain detailed information about factors contributing to their accidents. Accidents were almost equally divided between straight ladders (N = 39) and step- ladder (N = 33). The majority of accidents occurred while the victim was working from the ladder. Climbing up and, particularly, down straight ladders was associated with numerous accidents. For straight ladders, sliding at the base was the most common event preceding the injury. Low angle of inclination was a common contributing factor. For step-ladders, tipping sideways was the most common preceding event. Misstepping the final step while descending accounted for 10% of all accidents. More than 90% of the victims fell from less than 4 m. The interviews provided detailed information which served as a basis for proposals for alternatives to portable ladders; a step-scaffold adjustable for work at levels up to 3 m and a portable scaffold for work at levels of 1-3 m. These alternatives are under development. In addition, proposals for improving the stability of current portable ladders are made.