Factors Associated With Incident and Recurrent Falls Among Men Enrolled in Evidence-Based Fall Prevention Programs: An Examination of Race and Ethnicity.

We examined factors associated with incident (one) and recurrent (2+) falls among 7207 non-Hispanic White (NHW) (89.7%), non-Hispanic Black (NHB) (5.0%), and Hispanic (5.3%) men ages ≥60 years with ≥1 chronic conditions, enrolled in an evidence-based fall program. Multinomial and binary regression analyses were used to assess factors associated with incident and recurrent falls. Relative to zero falls, NHB and Hispanic men were less likely to report incident (OR = 0.55, p < .001 and OR = 0.70, p = .015, respectively) and recurrent (OR = 0.41, p < .001 and OR = 0.58, p < .001, respectively) falls. Men who reported fear of falling and restricting activities were more likely to report incident (OR = 1.16, p < .001 and OR = 1.32, p < .001, respectively) recurrent and (OR = 1.46, p < .001 and OR = 1.71, p < .001, respectively) falls. Men with more comorbidities were more likely to report recurrent falls (OR = 1.10, p < .001). Compared to those who experienced one fall, men who reported fear of falling (OR = 1.28, p < .001) and restricting activities (OR = 1.31, p < .001) were more likely to report recurrent falls. Findings highlight the importance of multi-component interventions to prevent falls.

Digital human ergonomics training for remote office workers: Comparing a novel method to a traditional online format.

OBJECTIVE: This randomized controlled trial investigated the effectiveness of an online ergonomics training program with a digital human compared to an online ergonomics training program without a digital human. METHOD: Remote office workers (n = 138) were randomly assigned to either a digital human training, a traditional webpage training without a digital human, or a control group. Musculoskeletal discomfort, knowledge retention, and behavior change were measured. RESULTS: The overall group differences for increased behavior change and knowledge retention were statistically significant (p < 0.05). For knowledge retention, the digital human training group showed comparable improvement in knowledge scores compared to the traditional training group. For behavior scores, the traditional training showed improvement compared to the control group. Decreases in musculoskeletal discomfort for all groups were not statistically significant (p > 0.05). CONCLUSION: Digital humans have the potential to meet large-scale remote worker training needs.

Automated vehicles for older adults with cognitive impairment: a survey study.

As the population is ageing, the number of older adults with cognitive impairment (CI) is increasing. Automated vehicles (AVs) can improve independence and enhance the mobility of these individuals. This study aimed to: (1) understand the perception of older adults (with and without CI) and stakeholders providing services and supports regarding care and transportation about AVs, and (2) suggest potential solutions to improve the perception of AVs for older adults with mild or moderate CI. A survey was conducted with 435 older adults with and without CI and 188 stakeholders (e.g. caregivers). The results were analysed using partial least square - structural equation modelling and multiple correspondence analysis. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided recommendations to improve older adults' perception of AVs including education and adaptive driving simulation-based training. Practitioner summary: This study investigated the perception of older adults and other stakeholders regarding AVs. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided guidelines to improve older adults' perception of AVs.

Examining workweek variations in computer usage patterns: An application of ergonomic monitoring software.

Alternative work arrangements have emerged as potential solutions to enhance productivity and work-life balance. However, accurate and objective measurement of work patterns is essential to make decisions about adjusting work arrangements. This study aimed at evaluating objective computer usage metrics as a proxy for productivity using RSIGuard, an ergonomics monitoring software. Data were collected from 789 office-based employees over a two-year period between January 1, 2017 and December 31, 2018 at a large energy company in Texas. A generalized mixed-effects model was utilized to compare computer usage patterns across different days of the week and times of the day. Our findings demonstrate that computer output metrics significantly decrease on Fridays compared to other weekdays, even after controlling for total active hours. Additionally, we found that workers' output varied depending on the time of day, with reduced computer usage observed in the afternoons and a significant decrease on Friday afternoons. The decrease in the number of typos was much less than that in the number of words typed, indicating reduced work efficiency on Friday afternoons. These objective indicators provide a novel approach to evaluating the productivity during the workweek and can help optimize work arrangements to promote sustainability for the benefit of employers, employees, and the environment.

A novel autonomous vehicle interface for older adults with cognitive impairment.

The population of older Americans with cognitive impairments, especially memory loss, is growing. Autonomous vehicles (AVs) have the potential to improve the mobility of older adults with cognitive impairment; however, there are still concerns regarding AVs' usability and accessibility in this population. Study objectives were to (1) better understand the needs and requirements of older adults with mild and moderate cognitive impairments regarding AVs, and (2) create a prototype for a holistic, user-friendly interface for AV interactions. An initial (Generation 1) prototype was designed based on the literature and usability principles. Based on the findings of phone interviews and focus group meetings with older adults and caregivers (n = 23), an enhanced interface (Generation 2) was developed. This generation 2 prototype has the potential to reduce the mental workload and anxiety of older adults in their interactions with AVs and can inform the design of future in-vehicle information systems for older adults.

The impact of multiple regions of pain and work-life balance among healthcare workers.

BACKGROUND: Although the association of chronic pain (CP) with a poor work-life balance has been well studied, the interaction effect of multiple pain sites on work-life balance is unknown. OBJECTIVE: To evaluate the most prevalent CP site among healthcare workers, the demographic characteristics of the individuals with the predominant pain type, and to assess the interaction of multiple pain sites on work-life balance. METHODS: Using data from the National Health Interview Survey, 2,458 healthcare works were identified for this study. The independent variables were chronic low back and hip pain. The dependent variables were (1) if pain affected their family or significant other, (2) if pain limited their life or work activities, and (3) Usually working >35 hours/week. Multiple logistic regression and an interaction analysis were used to analyze the impact of different pain sites on work-life balance. RESULTS: Among healthcare workers, chronic low back pain was more prevalent than chronic hip pain (69.4% vs 61.4%, p-value<0.001). Respondents with chronic low back pain were mostly 40 - 64 years of age (49.6%), females (71.2%), white (77.6%), married (55.5%), had no college degree (85.4%), earn greater than $75,000 (50.0%). In the interaction analysis, in the presence of chronic hip pain, those with chronic low back pain had an AOR of 2.20 (1.05 - 4.64), p-value 0.038 of chronic low back pain affecting their family and significant others, and an AOR of 2.18 (1.17- 4.05), p-value 0.014 of chronic low back pain affecting their life or work. CONCLUSION: Chronic low back pain was more prevalent than chronic hip pain among healthcare workers. Together both pain sites had a significant impact on the work-life balance of this population. Further studies should assess other dimensions of work-life balance and chronic pain.

Impact of workplace displacement during a natural disaster on computer performance metrics: A 2-year interrupted time series analysis.

BACKGROUND: Remote working may enhance company resiliency during natural disasters and other events causing workplace displacement. OBJECTIVE: We conducted an interrupted time series analysis to investigate the impact of Hurricane Harvey on employee computer use during and after a seven-month displacement period from the physical workplace. METHODS: Ergonomic software was used to collect information on employees' computer usage. RESULTS: Although there was no change in total computer use in response to the hurricane (ß 0.25), active computer use significantly declined (ß -0.90). All measured computer use behaviors returned to baseline prior to the complete return to the physical workspace. CONCLUSION: Despite a transient period of reduced activity during closure of the workplace building, productivity returned to normal prior to the employees' return to a commercial workspace. The ability to work remotely may improve resiliency of employees to perform workplace tasks during events causing workplace displacement.

Pediatric asthma hospitalization: individual and environmental characteristics of high utilizers in South Texas.

Objective: Few studies have examined factors affecting the high frequency of hospitalization for pediatric asthma. This study identifies individual and environmental characteristics of children with asthma from a low-income community with a high number of hospitalizations.Methods: The study population included 902 children admitted at least once to a children's hospital in South Texas because of asthma from 2010 to 2016. The population was divided into three groups by utilization frequency (high: ≥4 times, medium: 2-3 times, or low: 1 time). Individual-level factors at index admission and environmental factors were included for the analysis. Unadjusted and adjusted multivariate ordered logistic regression models were applied to identify significant characteristics of high hospital utilizers.Results: The high utilization group comprised 2.4% of total patients and accounted for substantial hospital resource utilization: 10.8% of all admissions and 13.5% of days stayed in the hospital. Patients in the high utilization group showed longer length of stay (LOS) and shorter time between admissions on average than the other two groups. The multivariate ordered logistic regression models revealed that age of 5-11 years (OR = 0.57, 95%CI = 0.35-0.93), longer LOS (2 days: OR = 1.80, 95%CI = 1.15-2.84; ≥3 days: OR = 3.38, 95%CI = 2.10-5.46), warm season at index admission (OR = 1.49, 95%CI = 1.01-2.20), and higher average ozone level in children's residential neighborhoods (OR = 1.78, 95%CI = 1.01-3.14) were significantly associated with a higher number of asthma hospitalizations.Conclusions: The findings suggest the importance of monitoring high hospital utilizers and establishing strategies for such patients based on their characteristics to reduce repeated hospitalizations and to increase optimal use of hospital resources.

Health-related consequences of the type and utilization rates of electronic devices by college students.

BACKGROUND: College students are leading an evolution of device use both in the type of device and the frequency of use. They have transitioned from desktop stations to laptops, tablets, and especially smartphones and use them throughout the day and into the night. METHODS: Using a 35-min online survey, we sought to understand how technology daily usage patterns, device types, and postures affect pain and discomfort to understand how knowledge of that pain might help students avoid it. Data were analyzed from 515 students (69.5% male) who completed an internet-delivered survey (81.3% response rate). RESULTS: Participants ranked smartphones as their most frequently used technology (64.0%), followed by laptops and tablets (both 53.2%), and desktop computers (46.4%). Time spent using smartphones averaged over 4.4 h per day. When using their devices, students were more likely to adopt non-traditional workplace postures as they used these devices primarily on the couch or at a chair with no desk. CONCLUSION: Recent trends in wireless academic access points along with the portability of small handheld devices, have made smartphones the most common link to educational materials despite having the least favorable control and display scenario from an ergonomic perspective. Further, the potential impact of transitions in work environments due to COVID-19 may further exacerbate ergonomic issues among millions highlighting the need for such work to be carried out.

Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study.

Few studies have evaluated the association between ambient air pollution and hospital readmissions among children with asthma, especially in low-income communities. This study examined the short-term effects of ambient air pollutants on hospital readmissions for pediatric asthma in South Texas. A time-stratified case-crossover study was conducted using the hospitalization data from a children's hospital and the air pollution data, including particulate matter 2.5 (PM2.5) and ozone concentrations, from the Centers for Disease Control and Prevention between 2010 and 2014. A conditional logistic regression analysis was performed to investigate the association between ambient air pollution and hospital readmissions, controlling for outdoor temperature. We identified 111 pediatric asthma patients readmitted to the hospital between 2010 and 2014. The single-pollutant models showed that PM2.5 concentration had a significant positive effect on risk for hospital readmissions (OR = 1.082, 95% CI = 1.008-1.162, p = 0.030). In the two-pollutant models, the increased risk of pediatric readmissions for asthma was significantly associated with both elevated ozone (OR = 1.023, 95% CI = 1.001-1.045, p = 0.042) and PM2.5 concentrations (OR = 1.080, 95% CI = 1.005-1.161, p = 0.036). The effects of ambient air pollutants on hospital readmissions varied by age and season. Our findings suggest that short-term (4 days) exposure to air pollutants might increase the risk of preventable hospital readmissions for pediatric asthma patients.

Association between Ambient Air Pollution and Hospital Length of Stay among Children with Asthma in South Texas.

Although hospital length of stay (LOS) has been identified as a proxy measure of healthcare expenditures in the United States, there are limited studies investigating the potentially important association between outdoor air pollution and LOS for pediatric asthma. This study aims to examine the effect of ambient air pollution on LOS among children with asthma in South Texas. It included retrospective data on 711 children aged 5-18 years old admitted for asthma to a pediatric tertiary care hospital in South Texas between 2010 and 2014. Air pollution data including particulate matter (PM2.5) and ozone were collected from the U.S. Centers for Disease Control and Prevention. The multivariate binomial logistic regression analyses were performed to determine the association between each air pollutant and LOS, controlling for confounders. The regression models showed the increased ozone level was significantly associated with prolonged LOS in the single- and two-pollutant models (p < 0.05). Furthermore, in the age-stratified models, PM2.5 was positively associated with LOS among children aged 5-11 years old (p < 0.05). In conclusion, this study revealed a concerning association between ambient air pollution and LOS for pediatric asthma in South Texas.

Stand-Biased Desk Intervention on Sleep Quality of High School Students: A Pilot Study Using Tri-Axial Accelerometery.

Prolonged sitting is related to a sedentary inactive lifestyle and related to obesity and many metabolic problems caused by inactivity. The problem gets more serious for people who spent most of their work time in a seated position like students or office workers. In this study, we provided standing desk and stool to the local public high school and observed the changes in their behavior in terms of physical activity using tri-axial accelerometer before and after intervention. Previously published study using the same dataset under the larger project reported increased physical activity during school hours. In this study, we extracted more diverse features directly from the raw data instead of using data processed by the software that manufacturer provided. Hence, we were able to analyze the same features (sedentary, physically active time) as well as sleep-related variables. Of the interest, sleep is another important feature that can tell us about participants' health conditions. Even if the intervention contributed to updating their behavioral patterns, the result might be nullified in the long run if their sleep pattern was compromised. The quantity and quality of sleep was not changed after the intervention. Therefore, the efficacy of standing desks has been confirmed again.

Smart Software Can Increase Sit-Stand Desk Transitions During Active Computer Use.

The objective use of table top adjustable sit-stand desks has yet to be determined, due to the lack of an effective digital evaluation method. The objective of this study was to evaluate the impact of computer prompt software on table top sit-stand desks to determine if there was a difference in the frequency of desk position changes. This five month, pre-post pilot study on 47 university staff members used a novel USB accelerometer sensor and computer software reminders to continuously record and prompt increases in desk usage to promote physical activity at the workstation. During the baseline phase (3 months), desk usage data were continuously recorded for all workers. Following the baseline, the results from a two-month intervention of personalized computer reminders doubled the number of desk position changes per work day from 1 desk position change every 2 work days to 1 change every work day. Furthermore, those who changed desk positions once or twice a day increased from 4% to 36% from baseline to intervention. Overall, the intervention was encouraging, but longer intervention studies are warranted to determine if the desk usage behavior change can be improved and sustained for years and whether that change results in health gains.

Instrumental variable approach to estimating the scalar-on-function regression model with measurement error with application to energy expenditure assessment in childhood obesity.

Wearable device technology allows continuous monitoring of biological markers and thereby enables study of time-dependent relationships. For example, in this paper, we are interested in the impact of daily energy expenditure over a period of time on subsequent progression toward obesity among children. Data from these devices appear as either sparsely or densely observed functional data and methods of functional regression are often used for their statistical analyses. We study the scalar-on-function regression model with imprecisely measured values of the predictor function. In this setting, we have a scalar-valued response and a function-valued covariate that are both collected at a single time period. We propose a generalized method of moments-based approach for estimation, while an instrumental variable belonging in the same time space as the imprecisely measured covariate is used for model identification. Additionally, no distributional assumptions regarding the measurement errors are assumed, while complex covariance structures are allowed for the measurement errors in the implementation of our proposed methods. We demonstrate that our proposed estimator is L2 consistent and enjoys the optimal rate of convergence for univariate nonparametric functions. In a simulation study, we illustrate that ignoring measurement error leads to biased estimations of the functional coefficient. The simulation studies also confirm our ability to consistently estimate the function-valued coefficient when compared to approaches that ignore potential measurement errors. Our proposed methods are applied to our motivating example to assess the impact of baseline levels of energy expenditure on body mass index among elementary school-aged children.

Computer-based Prompt's impact on postural variability and sit-stand desk usage behavior; a cluster randomized control trial.

Sit-to-stand workstations have been deployed in office environments to reduce sedentary behavior and improve worker's health. However, efforts to initiate and sustain long-term usage of sit-stand workstations has been a challenge, with primarily anecdotal evidence suggesting many employees cease using their sit-stand workstations once the newness diminishes. To objectively determine sit-stand workstation usage and what impact computer-based prompts would have on sit-stand desk use and sustainability, 200 office workers (118 control and 82 treatment) in two different geographic locations were continuously monitored over a 4 ½ month period, which consisted of a 6-week baseline and a 3-month experimental period. During the 3-month experimental period, computer-based prompts elicited a 229% increase in daily standing transitions which was sustained over the entire 3 months with 40% of the participants adhering to a pre-determined sit to stand schedule. These findings indicate that the use of computer-based prompts can be used to motivate employees to change their behavior regarding the use of sit-to-stand workstations.

Development of the Fatigue Risk Assessment and Management in High-Risk Environments (FRAME) Survey: A Participatory Approach.

Existing risk assessment tools are not effective or sustainable in identifying Oil and Gas Extraction (OGE) workers at high risk of fatigue-related injuries or incidents. We developed a comprehensive Fatigue Risk Assessment and Management in high-risk Environments (FRAME) survey through an industry-academic participatory approach. The FRAME survey was developed through: (1) systematic gathering of existing fatigue scales; (2) refining the inventory using the Delphi Consensus technique; and (3) further refinement through employee/worker focus groups. The participatory approach resulted in a final FRAME survey across four fatigue dimensions-sleep, shiftwork, physical, and mental fatigue, and was composed of 26 items. The FRAME survey was founded on occupational fatigue science and refined and tailored to the OGE industry, through rigorous industry stakeholder input, for safer, effective, practical, and sustainable fatigue assessment and management efforts.

Sit-Stand Desk Software Can Now Monitor and Prompt Office Workers to Change Health Behaviors.

OBJECTIVE: To determine the effectiveness of a computer-based intervention designed to increase sit-stand desk usage and help reverse workplace physical inactivity. BACKGROUND: Sit-stand desks have been successful in reducing workplace sedentary behavior, but the challenge remains for an effective method to increase the usage in order to experience the health and productivity benefits. METHOD: Data collection (1-year field study with 194 workers) used a novel method of computer software that continuously recorded objective electric sit-stand desk usage, while taking into account the time a worker spends away from their desk (breaks, meetings). During the baseline period, all workers' desk usage was recorded by the software, and the intervention period consisted of software reminders and real-time feedback to all workers to change desk positions. Pooled means were calculated to determine desk usage patterns, and effect sizes and pairwise mean differences were analyzed to test for intervention significance. RESULTS: The intervention doubled desk usage by increasing ~1 change to ~2 changes per work day. There was a 76% reduction in workers who never used the sit-stand function of the desk. Medium to large effect sizes from the intervention were observed in all three primary outcome measures (desk in sitting/standing position and desk position changes per work day). CONCLUSION: These findings demonstrate an effective intervention that increased postural transitioning and interrupted prolonged inactivity while remaining at the workstation. APPLICATION: The methods and results in this research study show that we can quantify an increase in desk usage and collect aggregate data continuously.

Physical activity and associated medical cost savings among at-risk older adults participating a community-based health & wellness program.

INTRODUCTION: Physical activity declines are seen with increasing age; however, the US CDC recommends most older adults (age 65 and older) engage in the same levels of physical activity as those 18-64 to lessen risks of injuries (e.g., falls) and slow deteriorating health. We aimed to identify whether older adults participating in a short (approx. 90-minute sessions) 20 session (approximately 10-weeks) health and wellness program delivered in a community setting saw improvements in physical activity and whether these were sustained over time. METHODS: Employing a non-equivalent group design, community-dwelling older adults were purposely recruited into either an intervention or comparison group. The intervention was a multicomponent lifestyle enhancement intervention focused on healthy eating and physical activity, including structured physical activity exercises within the class sessions. Two groups were included: intervention (survey group: n = 65; accelerometer subgroup: n = 38) and the comparison group (survey group: n = 102; accelerometer subgroup: n = 55). Measurements were made at baseline and approximately three months later to reflect immediate post-treatment period (survey, accelerometer) with long-term follow-up 6 months after baseline (survey). Adults not meeting the physical activity guidelines (i.e., 150/75 minutes of moderate-to-vigorous physical activity or MVPA) were targeted for subgroup analyses. Paired t-tests were used for bivariate comparisons, while repeated measures random coefficient models (adjusting for propensity scores using inverse probability of treatment weighted (IPTW) estimation) were used for multivariate models. Estimated medical costs associated with gains in physical activity were also measured among survey respondents in the intervention group. RESULTS: The accelerometer group contained 38 participants in the intervention group with 71% insufficiently active at baseline and 55 participants in the comparison group with 76% insufficiently active at baseline (<150 weekly MVPA minutes). The survey group contained 65 participants in the intervention group with 73.85% insufficiently active at baseline and 102 participants in the comparison group with 76.47% insufficiently active at baseline. In paired t-tests with the accelerometer group, a moderate effect size (-0.4727, p = 0.0210) indicating higher MVPA was found for intervention participants with <150 weekly MVPA at baseline. In fully adjusted analyses using propensity score matching, among the subjectively measured physical activity (survey) group, there was a differential impact from baseline to 6-month post among the intervention group with an improvement of 160 minutes among all study participants (p < .0001) versus no difference among the comparison group. For those insufficiently active at baseline, there was an improvement of 103 minutes among intervention (p < .0001) and 55 minutes among the comparison (p < .0001) with the improvement of the intervention significantly greater than that among the comparison (p = 0.0224). Further, among those insufficiently active at baseline there was a relative cost savings from baseline to 6-months over and above the estimated cost of the intervention estimated between $143 and $164 per participant. DISCUSSION: This intervention was able to reach and retain older adults and showed significant MVPA gains and estimated medical cost savings among more at-risk individuals (baseline <150 MVPA). This intervention can be used in practice as a strategy to improve MVPA among the growing population of older community-dwelling adults.

Accessing physical activity among young adults attending a university: the role of sex, race/ethnicity, technology use, and sleep.

BACKGROUND: Identifying factors associated with recommended physical activity (PA) levels are critical in efforts to combat the obesity epidemic and related comorbidities. METHODS: We conducted cross-sectional analyses of college students (n = 490) enrolled in a large southern state university in October of 2014. Our aim was to identify sociodemographic characteristics, technology use, and sleep patterns among college students and their independent relationship to recommended PA. An online survey was sent to all enrolled students. Logistic regression predicted achieving recommended ≥150 min per week of moderate-vigorous PA (MVPA) versus not (≤149 min MVPA). RESULTS: Approximately 69% of study participants were males, 18% were Hispanic, and more than half (60%) were within the normal body mass index (12% were obese). The average age of students was 21 years. On a daily average, individuals used smartphones most often (nearly 4.4 h), followed by laptops at 4.0 h, desktops at 1.2 h, and tablets at 0.6 h. The mean number of hours individuals reported sleeping was 6.7. Sociodemographic factors associated with reporting ≥150 min of MVPA included being male (OR = 4.0, 95% CI 2.2-7.1) versus female, being non-Hispanic White (OR = 1.8, CI 1.1-3.2) versus being a member of minority race group. Behavioral factors associated with reporting ≥150 min of MVPA included technology use (being moderate-heavy (OR = 2.3, CI 1.1-4.8) or heavy (OR = 3.4, CI 1.6-7.5) users of technology), and receiving low-moderate (OR = 1.9, 1.01-3.7) levels of sleep versus the lowest level of sleep. CONCLUSIONS: In the current study, minority status and being female were the strongest sociodemographic factors associated with inadequate PA levels, while high technology use (primarily driven by smartphone use) were associated with recommended PA levels. Identifying factors associated with being physically active will allow for targeted interventions to improve the health of young adults.