Developing Community-Level Implementation Networks to Connect Older Adults to Evidence-Based Falls Prevention Programs.

Background: Evidence-based falls prevention programs are available in many communities, but participation in such programs remains low. This study aimed to develop community-based referral networks of organizations to facilitate the uptake of evidence-based falls prevention programs through engaging older adults at risk for falls with the RememberingWhen™ program and connecting them to evidence-based programs in Midwestern communities. Methods: Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), referral networks were developed in two Midwestern communities (urban and micropolitan) through a seven-step community engagement plan: establishing and operationalizing the State-level Advisory Board (SAB), identifying falls prevention resources, conducting community assessments, developing Local Advisory Groups (LAG), operationalizing the LAG, developing referral network and protocols, and implementing the network. Semistructured interviews guided by the RE-AIM framework were conducted with members of the SAB, LAG, administrators and staff from organizations that participated in networks, and older adult participants. Results: After participating in the development of referral networks, participants felt they learned important skills that they can use to develop additional collaborations and networks in the future, emphasized the benefits of building community capacity among organizations with common missions. Interview data yielded strategies on enhancing the referral network's reach, impact, adoption, implementation efficiency, and maintenance. Conclusion: Future sustainability studies of such networks should explore identified challenges and strategies to sustain efforts. Results highlight the importance of ongoing funds to support the efforts of organizational networks in communities.

Recruitment of Row Crop Farmers into a Research Study to Assess Farm Hazards.

Farmers are at an elevated risk for injuries and are, therefore, highly sought after for research studies. However, their participation in research studies is low. We examine how characteristics of the farmer, farm location, and timing of recruitment contact impact the probability that farmers will engage and participate in a study of injuries and related farm hazards. Study data were obtained from the Farm Safety Study conducted at the University of Iowa between June 2019 and March 2020. We used recruitment data from participants enrolled using Farm Journal magazine subscription lists. Multinomial logistic regression was used for predictive modeling. Predictor variables included the time of day and the farm season in which phone contact for study recruitment was attempted, as well as the rurality of the farm. Two models were created to characterize screening and participation of farmers in the study. Farm season and time of day of the last recruitment call increased the likelihood of farmers being screened for study participation and completing the study. Specifically, contacting farmers during the growing season and during the daytime, regardless of farm rurality, resulted in higher probabilities of participation. Studies of agricultural injury may be more efficiently conducted, with higher participation responses, when circumstances of the recruitment call are considered. This work serves as a starting place for much-needed methodological research to identify factors that increase participation of farmers and farm workers in research studies.

Fracture risk and opioid use in patients aged 17-64 years: An analysis of administrative claims data.

STUDY OBJECTIVE: The objective of this work is to describe the risk of fracture in adults aged 17 to 64 years across categories of daily opioid dose. DESIGN: A retrospective analysis of insurance claims data. DATA SOURCE: Information from a private health insurance provider for the years 2003-2014 for enrolled individuals living in Iowa. PATIENTS: Patients who were aged 17 to 64 years and prescribed an opioid were followed for the length of opioid treatment plus 30 days to determine whether a fracture occurred. MEASUREMENTS: Average daily morphine milligram equivalent (MME) was determined for patients who received a prescription for opioids. The outcome of interest was incident fracture following opioid treatment initiation. Cox proportional hazard models were used to compare the risk of fracture across categorical groups of average daily MME. Inverse probability weighting was used to control for patient-level variables. MAIN RESULTS: In total, 316,024 individual patients were identified in the administrative claims data as having an opioid prescription from 2003 to 2014, and 3038 fractures occurred during follow-up (9.6 fractures per 1000 opioid-prescribed patients). Relative to the lowest quartile of prescribed opioid (⟨22 MME), patients in each higher prescribed level were more likely to experience a fracture (22-36 MME Hazard Ratio (HR) = 1.35, 95% Confidence Interval (CI): 1.21-1.51; 37-50 MME HR = 1.38, 95% CI: 1.24-1.54; ⟩50 MME HR = 1.35, 95% CI: 1.20-1.52). CONCLUSIONS: We observed an increased fracture risk in all three higher categories of opioid exposure relative to the lowest category (⟨22 MME). The risk of a fracture should be considered in opioid treatment decisions.

Applying the Worker Well-Being Framework to Identify Factors that Impact Turnover Among Long-Haul Truck Drivers.

BACKGROUND: Drivers in the long-haul trucking industry have chronic health conditions, engage in unhealthy behaviors, and leave the industry at high rates. Previous work has not considered the health and safety outcomes resulting from the conditions of work in the trucking industry and their role in turnover. The goal of this study was to understand the expectations of an incoming workforce, explore how work conditions impact their well-being, and identify strategies for retention. METHODS: Semi-structured interviews were conducted among current long-haul drivers and supervisors at trucking companies, and students and instructors at trucking schools (n = 33). Participants were asked about why they decided to enter the industry, their health challenges related to being in the trucking industry and whether these challenges were related to turnover, and strategies for retention. FINDINGS: Health conditions, differences in job expectations, and work demands were associated with leaving the industry. Workplace policies and culture (e.g., lack of supervisor support, schedules that limited home time, company size, and lack of benefits) were associated with workers' intention to leave an organization. Strategies identified to improve retention included integrating health and wellness into onboarding, creating realistic job expectations for those entering the industry, establishing relationships with drivers and dispatchers, and developing policies to limit time away from family. CONCLUSION/APPLICATION TO PRACTICE: Turnover in the trucking industry is a persistent problem and leads to a shortage of skilled workers, increases the workload, and reduces productivity. Understanding the relationship between the conditions of work and well-being provides a more holistic approach to address the health, safety, and well-being of long-haul truck drivers. Health conditions, differences in job expectations, and work demands were associated with leaving the industry. Workplace policies and culture (e.g., supervisor support, schedules that limited home time, lack of benefits) were associated with workers' intention to leave an organization. These conditions provide an opportunity for occupational health interventions to promote the physical as well as psychological health of long-haul truck drivers.

Prevalence of workplace violence against young workers in the United States.

BACKGROUND: Workers under the age of 25 may be at particular risk for workplace violence, given their predominant employment in the high-risk retail and service industries. Little research exists, however, that estimates the scope of the problem within this population. To fill this gap, we conducted the first national study of workplace violence against young people in the United States. METHODS: We analyzed survey data collected via telephone interview from a national sample of 1031 young workers ages 14 through 24 who held a formal job in the last 12 months. Weighted frequencies were calculated and χ2 tests of significance were used to detect differences between groups. RESULTS: Many youth experience workplace violence (60%). Verbal abuse of the sort that made victims feel scared and unsafe (53%) and sexual harassment (24%) were the most commonly reported forms of violence. Females were more likely than males to experience workplace violence overall (p < 0.001) and sexual harassment (p < 0.001) in particular. Males were more likely to experience verbal abuse (p < 0.001). Workplace violence was most prevalent among workers in healthcare settings and eating and drinking places. The occupation with the highest prevalence of workplace violence was customer service. CONCLUSIONS: Workplace violence is common among young workers in the United States and more widespread than prior estimates have suggested. This study is the first to provide a true national prevalence estimate of the problem of workplace violence among young workers ages 14 to 24 in the United States. These findings should be used to locate areas of concern and target resources where they are needed most to address this significant problem.

Circumstances Contributing to Installation, Maintenance, and Repair Worker Death by Suicide.

OBJECTIVE: To examine risk factors related to death by suicide among installation, maintenance, and repair (IMR) workers compared with workers in other occupational groups. METHODS: The National Violent Death Reporting System (NVDRS) data for the years 2013 to 2018 was used to identify suicide deaths. Circumstance variables were used to examine differences between IMR workers and other workers. RESULTS: Having a physical health problem (1.13; 95% confidence interval [CI], 1.03 to 1.23) or a diagnosis of posttraumatic stress disorder (1.24; 95% CI, 1.03 to 1.50) was more likely to contribute to IMR worker suicide compared with other occupations. Installation, maintenance, and repair workers were less likely to receive treatment for a mental health diagnosis or substance use disorder (0.88; 95% CI, 0.81 to 0.94). CONCLUSIONS: Additional support for physical health problems, posttraumatic stress disorder diagnoses, and mental health care access among IMR workers may reduce suicide deaths.

Organizational Resources and Social Support Influences on Stress and Depression: A Comparison among Cooperative and Non-Cooperative Farmers.

BACKGROUND: Farmers are disproportionally affected by depression and suicide. Social connectedness has been shown to reduce depression and suicide among the general population but its impact on farmers is less well-known. Our previous research indicated that farmers who had cooperative resources and social support reported decreased symptoms of depression. However, it was unclear whether farmers who were not cooperative members or utilized resources from non-cooperative organizations differed from cooperative farmers in mental health. METHODS: A survey consisted of online self-completion and phone interviews was conducted among 307 participants (197 co-op, 110 non-co-op) to examine whether Midwest (north central United States) cooperative and non-cooperative farmers differ in perceived stress and symptoms of depression and whether potential differences were impacted by program use, program satisfaction, and social support. RESULTS: Cooperative farmers reported lower perceived stress and symptoms of depression than non-cooperative farmers and the difference was statistically significant for perceived stress. Use of educational programs, such as training and mentorship, was associated with decreased perceived stress but not symptoms of depression. Satisfaction with programs and social support were associated with decreased perceived stress and symptoms of depression. Program satisfaction was observed to have more associations with decreased perceived stress and symptoms of depression than program use. CONCLUSIONS: Results reveal that organizational resources and social support can mitigate mental health risks among farmers. This study highlighted an opportunity for future investigation of social connectedness in addressing farmers' mental health.

Safety Measures, Pesticide Concerns and Resources Utilized among Young Adult Workers: A Brief Report.

INTRODUCTION: Resources on pesticide information are widely available; however, little is known about the concerns young agricultural workers have about pesticides, whether they use existing resources to find information about pesticides, and how these resources influence safety behaviors such as personal protective equipment (PPE) use. OBJECTIVES: To examine demographic characteristics, safety measures, concerns about pesticide use and resources for pesticide information. METHODS: Young agricultural workers were recruited through three collegiate agricultural programs and completed an online questionnaire related to pesticide safety and use. RESULTS: Most participants who applied pesticides reported always wearing gloves (60.5%), using a tractor with an enclosed cab (68.4%), and always wearing long pants (76.3%). Among all participants, pesticide drift to crops (65.1%) and water contamination (62.3%) were the biggest concerns among young agricultural workers. The internet was the most utilized source to locate information about pesticides (76.4%), with the most common internet resources being online materials from universities or colleges (71.6%), the government (69.1%), or pesticide companies (66.7%). Accessibility (90.6%) and speed (78.3%) were the most common reasons for using the internet for information. Misinformation was the most common barrier (80.2%). CONCLUSIONS: Future studies should examine the accuracy and accessibility of pesticide information available on the internet since young adult workers rely on these resources for pesticide information.

Incorporation of an Efficient Pharmacist Workflow During the Transition From In-Person to Telemedicine Geriatric Clinics in Response to the COVID-19 Pandemic.

The COVID-19 pandemic created care continuity challenges for older adults in the ambulatory care setting. Similarly, maintaining the multidisciplinary team concept of geriatric care among healthcare practitioners working from home presented several logistical difficulties. It became apparent there was a need to address these problems to avoid care gaps in this vulnerable population. Realizing that in-person clinics could put vulnerable older adults at increased risk of contracting COVID-19, a workflow was proactively developed to convert a traditional in-person multidisciplinary geriatric clinic to a telemedicine-based model. A video patient encounter option within our electronic health record along with a secure on-line meeting platform was used to maintain a team-based approach to care. This resulted not only in a high level of efficiency in care delivery, but also ensured the safety of older adult patients served by the clinic. This model provides a template for the continued use of telemedicine as a strategy for the care of vulnerable older adults who experience challenges with attending in-person clinics.

Development of a Checklist to Identify Injury Hazards on Row Crop Farms in the Midwestern United States.

Agriculture is among the most dangerous industries in the U.S., yet routine surveillance of injury hazards is not currently being conducted on a national level. The objectives of this study were to describe a new tool, called the Hazard Assessment Checklist (HAC), to identify and characterize farm hazards that increase injury risk to farmers and farm workers, and (2) report the inter-rater reliability of the new tool when administered on row-crop farms in Iowa. Based on a literature review and a consensus of expert opinion, the HAC included hazards related to self-propelled vehicles, powered portable implements, fixed machinery and equipment, farm buildings and structures, fall risks, and portable equipment associated with fall risk. A scoring metric indicating the extent of compliance with recommended safety guidelines and standards was developed for each item of the HAC, which included compliant, minimal improvement needed, substantial improvement needed, and not compliant. Inter-rater reliability was assessed from data collected by research staff on 52 row crop farms in Iowa. Cohen's weighted Kappa values demonstrated high inter-rater reliability, ranging between 0.86 and 0.94, for all HAC sections. The HAC can be completed in 1.5-2 hours on each farm and requires about three hours of training, two hours of which are spent in field training. The ability to monitor injury-related hazards over time using an empirically driven tool will contribute significantly to injury prevention efforts in an industry with consistently high rates of fatal and nonfatal injury.

Pediatric Unintentional Fall-Related Injuries in a Statewide Trauma Registry.

OBJECTIVES: The purpose of the study was to evaluate patterns of fall-related injury through childhood and identify risk factors for more severe fall-related injuries with the goal of informing targeted prevention strategies for different ages. METHODS: The study population consisted of pediatric patients in the Iowa Trauma Registry from January 1, 2010, to December 31, 2014, who sustained an unintentional fall-related injury (N = 3856 patients). Multinomial logistic regression analysis was used to predict injury severity. Adjusted odds ratios were calculated characterizing the relationship between fall severity and age, sex, race, and fall type. RESULTS: More males (62%) sustained a fall-related injury during the study period when compared with females (38%; P < 0.0001). Head injuries were the most common type of injury in the younger than 1 year age group (77%), whereas fractures were the predominant injury type in all other age groups, followed by head injuries. Those younger than 1 year (adjusted odds ratio, 4.0; 95% confidence interval, 2.36-6.90) and aged 15 to 18 years (adjusted odds ratio, 1.9; 95% confidence interval, 1.17-3.03) were more likely to have an Injury Severity Score of ≥16 than those aged 10 to 14 years. CONCLUSIONS: Recommendations and prevention strategies need to focus on specific risk factors to reduce the harm of multilevel falls. As we have shown, patterns of fall injuries presenting to trauma hospitals differ by age, thus suggesting that prevention strategies focus on specific age groups.

Agricultural Cooperatives in Mental Health: Farmers' Perspectives on Potential Influence.

Agricultural cooperatives are formed to promote farmers' economic, social, and legislative interests. Their role in influencing mental health is less known. We characterized farmers' experiences with cooperatives and identified the potential impact of cooperatives in promoting mental health. Semi-structured interviews were conducted in Wisconsin with 12 participants, including farmers, cooperative professionals, and agricultural extension educators. Participants were asked about stress among farmers; cooperative structures and services provided to farmers, and farmers' interactions with the cooperatives; and the role cooperatives play in reducing stress among farmers. Three main themes were developed: stress farmers were experiencing, available resources from cooperatives, and the role of cooperatives in promoting farmers' mental health. Stress farmers were experiencing was elucidated through the subthemes: increased stress, depression, and suicide and stressors involving finances, occupational pressure, relationships, isolation, and loneliness. Available resources from cooperatives were described in subthemes: cooperative characteristics, services, and engagement activities. The role of cooperatives in promoting farmers' mental health was discussed through subthemes: responder, community, facilitator, and divergent views on whether co-ops can protect farmers' mental health. Cooperatives provide members market stability, services, and opportunities for decision-making, social interaction, and civic engagement. These resources create a community where farmers feel a sense of belonging and retain a level of control. As rural communities continue to struggle with mental health resource shortages, identifying and evaluating community-based resources such as those offered by the cooperatives is imperative.

Determining occupation for National Violent Death Reporting System records: An evaluation of autocoding programs.

BACKGROUND: Suicide is a leading cause of death for working-age adults. Suicide risk varies across occupations. The National Violent Death Reporting System (NVDRS) collects information about violent deaths occurring in the United States. Occupation can be determined using autocoding programs with NVDRS data. The objective of this analysis is to determine the accuracy of autocoding programs for assigning occupations in the NVDRS. METHODS: Deaths from suicide were identified in NVDRS for individuals age 16 and older from 2010 to 2017. Occupations were assigned after processing job description free text with autocoding programs. Job assigned by autocoding program were compared with the occupation code recorded on the death certificate. RESULTS: Assignment of major occupation group had substantial agreement (Cohen's kappa > 0.7) for the two autocoding programs evaluated. Agreement of assigned code varied across race/ethnicity and occupation type. CONCLUSIONS: Autocoding programs provide an efficient method for identifying the occupation for decedents in NVDRS data. By identifying occupation, circumstances of suicide and rates of suicide can be studied across occupations.

Examining the Association Between Age and Tractor Driving Performance Measures Using a High-Fidelity Tractor Driving Simulator.

HIGHLIGHTS This study uses a new tractor driving simulator to examine the impact of age on perception response time in an emergency braking situation. The results demonstrate increased risk for crash among older farm equipment operators. ABSTRACT. Transportation-related incidents are the leading cause of occupational fatalities for all industries in the U.S. In the agriculture industry, where tractor-related incidents are the leading cause of occupational fatality, fatal crashes occur more frequently among senior farm equipment operators (FEOs) than younger FEOs. This study examined the association between age and driving performance among FEOs using a simulated driving environment. We demonstrated that older FEOs have longer perception response times when encountering an incurring semi-truck during a simulated drive than younger FEOs. These results persisted when adjusted for selected medical diagnoses and medications, tractor generation, and tractor horsepower. However, due to the small sample size and limitations of the tractor driving simulator, its use for event perception response time research is questionable. The tractor driving simulator used in this study may be better suited for distracted driving studies and studies comparing the ways in which FEOs drive passenger vehicles compared to tractors.

Medication Management and Deprescribing in Assisted Living Facilities.

Medication management for seniors is a foundation for keeping them healthy and independent. A vital aspect of medication management is the selective discontinuation of medications, or deprescribing. While this is a common practice within nursing homes it seems to be less common among those who live in assisted living facilities. Shockingly little exiting literature was found when conducting a literature review concerning deprescribing in assisted living facilities. Therefore, it was determined to set forth this call to action to focus on deprescribing in assisted living facilities hoping that it would be given more attention to keep our seniors healthy and safe.

Cost, Severity and Prevalence of Agricultural-Related Injury Workers' Compensation Claims in Farming Operations from 14 U.S. States.

(1) Background: There is no national surveillance of agricultural injuries, despite agricultural occupations being among the most hazardous in the U.S. This effort uses workers' compensation (WC) data to estimate the burden of agricultural injuries and the likelihood of experiencing an injury by body part involved, cause, and nature in farming operations. (2) Methods: WC data from 2010 to 2016 provided by a large insurance company covering small to medium-sized farm operations from 14 U.S. states was used. We investigated the associations between injury characteristics and WC costs and the risk of having a more severe versus a less severe claim. The proportion of costs attributable to specific claim types was calculated. (3) Results: Of a total 1000 claims, 67% were medical only. The total cost incurred by WC payable claims (n = 866) was USD 21.5 million. Of this, 96% was attributable to more severe claims resulting in disabilities or death. The most common body part injured was the distal upper extremity. Falling or flying objects and collisions were the most expensive and common causes of injury. (4) Conclusions: Characterizing the cost and severity of agricultural injury by key injury characteristics may be useful when prioritizing prevention efforts in partnership with insurance companies and agricultural operations.

The prevalence of work-related suicides varies by reporting source from the National Violent Death Reporting System.

INTRODUCTION: Both suicides overall and work-related suicides are increasing in the United States, and efforts to reduce suicide risk will require an understanding of the frequency and role of work in suicides. This study examines the incidence of occupational suicides using the National Violent Death Reporting System (NVDRS), which identified the role of work in suicides using the traditional death certificate as well as from death investigations. METHODS: NVDRS suicides among those aged 16 through 65 from 2013 through 2017 were examined to determine if the death certificate identified the death as work-related, if the death investigation identified a job problem as a suicide circumstance, and if the death investigation indicated that the job problem was a crisis at the time of the suicide. RESULTS: Overall, 1.13% of death certificates identified the suicides as work-related, 2.34% of suicides included a job crisis, and 11.2% a job problem, and proportions did not vary over the years of the study. Overlap between the death certificate and death investigation was very low, with only 0.21% of suicides identified as related to work by both sources. Identification of work-relatedness varied by source for demographic characteristics, mechanism of suicide, and occupation. For example, the death certificate identified 2.1% of suicides among those working in protective services as work-related, but death investigations identified 15.2% as having a job problem. CONCLUSION: Work-related factors may be associated with a far higher proportion of suicides than previously documented.

Examination of Symptoms of Depression among Cooperative Dairy Farmers.

Farmers experience a high risk of stress, depression, and suicide. Risk factors are well documented but protective factors are seldom examined. Social support has been reported to reduce psychological distress among the general population but its effect on farmers is inconclusive. Agricultural cooperatives are typically created and owned by farmers to secure markets, access supplies and services, and participate in decision-making. It is unknown whether having cooperative resources impacts symptoms of depression. A survey was used to examine whether having access to cooperative programs and social support impacted symptoms of depression among dairy farmers. Farm bankruptcies, stress, depression, and suicide were identified as ongoing concerns. Having social support and cooperative educational opportunities and mentorship programs were associated with decreased symptoms of depression. Conversely, having cooperative policy discussions was associated with increased symptoms of depression. Results suggest that social support can potentially reduce symptoms of depression among farmers and having access to cooperative resources can reduce or increase it, depending on the type of program. Our findings identified an opportunity to further examine how programs provided by farmer-led organizations such as cooperatives can impact stress, depression, and suicide among farmers.

Impact of a crime prevention ordinance for small retail establishments.

BACKGROUND: Ordinances requiring the implementation of robbery prevention measures have been enacted at the city level in many jurisdictions. We evaluated the impact of an ordinance requiring crime prevention measures on subsequent crime rates. METHODS: Crime reports for robbery and aggravated assault from January 2006 through December 2015 were linked to randomly-selected convenience stores and small retail grocers in Houston (n = 293). Store characteristics and compliance with a list of safety measures were collected by surveyors in 2011. Generalized linear mixed models were used to compare rates of crime before and after the implementation of the ordinance. RESULTS: Robberies decreased significantly after the ordinance went into effect (rate ratio = 0.38; 95% confidence interval 0.29-0.51). No individual safety measure was associated with decreased robbery rates. No similar decrease was observed for aggravated assault. CONCLUSIONS: City ordinances mandating crime prevention measures can be effective. We could not parse out the effectiveness of individual elements, suggesting a comprehensive approach may be more effective.

Effect of a Multifactorial Fall Injury Prevention Intervention on Patient Well-Being: The STRIDE Study.

BACKGROUND/OBJECTIVES: In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, a multifactorial intervention was associated with a nonsignificant 8% reduction in time to first serious fall injury but a significant 10% reduction in time to first self-reported fall injury relative to enhanced usual care. The effect of the intervention on other outcomes important to patients has not yet been reported. We aimed to evaluate the effect of the intervention on patient well-being including concern about falling, anxiety, depression, physical function, and disability. DESIGN: Pragmatic cluster-randomized trial of 5,451 community-living persons at high risk for serious fall injuries. SETTING: A total of 86 primary care practices within 10 U.S. healthcare systems. PARTICIPANTS: A random subsample of 743 persons aged 75 and older. MEASUREMENTS: The well-being measures, assessed at baseline, 12 months, and 24 months, included a modified version of the Fall Efficacy Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scales, and Late-Life Function and Disability Instrument. RESULTS: Participants in the intervention (n = 384) and control groups (n = 359) were comparable in age: mean (standard deviation) of 81.9 (4.7) versus 81.8 (5.0) years. Mean scores were similar between groups at 12 and 24 months for concern about falling, physical function, and disability, whereas the intervention group's mean scores on anxiety and depression were .7 points lower (i.e., better) at 12 months and .6 to .8 points lower at 24 months. For each of these outcomes, differences between the groups' adjusted least square mean changes from baseline to 12 and 24 months, respectively, were quantitatively small. The overall difference in means between groups over 2 years was statistically significant only for depression, favoring the intervention: -1.19 (99% confidence interval, -2.36 to -.02), with 3.5 points representing a minimally important difference. CONCLUSIONS: STRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient well-being.