Cleaning Tasks and Products and Asthma Among Health Care Professionals.

OBJECTIVE: Health care workers are at risk for work-related asthma, which may be affected by changes in cleaning practices. We examined associations of cleaning tasks and products with work-related asthma in health care workers in 2016, comparing them with prior results from 2003. METHODS: We estimated asthma prevalence by professional group and explored associations of self-reported asthma with job-exposure matrix-based cleaning tasks/products in a representative Texas sample of 9914 physicians, nurses, respiratory/occupational therapists, and nurse aides. RESULTS: Response rate was 34.8% (n = 2421). The weighted prevalence rates of physician-diagnosed (15.3%), work-exacerbated (4.1%), and new-onset asthma (6.7%) and bronchial hyperresponsiveness symptoms (31.1%) were similar to 2003. New-onset asthma was associated with building surface cleaning (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.10-3.33), use of ortho-phthalaldehyde (OR, 1.77; 95% CI, 1.15-2.72), bleach/quaternary compounds (OR, 1.91; 95% CI, 1.10-3.33), and sprays (OR, 1.97; 95% CI, 1.12-3.47). CONCLUSION: Prevalence of asthma/bronchial hyperresponsiveness seems unchanged, whereas associations of new-onset asthma with exposures to surface cleaning remained, and decreased for instrument cleaning.

When falls become fatal-Clinical care sequence.

OBJECTIVES: This study encompassed fall-related deaths, including those who died prior to medical care, that were admitted to multiple healthcare institutions, regardless of whether they died at home, in long-term care, or in hospice. The common element was that all deaths resulted directly or indirectly from injuries sustained during a fall, regardless of the temporal relationship. This comprehensive approach provides an unusual illustration of the clinical sequence of fall-related deaths. Understanding this pathway lays the groundwork for identification of gaps in healthcare needs. DESIGN: This is a retrospective study of 2014 fall-related deaths recorded by one medical examiner's office (n = 511) within a larger dataset of all trauma related deaths (n = 1848). Decedent demographic characteristics and fall-related variables associated with the deaths were coded and described. RESULTS: Of those falling, 483 (94.5%) were from heights less than 10 feet and 394 (77.1%) were aged 65+. The largest proportion of deaths (n = 267, 52.3%) occurred post-discharge from an acute care setting. Of those who had a documented prior fall, 216 (42.3%) had a history of one fall while 31 (6.1%) had ≥2 falls prior to their fatal incident. For the 267 post-acute care deaths, 440 healthcare admissions were involved in their care. Of 267 deaths occurring post-acute care, 129 (48.3%) were readmitted within 30 days. Preventability, defined as opportunities for improvement in care that may have influenced the outcome, was assessed. Of the 1848 trauma deaths, 511 (27.7%) were due to falls of which 361 (70.6%) were determined to be preventable or potentially preventable. CONCLUSION: Our data show that readmissions and repeated falls are frequent events in the clinical sequence of fall fatalities. Efforts to prevent fall-related readmissions should be a top priority for improving fall outcomes and increasing the quality of life among those at risk of falling.

Prevalence of Musculoskeletal Work-related Injuries Among Radiation Therapists.

PURPOSE: To evaluate the prevalence of and risk factors associated with work-related musculoskeletal injuries among radiation therapists in the United States. METHODS: Approximately 16 000 radiation therapists were identified and electronically mailed a modified Nordic Musculoskeletal Questionnaire. For inclusion in the analysis, participants were required to be actively employed during the preceding 12-month period and hold a current position as a radiation therapist. Descriptive statistics, univariate and multivariate analyses, and text analysis were performed to assess personal and work-related factors that correlated with injury risk. RESULTS: Contact was established with 5827 radiation therapists (contact rate, 37%). Of these, 2747 responded (cooperation rate, 47%), of which 1867 met inclusion criteria. Prevalence of work-related musculoskeletal injuries at 12 months was 76%, with the most common site-specific injury in the lumbar back (20%), followed by the neck (17%) and shoulders (15%). An incident rate of 33 injuries per 100 full-time equivalents per year was calculated. Multiple logistic regression analyses revealed the following variables to be significantly associated with increased injury risk: female sex, a body mass index of 30 or greater, and tobacco use. Daily exercise was associated with decreased risk. Patient transfers, body mechanics, and heavy lifting were the primary reported sources of injuries. DISCUSSION: Radiation therapists appear to be at considerable risk for work-related musculoskeletal injuries, which corresponds with findings of studies on health care employees. The high prevalence observed among radiation therapists (76%) is similarly high among nurses, and the increased risk for women also has been reported among physical therapists. Furthermore, other study results support obesity and tobacco use as risk factors and daily exercise as decreasing risk. In this study, most radiation therapists indicated interest in safety training courses, which could be addressed by involving national programs and competency requirements. CONCLUSION: Further study is needed to address modifiable risk factors and implement interventions that reduce the high prevalence of work-related musculoskeletal injuries among radiation therapists. The results of such research might help decrease personal, societal, and radiation oncology practice-specific costs.

Physical activity trajectories and subsequent fall risk: ARIC Study.

To examine the impact of moderate to vigorous intensity physical activity (MVPA) trajectories during midlife and older adulthood with subsequent fall risk in later life. Cross-temporal analyses were conducted in 15,792 participants (27% black, 55% women) aged 45 to 64 years enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. MVPA was collected at Exams 1 (1987-89), 3 (1993-95) and 5 (2011-13) using the ARIC/Baecke questionnaire. Latent class growth analysis was used to identify the MVPA trajectory groups. Reported falls outcomes were collected in 2013-14, 2015-16, and 2016-17. Generalized Linear Models were used to estimate associations of baseline predictors with trajectory class membership, as well as associations of trajectory classes with any falling (adjusted incident relative risks, aIRR) and with number of falls (adjusted relative rates, aRR). Four primary trajectory classes emerged, reflecting longitudinal patterns of maintained high (48%), maintained low (22%), increasing (14%) and decreasing (15%) MVPA. After adjustment for covariates, the decreasing MVPA trajectory group had a 14% higher risk of reporting any falling compared to the maintained high MVPA group [aIRR = 1.14 (1.01, 1.28)]. When compared to the maintained high MVPA group, the maintained low and decreasing group had a 28% [aRR = 1.28 (1.14, 1.44)] and 27% [aRR = 1.27 (1.17, 1.38)] higher rate in the reported number of falls, respectively. Findings support public health campaigns targeting habitual MVPA or exercise for fall prevention and suggest that interventions should be initiated in midlife; a time when individuals may be more able and willing to change behavior.

Short time between shifts and risk of injury among Danish hospital workers: a register-based cohort study.

Objectives Short time between consecutive work shifts (quick returns, ie, ≤11 hours between shifts) is associated with sleepiness and fatigue, both of which have been linked to risk of injury. This paper aims to study quick returns between work shifts and risk of injury among Danish hospital workers. Method The study population included 69 200 employees, primarily working at hospitals, corresponding to 167 726 person years at risk between 2008-2015. Information on working hours was obtained from payroll data in the Danish Working Hour Database and linked, at an individual level, with data on 11 834 injury records identified in the National Patient Register and the Danish Register of Causes of Death. Multivariate Poisson regression models were used to calculate incidence rate ratios (IRR) with 95% confidence intervals (CI). Results Results showed the shorter the time between shifts, the higher the risk of injury. Thus, an elevated risk of injury was observed after quick returns compared with the standard 15-17 hours between shifts (IRR 1.39, 95% CI 1.23-1.58). Furthermore, when assessing the number of days since a quick return, the risk of injury was especially high within the first two days (day 1: IRR 1.39, 95% CI 1.23-1.58; day 2: IRR 1.39, 95% CI 1.21-1.58) following a quick return. Conclusions Our results suggest that quick returns increased the risk of injury, in particular within the first two days following a quick return. These findings point towards avoiding or reducing the number of quick returns in order to lower employees' risk of injury.

Risk of injury after evening and night work - findings from the Danish Working Hour Database.

Objectives Evening and night work have been associated with higher risk of injury than day work. However, previous findings may be affected by recall bias and unmeasured confounding from differences between day, evening and night workers. This study investigates whether evening and night work during the past week increases risk of injury when reducing recall bias and unmeasured confounding. Methods We linked daily working hours at the individual level of 69 200 employees (167 726 person years from 2008-2015), primarily working at hospitals to registry information on 11 834 injuries leading to emergency room visits or death. Analyses were conducted with Poisson regression models in the full population including permanent day, evening and night workers, and in two sub-populations of evening and night workers, with both day and evening or night work, respectively. Thus, the exchangeability between exposure and reference group was improved in the two sub-populations. Results Risk of injury was higher after a week with evening work [incidence rate ratio (IRR) 1.32, 95% confidence interval (CI) 1.26-1.37] and night work (IRR 1.33, 95% CI 1.25-1.41) compared with only day work. Similar, although attenuated, estimates were found for evening work among evening workers (IRR 1.18, 95% CI 1.12-1.25), and for night work among night workers (IRR 1.10, 95% CI 1.01-1.20). Conclusion There is an overall increased risk of injury after a week that has included evening or night work compared with only day work. Though attenuated, the higher risk remains after reducing unmeasured confounding.

The Identification of a Threshold of Long Work Hours for Predicting Elevated Risks of Adverse Health Outcomes.

Working long hours has been associated with adverse health outcomes. However, a definition of long work hours relative to adverse health risk has not been established. Repeated measures of work hours among approximately 2,000 participants from the Panel Study of Income Dynamics (1986-2011), conducted in the United States, were retrospectively analyzed to derive statistically optimized cutpoints of long work hours that best predicted three health outcomes. Work-hours cutpoints were assessed for model fit, calibration, and discrimination separately for the outcomes of poor self-reported general health, incident cardiovascular disease, and incident cancer. For each outcome, the work-hours threshold that best predicted increased risk was 52 hours per week or more for a minimum of 10 years. Workers exposed at this level had a higher risk of poor self-reported general health (relative risk (RR) = 1.28; 95% confidence interval (CI): 1.06, 1.53), cardiovascular disease (RR = 1.42; 95% CI: 1.24, 1.63), and cancer (RR = 1.62; 95% CI: 1.22, 2.17) compared with those working 35-51 hours per week for the same duration. This study provides the first health risk-based definition of long work hours. Further examination of the predictive power of this cutpoint on other health outcomes and in other study populations is needed.

A qualitative assessment of safe work practices in logging in the southern United States.

BACKGROUND: The logging industry is recognized as one of the most dangerous professions in the U.S., but little is known about safety management practices on remote logging sites. METHODS: A total of six focus group sessions were held among logging supervisors and front line crew members in Arkansas, Louisiana, and Texas (N = 27 participants). RESULTS: Participants perceived that logging was a dangerous profession, but its risks had been mitigated in several ways, most notably through mechanization of timber harvesting. Log trucking-related incidents were widely identified as the primary source of risk for injury and death on logging work sites. Human error, in general, and being out of the machinery on the work site were highlighted as additional sources of risk. CONCLUSIONS: Participants indicated high levels of personal motivation to work in a safe manner but tended to underestimate workplace hazards and expressed widely varying levels of co-worker trust. Am. J. Ind. Med. 60:58-68, 2017. © 2016 Wiley Periodicals, Inc.

The American Association of Occupational Health Nurses' Respiratory Protection Education Program and Resources Webkit for Occupational Health Professionals.

Organizations are required to adhere to the Occupational Safety and Health Administration's (OSHA) Respiratory Protection Standard (29 CFR 1910.134) if they have workers that wear a respirator on the job. They must also have an employee "suitably trained" to administer their program. The National Institute for Occupational Safety and Health and its National Personal Protective Technology Laboratory have worked to champion the occupational health nurse in this role by collaborating with the American Association of Occupational Health Nurses to develop free, online respiratory protection training and resources (RPP Webkit). This article describes the development, content, and success of this training. To date, 724 participants have completed the training, 32.6% of whom lead their organization's respiratory protection program, 15.3% who indicated they will lead a program in the near future, and 52% who did not lead a program, but indicated that the training was relevant to their work. The majority "strongly agreed" the training was applicable to their work and it enhanced their professional expertise.

Hospital workers bypass traditional occupational injury reporting systems when reporting patient and visitor perpetrated (type II) violence.

BACKGROUND: Under-reporting of type II (patient/visitor-on-worker) violence by workers has been attributed to a lack of essential event details needed to inform prevention strategies. METHODS: Mixed methods including surveys and focus groups were used to examine patterns of reporting type II violent events among ∼11,000 workers at six U.S. hospitals. RESULTS: Of the 2,098 workers who experienced a type II violent event, 75% indicated they reported. Reporting patterns were disparate including reports to managers, co-workers, security, and patients' medical records-with only 9% reporting into occupational injury/safety reporting systems. Workers were unclear about when and where to report, and relied on their own "threshold" of when to report based on event circumstances. CONCLUSIONS: Our findings contradict prior findings that workers significantly under-report violent events. Coordinated surveillance efforts across departments are needed to capture workers' reports, including the use of a designated violence reporting system that is supported by reporting policies. Am. J. Ind. Med. 59:853-865, 2016. © 2016 Wiley Periodicals, Inc.

Association between long work hours and poor self-reported general health among Latin American immigrant and native workers in the United States and Spain.

BACKGROUND: The relationship between hours worked per week and self-reported general health (SRGH) has not been assessed in Latin American immigrant and native workers across host countries. METHODS: Cross-sectional study of the association between long work hours (LWH) (i.e., >51 hr per week) and poor SRGH using data from 2,626 workers in the United States (immigrants = 10.4%) and 8,306 workers in Spain (immigrants = 4.1%). RESULTS: Both countries' natives working >51 hr per week had increased odds of reporting poor SRGH compared to those working fewer hours (U.S.: OR = 1.59; 95%CI = 1.01-2.49; Spain: OR = 2.17; 95%CI = 1.71-2.75); when stratified by sex, increased odds also were observed among immigrant female workers in Spain (OR = 3.47; 95%CI = 1.15-10.5). CONCLUSIONS: LWH were associated with differential health outcomes in populations of native and Latin American immigrant workers in the United States and Spain, which may reflect social or occupational inequalities in general or resulting from the 2008 financial crisis. Am. J. Ind. Med. 59:1105-1111, 2016. © 2016 Wiley Periodicals, Inc.

Dose-Response Relation Between Work Hours and Cardiovascular Disease Risk: Findings From the Panel Study of Income Dynamics.

OBJECTIVES: The aim of this study was to examine the presence of a dose-response relationship between work hours and incident cardiovascular disease (CVD) in a representative sample of U.S. workers. METHODS: A retrospective cohort study of 1926 individuals from the Panel Study of Income Dynamics (1986 to 2011) employed for at least 10 years. Restricted cubic spline regression was used to estimate the dose-response relationship of work hours with CVD. RESULTS: A dose-response relationship was observed in which an average workweek of 46 hours or more for at least 10 years was associated with an increased risk of CVD. Compared with working 45 hours per week, working an additional 10 hours per week or more for at least 10 years increased CVD risk by at least 16%. CONCLUSION: Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.