A retrospective analysis of the aspiration of fracture blisters.

INTRODUCTION: Fracture blisters are frequently encountered in orthopaedic trauma. Fracture blisters are associated with increased infection rates and wound breakdown. This study was performed to determine whether fluid aspirate from blisters is sterile or colonized. MATERIALS AND METHODS: This is a retrospective review of a prospectively gathered cohort of patients. Patients with fracture blisters were recruited from a U.S. level I trauma center between 2011 and 2017. The blisters were aspirated under sterile conditions. Fluid was analyzed for gram stain and quantitative culture. Medical history obtained included blister location, presence of blood in blister, injury mechanism, gender, diabetes status and tobacco use. The demographic and behavioral descriptors were compared across positive aspirate or infection status using chi-square and Fisher's exact tests. RESULTS: We enrolled 64 patients in the study, seven of which had colonized aspirates (10.9%). None of the potential risk factors were significantly associated. Tobacco use trended towards significance for a positive aspirate (p = 0.09), but not for infection (p = 0.61). We followed patients for an average of 4.6 months. Four patients went on to have surgical site infections and none of them had positive aspirates. CONCLUSION: Fracture blisters cannot be assumed to be sterile with more than 10% of our sample being colonized. Blister rupture during surgery or prepping for surgery could represent a contamination of the sterile field. No risk factors were significantly associated with colonization in our sample. However, colonized aspirates may not predispose patients to increased infection rates.

Reciprocal associations between depression, anxiety and work-related injury.

OBJECTIVE: To examine the reciprocal longitudinal associations between depression or anxiety with work-related injury (WRI) at a large employer in the southwestern United States. METHOD: Three administrative datasets (2011-2013) were merged: employee eligibility, medical and prescription claims, and workers' compensation claims. The sample contained 69 066 active employees. Depression and anxiety were defined as episodes of medical visits care (ie, claims) with corresponding ICD-9-CM codes. For an individual's consecutive claims, a new case of depression or anxiety was defined if more than 8 weeks have passed since the prior episode. The presence of a workers' compensation injury claim was used to identify WRI. Three-wave (health plan years 2011 or T1, 2012 or T2, and 2013 or T3) autoregressive cross-lagged models were used to estimate whether depression or anxiety predicted WRI, also if WRI predicted depression or anxiety in the following year(s). RESULTS: Depression predicted injury from T1 to T2 (ß=0.127, p<0.001) and from T2 to T3 (ß=0.092, p=0.001). Injury predicted depression from T1 to T3 (ß=0.418, p<0.001). Effects of anxiety on WRI were small and inconsistent, from T1 to T2 (ß=0.013, p=0.622) and from T2 to T3 (ß=-0.043, p=0.031). T1 injury had a protective effect on T3 anxiety (ß=-0.273, p<0.001). CONCLUSIONS: We found evidence of reciprocal effects for depression with WRI after adjustment for prior injuries and depression. The evidence for the relationship between anxiety and WRI is less clear. WRI prevention and management programmes should incorporate depression prevention and management.

Evaluation of a Worksite-Based Small Group Team Challenge to Increase Physical Activity.

PURPOSE: To investigate whether participants in a small group team challenge had greater completion rates in an institution-wide step-challenge than other participants. DESIGN: A quasi-experimental, posttest-only design with a comparison group was used to evaluate group differences in completion rates. SETTING: A large university system provided the opportunity to participate in a physical activity challenge. PARTICIPANTS: The study was limited to employees who participated in the physical activity challenge. INTERVENTION: Two institutions offered participants the chance to compete as smaller groups of teams within their institution. These team-challenge participants (N = 414) were compared to participants from the same institutions that did not sign up for a team and tracked their steps individually (N = 1454). MEASURES: Participants who reported 50 000 steps per week for 5 of the 6 weeks were classified as challenge completers. We also evaluated total step count and controlled for several potential covariates including age, gender, and body mass index. ANALYSIS: Logistic regression was used to model the dichotomous outcome of challenge completion. RESULTS: Team-challenge participants were more likely to complete the physical activity challenge than other participants. Team-challenge participants had 1922 more steps per day than individual participants. However, at an institution level, overall completion rates were not higher at institutions that offered a team challenge.

The longitudinal relation between self-reported physical activity and presenteeism.

This study evaluates the longitudinal relation between self-reported physical activity and health related work limitations (also known as presenteeism) among employees from a public university system. A retrospective longitudinal study design was used to examine research aims. Data were from self-reported health assessments collected from employees at a large University System in Texas during the 2013-2015 plan years (n=6515).Work limitations were measured using the self-report 8-item work limitations questionnaire. Latent growth curve models were used to test whether: 1) baseline physical activity was associated with baseline work limitations; 2) changes in physical activity were related to changes in work limitations; and 3) baseline physical activity predicted changes in work limitations. Models were adjusted for demographic and health-related variables. The final adjusted growth curve model demonstrated excellent fit. Results revealed baseline physical activity was inversely associated with baseline work limitations (ß=-0.12, p<0.001). In addition, changes in physical activity were related to changes in work limitations (ß=-0.33, p=0.02). However, no relation was found between baseline physical activity and changes in work limitations (ß=-0.06, p=0.42). Results provide evidence that increasing physical activity among employees leads to decreases in health-related work limitations. Therefore, promoting physical activity among employee populations can help prevent and reduce presenteeism.

The Relation of Combined Aerobic and Muscle-Strengthening Physical Activities With Presenteeism.

BACKGROUND: There is a need to understand physical activity types associated with health-related work limitations (also known as presenteeism). This study tests whether additive effects between physical activity types are associated with health-related work limitations among employees from a public university system. METHODS: A cross-sectional study using health assessment data (n = 10,791) was used to examine aims. Analysis of covariance models tested differences in work limitations between physical activity groups based on combinations of stretching behavior, aerobic, and muscle-strengthening physical activities. Planned contrasts compared differences between selected groups. RESULTS: There were significant group differences (P < .001) in reported work limitations after controlling for demographic, season, and health-related variables. Employees who reported participating in aerobic physical activity had significantly lower work limitation levels compared with inactive employees (P = .027). Employees who reported participating in both aerobic and muscle-strengthening physical activities had the lowest work limitation levels compared with all groups and significantly lower work limitation levels compared with employees who participated in aerobic physical activity only (P = .026). CONCLUSIONS: Results provide evidence of an additive effect where participating in a combination of aerobic and muscle-strengthening physical activities may be most beneficial when targeting health-related work limitations.

Association of Self-Reported Aerobic Physical Activity, Muscle-Strengthening Physical Activity, and Stretching Behavior With Presenteeism.

OBJECTIVE: The aim of this study was to evaluate relations between aerobic physical activity (PA), muscle-strengthening PA, and stretching behavior and presenteeism in university employees. METHODS: A cross-sectional study used health assessment data from two employee respondent groups (n2015 = 10,791 and n2009 = 10,165). Multivariable zero-inflated negative binomial regression models assessed the association between self-reported PA types and presenteeism. RESULTS: There was consistent evidence that employees who reported participating in sufficient aerobic PA had higher odds for no work limitations [odds ratio (OR2015) = 1.45, P < 0.001; OR2009 = 1.55, P < 0.001] and lower levels of work limitations [incidence rate ratio (IRR)2015 = 0.92, P < 0.05; IRR2009 = 0.83, P < 0.001] than employees who reported participating in no activity. There was some evidence of an inverse association between muscle-strengthening PA and work limitations, but no evidence between stretching behavior and work limitations. CONCLUSIONS: Promoting PA among employees is a key health behavior to target for worksites concerned about presenteeism.

How Do Stages of Change for Physical Activity Relate to Employee Sign-Up for and Completion of a Worksite Physical Activity Competition?

INTRODUCTION: This study evaluated whether stages of change for physical activity (PA) predict sign-up, participation, and completion in a PA competition. METHOD: Deidentified data were provided to evaluate a PA competition between 16 different institutions from a public university system. Employees who completed a health assessment (HA) prior to the start of the PA competition ( n = 6,333) were included in the study. Participants completed a self-report HA and logged their PA throughout the competition. Multivariable logistic regression models tested whether stages of change predicted PA competition sign-up and completion. An ordinal logistic regression model tested whether stages of change predicted number of weeks of PA competition participation. RESULTS: Stages of change predicted PA competition sign-up and completion, but not weeks of participation. The odds for PA competition sign-up were 1.64 and 1.98 times higher for employees in preparation and action/maintenance (respectively) compared with employees in precontemplation/contemplation. The odds for PA competition completion were 4.17 times higher for employees in action/maintenance compared with employees in precontemplation/contemplation/preparation. CONCLUSION: The PA competition was more likely to reach employees in preparation, action, or maintenance stages than precontemplation/contemplation. Most of the completers were likely participating in regular PA prior to the competition.

Validity and Reliability of the 8-Item Work Limitations Questionnaire.

Purpose To evaluate factorial validity, scale reliability, test-retest reliability, convergent validity, and discriminant validity of the 8-item Work Limitations Questionnaire (WLQ) among employees from a public university system. Methods A secondary analysis using de-identified data from employees who completed an annual Health Assessment between the years 2009-2015 tested research aims. Confirmatory factor analysis (CFA) (n = 10,165) tested the latent structure of the 8-item WLQ. Scale reliability was determined using a CFA-based approach while test-retest reliability was determined using the intraclass correlation coefficient. Convergent/discriminant validity was tested by evaluating relations between the 8-item WLQ with health/performance variables for convergent validity (health-related work performance, number of chronic conditions, and general health) and demographic variables for discriminant validity (gender and institution type). Results A 1-factor model with three correlated residuals demonstrated excellent model fit (CFI = 0.99, TLI = 0.99, RMSEA = 0.03, and SRMR = 0.01). The scale reliability was acceptable (0.69, 95% CI 0.68-0.70) and the test-retest reliability was very good (ICC = 0.78). Low-to-moderate associations were observed between the 8-item WLQ and the health/performance variables while weak associations were observed between the demographic variables. Conclusions The 8-item WLQ demonstrated sufficient reliability and validity among employees from a public university system. Results suggest the 8-item WLQ is a usable alternative for studies when the more comprehensive 25-item WLQ is not available.

Improve employee engagement to retain your workforce.

BACKGROUND: Turnover hurts patient care quality and is expensive to hospitals. Improved employee engagement could encourage employees to stay at their organization. PURPOSE: The aim of the study was to test whether participants in an employee engagement program were less likely than nonparticipants to leave their job. METHODS: Health care workers (primarily patient care technicians and assistants, n = 216) were recruited to participate in an engagement program that helps employees find meaning and connection in their work. Using human resources data, we created a longitudinal study to compare participating versus nonparticipating employees in the same job titles on retention time (i.e., termination risk). FINDINGS: Participants were less likely to leave the hospital compared to nonparticipating employees (hazard ratio = 0.22, 95% CI [0.11, 0.84]). This finding remained significant after adjusting for covariates (hazard ratio = 0.37, 95% CI [0.17, 0.57]). PRACTICE IMPLICATIONS: Improving employee engagement resulted in employees staying longer at the hospital.

Predictors of Serious Psychological Distress in an Urban Population.

While there are state and national estimates of serious psychological distress (SPD), these are not useful for targeting local mental health interventions or for addressing the needs of sub-populations at increased risk for SPD. This cross-sectional study uses data from the population-based 2010 Health of Houston Survey (n = 5,116) to examine (1) the prevalence of SPD and its determinants in Houston area and (2) predictors of the utilization of mental health services among people with SPD. The prevalence of SPD among the Houston area adult population was 7 %, more than twice the national average. Correlates of SPD included: being female, under 65, lacking emotional support, smoking, having poor health status and financial distress. The odds of utilizing health services by those with SPD were affected by financial distress, insurance, employment and perceived need for services, among other factors. Interventions should be tailored to mitigate risk factors for SPD and to improve access to mental health services in the SPD sub-population.

Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion.

STUDY DESIGN: Retrospective comparative study using prospectively collected data. OBJECTIVE: To compare the rate of infection with and without the use of vancomycin powder application during posterior cervical instrumentation. SUMMARY OF BACKGROUND DATA: Surgical site infections (SSI) are a significant source of morbidity in multilevel posterior-instrumented fusions for cervical spondylotic myelopathy (CSM). Local delivery of antibiotics has been associated with decreased rates of SSI in posterior-instrumented fusions, but no study has addressed the effects of these measures on a population composed of exclusively multilevel posterior cervical instrumentation performed with decompression for CSM. METHODS: All patients undergoing multilevel posterior decompression and instrumentation for CSM by a single surgeon from 2003-2011 were included. Post hoc analysis of prospectively collected data was analyzed comparing consecutive patients treated without the use of vancomycin powder with those treated after the initiation of vancomycin powder prophylaxis. Intervention cohort and controls were examined for differences in SSI rate, body mass index, neurological status, comorbidities, and complications. RESULTS: A total of 112 patients were included in the study. Intervention (n = 40) and control (n = 72) groups were statistically similar with regard to age, body mass index, comorbidities, estimated blood loss, and operative time. Univariate analysis showed a significant decrease in infection rate in the intervention group (0%) compared with the control group (15%) in this high-risk population (P = 0.007; power = 81%). No adverse events were noted in the intervention group associated with the use of vancomycin powder. CONCLUSION: The local application of vancomycin was associated with a significant reduction in the risk of SSI in multilevel posterior cervical-instrumented fusions for CSM. This study supports the growing body of evidence that vancomycin powder placed in the wound can reduce the incidence of postoperative wound infections, and is the first that addresses this specific population. LEVEL OF EVIDENCE: 2.

Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector.

INTRODUCTION: Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards. METHODS: A systematic review of the literature used a best evidence synthesis approach to address the general question "Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?" This was followed by an evaluation of the effectiveness of specific interventions. RESULTS: The initial search identified 8,465 articles, for the period 1980-2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006-2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health. CONCLUSIONS: The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.