Assessing noise exposures in farm youths.

OBJECTIVE: This exploratory study evaluated the feasibility of field exposure assessment methods to characterize the noise sources and levels that farm youths experience during a typical workday. METHODS: Detailed exposure assessments were performed with a sample of 10 farm youths working on Vermont dairy farms to characterize potential noise hazards typical in the farm setting. Personal and area noise measurements were taken using noise dosimeters. Information concerning work- and non-work-related noise exposure histories was collected via questionnaire. RESULTS: The average age was 15.5 years (SD 2.5, range 10-18). Youths started working at an average age of 8.4 years (SD 2.3, range 6-12) and during the summer months worked an average of 41.3 hours per week (SD 32.3, range 2-68). Two youths exceeded the OSHA action level, having eight-hour time-weighted averages of 95 dBA and 92 dBA, or alternatively, doses of 206% and 127%. (The OSHA action level for the hearing conservation amendment is an eight-hour time-weighted average of 85 dBA or a dose of 50%.) Participants exceeding the action level reported working with tractors, skid steers (Bobcats), and all-terrain vehicles and doing general barn work. Additional sources of noise exposure included a mechanical silo elevator, chain saw, and wood splitter. CONCLUSION: Two of the monitored subjects were overexposed to noise in their farm work. Youths may be exposed to noise levels that exceed adult OSHA hearing conservation amendment action level as part of their daily farm activities.

Otolaryngologists' responses to errors and adverse events.

OBJECTIVES: The objectives of this study were to describe otolaryngologists' emotional reactions to errors and adverse events, their efforts to take responsibility, and their attempts to implement improvements. STUDY DESIGN AND METHODS: A retrospective, anonymous survey of 2,500 U.S. otolaryngologists who were members of the American Academy of Otolaryngology-Head and Neck Surgery about errors in their practice was conducted. Respondents were asked whether an error had occurred in their practice in the past 6 months and, if so, to describe the error, its consequences, and any corrective actions taken. Two aspects of these reports stood out, which were beyond the scope of the original study: the respondents' emotional responses and their corrective actions. RESULTS: The response rate was 18.6%. Two hundred ten (45%) respondents reported a total of 212 analyzable error reports and 230 corrective actions. Corrective actions included disclosure to the patient (20 [9%]), ameliorating the consequences of the event to the patient (107 [50%]), personal practice changes (14 [7%]), improvements in the respondent's practice or department (60 [28%]), and hospitalwide or broader corrective actions (19 [9%]). Emotional reactions to errors and adverse events were reported by 22 (10%) otolaryngologists, including regret, embarrassment, guilt, anxiety, loss of temper, and irritation. Legal action was mentioned by five physicians (2%). CONCLUSIONS: Otolaryngologists took actions not only to treat their patients, but also to improve patient care in their practice, department, hospital, or community. Emotional reactions to errors and adverse events are common and need to be addressed in medical training and practice.