Mass transit ridership and self-reported hearing health in an urban population.

Information on prevalence and risk factors associated with self-reported hearing health among mass transit riders is extremely limited, even though evidence suggests mass transit may be a source of excessive exposure to noise. Data on mass transit ridership were collected from 756 study participants using a self-administered questionnaire. Hearing health was measured using two symptom items (tinnitus and temporary audiometric threshold shift), two subjective measures (self-rated hearing and hearing ability), and two medical-related questions (hearing testing and physician-diagnosed hearing loss). In logistic regression analyses that controlled for possible confounders, including demographic variables, occupational noise exposure, nonoccupational noise exposure (including MP3 player use) and use of hearing protection, frequent and lengthy mass transit (all forms) ridership (1,100 min or more per week vs. 350 min or less per week) was the strongest predictor of temporary threshold shift symptoms. Noise abatement strategies, such as engineering controls, and the promotion of hearing protection use should be encouraged to reduce the risk of adverse impacts on the hearing health of mass transit users.

Exposures to transit and other sources of noise among New York City residents.

To evaluate the contributions of common noise sources to total annual noise exposures among urban residents and workers, we estimated exposures associated with five common sources (use of mass transit, occupational and nonoccupational activities, MP3 player and stereo use, and time at home and doing other miscellaneous activities) among a sample of over 4500 individuals in New York City (NYC). We then evaluated the contributions of each source to total noise exposure and also compared our estimated exposures to the recommended 70 dBA annual exposure limit. We found that one in ten transit users had noise exposures in excess of the recommended exposure limit from their transit use alone. When we estimated total annual exposures, 90% of NYC transit users and 87% of nonusers exceeded the recommended limit. MP3 player and stereo use, which represented a small fraction of the total annual hours for each subject on average, was the primary source of exposure among the majority of urban dwellers we evaluated. Our results suggest that the vast majority of urban mass transit riders may be at risk of permanent, irreversible noise-induced hearing loss and that, for many individuals, this risk is driven primarily by exposures other than occupational noise.

Evaluation of a pandemic preparedness training intervention of emergency medical services personnel.

INTRODUCTION: Emergency medical services (EMS) personnel play an integral role during the national response to a pandemic event. To help ensure their health and safety, especially during the early stages of an outbreak, knowledge and adherence with personal protective equipment (PPE) and infection control strategies will be essential. OBJECTIVES: The objective of this study was to assess the effectiveness of a multi-method, pandemic preparedness training intervention using a pre-/post-test design. METHODS: A convenience sample of 129 EMS personnel participated in a training program on pandemic preparedness. Training consisted of an educational intervention with a focus on the routes of transmission of the influenza virus, proper use of respiratory PPE, agency policies regarding infection control practices, and seasonal influenza vaccination. This was followed by a skill-based drill on respirator fit-checking and proper respirator donning and doffing procedures. RESULTS: Pre-/post-test results indicate a significant increase in knowledge and behavioral intentions with respect to respirator use, vaccination with seasonal influenza vaccine, and willingness to report to duty during a pandemic. CONCLUSIONS: This method was effective in increasing knowledge and compliance intentions in EMS healthcare personnel. Further research should focus on whether training results in behavior modification.

Consequences of negative information on perceptions of facial attractiveness.

The present study assessed the effect of negative information on perception of attractiveness of smiling and nonsmiling targets by undergraduate men and women. Analysis indicated that smiling faces were rated more attractive than nonsmiling faces, consistent with previous research. There was a significant interaction of participants' sex and target description, in which women rated smiling faces less attractive after exposure to negative information about the target, but men rated smiling faces more attractive after exposure to negative information. Results are discussed in terms of an affective model of perception of people.

Emergency Preparedness Safety Climate and Other Factors Associated With Mental Health Outcomes Among World Trade Center Disaster Evacuees.

OBJECTIVE: We examined psychological outcomes in a sample of participants who evacuated from the World Trade Center towers on September 11, 2011. This study aimed to identify risk factors for psychological injury that might be amenable to change, thereby reducing adverse impacts associated with emergency high-rise evacuation. METHODS: We used data from a cross-sectional survey conducted 2 years after the attacks to classify 789 evacuees into 3 self-reported psychological outcome categories: long-term psychological disorder diagnosed by a physician, short-term psychological disorder and/or memory problems, and no known psychological disorder. RESULTS: After nonmodifiable risk factors were controlled for, diagnosed psychological disorder was more likely for evacuees who reported lower "emergency preparedness safety climate" scores, more evacuation challenges (during exit from the towers), and evacuation-related physical injuries. Other variables associated with increased risk of psychological disorder outcome included gender (female), lower levels of education, preexisting physical disability, preexisting psychological disorder, greater distance to final exit, and more information sources during egress. CONCLUSIONS: Improving the "emergency preparedness safety climate" of high-rise business occupancies and reducing the number of egress challenges are potential strategies for reducing the risk of adverse psychological outcomes of high-rise evacuations. Focused safety training for individuals with physical disabilities is also warranted. (Disaster Med Public Health Preparedness. 2017;11:326-336).

Prevalence and factors associated with 2009 to 2011 influenza vaccinations at a university medical center.

BACKGROUND: Information on the rates and factors associated with influenza vaccinations, although limited, is important because it can inform the development of effective vaccination campaigns in a university medical center setting. METHODS: A study was conducted in 2011 to identify individual and organizational level barriers and facilitators to influenza vaccination among clinical and nonclinical personnel (N = 428) from a major university medical center. RESULTS: Seventy-one percent of clinical personnel (n = 170) reported pandemic H1N1 vaccination compared with 27% of nonclinical personnel (n = 258), even though vaccine was made widely available to all personnel at no cost. Similarly, disparate rates between clinical and nonclinical personnel were noted for the 2009/2010 seasonal influenza vaccine (82% vs 42%, respectively) and 2010/2011 combination (pandemic plus seasonal) influenza vaccine (73% vs 28%, respectively). Factors associated with pandemic vaccination in nonclinical personnel included the following: high level of influenza-related knowledge, concern regarding influenza contagion, history of previous influenza vaccinations or influenza illness, participation in vaccine-related training, and awareness of the institution's written pandemic plan. For clinicians, past history of seasonal influenza vaccination was associated with pandemic vaccination. For all participants, taking any 1 or more of the 3 influenza vaccines available in 2009 to 2011 was associated with intent to take a hypothetical future novel pandemic vaccine (odds ratio, 6.7; 95% confidence interval: 4.32-10.44; P < .001). CONCLUSION: Most of the risk factors associated with lack of vaccination uptake are amenable to organizational strategies.

Safety in the home healthcare sector: development of a new household safety checklist.

OBJECTIVES: Unsafe household conditions could adversely affect safety and quality in home health care. However, risk identification tools and procedures that can be readily implemented in this setting are lacking. To address this need, we developed and tested a new household safety checklist and accompanying training program. METHODS: A 50-item, photo-illustrated, multi-hazard checklist was designed as a tool to enable home healthcare paraprofessionals (HHCPs) to conduct visual safety inspections in patients' homes. The checklist focused on hazards presenting the greatest threat to the safety of seniors. A convenience sample of 57 HHCPs was recruited to participate in a 1-hour training program, followed by pilot testing of the checklist in their patients' households. Checklist data from 116 patient homes were summarized using descriptive statistics. Qualitative feedback on the inspection process was provided by HHCPs participating in a focus group. RESULTS: Pretesting and posttesting determined that the training program was effective; participating HHCPs' ability to identify household hazards significantly improved after training (P<0.001). Using the checklist, HHCPs were able to identify unsafe conditions, including fire safety deficiencies, fall hazards, unsanitary conditions, and problems with medication management. Home healthcare paraprofessionals reported that the checklist was easy to use and that inspections were well accepted by patients. Inspections took roughly 20 minutes to conduct. CONCLUSIONS: Home healthcare paraprofessionals can be effectively trained to identify commonplace household hazards. Using this checklist as a guide, visual household inspections were easily performed by trained HHCPS. Additional studies are needed to evaluate the reliability of the checklist and to determine if hazard identification leads to interventions that improve performance outcomes.

Mass fatality preparedness in the death care sector.

OBJECTIVE: To characterize mass fatality preparedness of the death care sector (ie, funeral industry organizations) and to determine the workforce's ability and willingness to report to duty during a hypothetical high fatality pandemic event. METHODS: Anonymous, Web-based, cross-sectional survey of a national funeral industry sample. Preparedness was characterized using descriptive statistics. Factors significantly associated with ability and willingness were identified using chi-squared bivariate analysis. RESULTS: Respondents (N = 492) generally rated their organizational preparedness planning as suboptimal; only six of thirteen preparedness checklist items were typically in place. In contrast, response intentions were uniformly high; more than 80% of the respondents were willing to report to work, although high prevalence of secondary obligations might hinder this. CONCLUSIONS: Preparedness strategies that address interorganizational, surge capacity, and personal emergency planning are likely to be most efficacious. STATEMENT OF CLINICAL SIGNIFICANCE: Occupational medicine plays an important role in emergency preparedness and response. Funeral industry organizations could benefit from skills and resources of occupational medicine, including training, fit testing, development of plans, and coordination and hosting of planning exercises.

Factors associated with the ability and willingness of essential workers to report to duty during a pandemic.

OBJECTIVE: To determine essential workers' ability and willingness to report to duty during a serious pandemic outbreak and to identify modifiable risk factors. METHODS: Workers (N = 1103) from six essential workgroups completed an anonymous, cross-sectional survey. RESULTS: Although a substantial proportion of participants reported that they would be able (80%), fewer would be willing (65%) to report to duty. Only 49% of participants would be both able and willing. Factors significantly associated with ability/willingness included individual-level (eg, intentions to adhere to respiratory protection and pandemic vaccination recommendations) and organizational-level factors (eg, preparedness planning for respiratory protection and worker vaccination programs). CONCLUSIONS: During a serious pandemic event, non-illness-related shortfalls among essential workers could be substantial. Organizational preparedness efforts should focus on worker protection programs and the development of policies that would facilitate the attendance of healthy workers.

Pandemic-related ability and willingness in home healthcare workers.

OBJECTIVE: To assess pandemic-related attitudes and behavioral intentions of home healthcare workers (HHCWs). DESIGN: Cross-sectional survey. SETTING: New York City. PARTICIPANTS: A convenience sample of 384 HHCWs. MAIN OUTCOME VARIABLES: Ability and willingness to report to work during a pandemic influenza outbreak. RESULTS: A large proportion of HHCWs reported that they would be either unable or unwilling (or both) to provide care to their current (83 percent) or new (91 percent) patients during a pandemic. Ability was significantly associated with not having children living at home, having alternatives to mass transportation, not having a spouse/partner employed as a first responder or healthcare worker, and having longer tenure (ie, six or more years) in homecare. During an outbreak, 43 percent of HHCWs said they would be willing to take care of current patients and only 27 percent were willing to take care of new patients. Willingness to care for both current and new patients was inversely associated with fear for personal safety (p < 0.01). Provision of key elements of a respiratory protection program was associated with decreased fear (p < 0.05). Most participants (86 percent) had not received any work-based, pandemic-related training, and only 5 percent reported that their employer had an influenza pandemic plan. CONCLUSIONS: Given that a large majority of the participating HHCWs would either be unable or unwilling to report to duty during a pandemic, potential shortfalls in this workforce may occur. To counter this, organizations should focus on strategies targeting intervenable barriers to ability and to willingness (ie, the provision of a vaccine and respiratory protection programs).

Web-based training on weapons of mass destruction response for emergency medical services personnel.

OBJECTIVE: To develop, implement, and assess a web-based simulation training program for emergency medical services (EMS) personnel on recognition and treatment of ocular injuries resulting from weapons of mass destruction (WMD) attacks. DESIGN: The training program consisted of six modules: WMD knowledge and event detection, ocular anatomy, ocular first aid (ie, flushing, cupping, and patching), and three WMD simulations (ie, sarin gas release, anthrax release, and radioactive dispersal device). Pretest, post-test, and 1-month follow-up test and a program evaluation were used to measure knowledge gain and retention and to assess the effectiveness of the program. SETTING: New York State EMS. PARTICIPANTS: Four hundred and sixty-four individuals participated in the training program and all waves of the testing (86 percent retention rate). MAIN OUTCOME VARIABLES: The effectiveness of the training intervention was measured using pretest and post-test questionnaires and analyzed using dependent t-tests. RESULTS: Assessment scores for overall knowledge increased from the pretest (mean = 15.7, standard deviation [SD] = 2.1) to the post-test (mean = 17.8, SD = 1.3), p < 0.001, and from pretest (mean = 15.7, SD = 2.1) to 1-month follow-up test (mean = 16.6, SD = 2.0), p < 0.001. Ninety-two percent of respondents indicated that the program reinforced understanding of WMDs. CONCLUSIONS: This training method provides an effective and low-cost approach to educate and evaluate EMS personnel on emergency treatment of eye trauma associated with the use of WMD. Online training should also be supplemented with hands-on practice and refresher trainings.

Violence, job satisfaction, and employment intentions among home healthcare registered nurses.

Workplace violence, defined as violent acts directed toward workers, includes physical assault, threat of assault, and verbal abuse and is widely recognized as a threat to workers' health and safety. Healthcare workers, especially nurses, are known to be at high risk. As employees who work alone, have access to drugs, provide care to people in distress, and/or have frequent close contact with clients, they face a greater likelihood of exposure to violence. Nurses' risk has been correlated with degree of patient contact; the odds of physical violence are 7.2 and 9.0 times greater for healthcare workers with moderate and high patient contact, respectively, compared with those with little or no contact.