Fatal and non-fatal childhood injuries in Metropolitan Toronto, 1986-1991

OBJECTIVE: To estimate the prevalence of human immunodeficiency virus (HIV) infection among health care workers who donate blood. DESIGN: Point prevalence survey of blood donors. SETTING: 20 U.S. blood centers that participate in an ongoing interview study of HIV-seropositive blood donors. MEASUREMENTS: Prevalence rates for HIV in persons who reported being health care workers were measured directly for 6 of the 20 blood centers. For the other 14 centers, we derived the numerator from the interview study in the same manner used for the 6 centers; we estimated the denominator using blood collection logs at those centers and extrapolations from the survey completed at the 6 blood centers. RESULTS: Between March 1990 and August 1991, 8519 health care workers donated blood at 6 hospitals and other medical facilities. Three persons were HIV seropositive: Two reported being health care workers and having nonoccupational risk factors for HIV infection; the occupation and other possible risk factors of the third seropositive donor could not be determined. Therefore, the highest overall prevalence of HIV infection among health care worker donors at these 6 centers was 0.04% (3 of 8519; upper limit of 95% CI, 0.1%). We estimated that during the same period, approximately 36,329 health care workers were tested for HIV at all 20 centers. Twenty-seven persons infected with HIV who donated at hospitals were identified; 7 did not return for interviews, so their health care occupations could not be verified. Thus, the highest estimated overall prevalence of HIV infection among health care worker donors at the 20 centers was 0.07% (27 of 36,329; upper limit of CI, 0.1%). Of the 20 known health care worker donors, 11 reported nonoccupational risks for HIV infection; 3 of the remaining 9 health care workers described occupational blood exposures that could have resulted in transmission of HIV. CONCLUSIONS: Blood donors can serve as a sentinel cohort when evaluating the risk for occupationally acquired HIV infection. These findings suggest that among the many health care worker donors in this study, HIV infection attributable to occupational exposure was uncommon.     

Premature separation of centromere and aneuploidy: an indicator of high risk in unaffected individuals from familial breast cancer families?

OBJECTIVES: Injury is the leading cause of death in the male working population of Brazil. An important fraction of these deaths are work related. Very few cohort studies of steel workers, and none from developing countries, have reported on mortality from injuries. This paper analyses mortality from work and non-work related injuries among Brazilian steel workers. METHODS: Deaths during employment from 1 January 1977 to 30 November 1992 were analysed in a cohort of 21,816 male steel workers. Mortality rates specific for age and calendar year among the workers were compared with those of the male population of the state where the plant is located. Work related injuries were analysed by comparing the mortality rates for different subgroups of the cohort. RESULTS: The number of deaths (391) was less than half that expected based on death rates of the general population. Over 60% (242) of deaths were due to injuries. Mortality from most causes was substantially below that in the general population, but that from unintentional injury, was 50% above that of the general population. Standardised mortality ratios (SMRs) were highest for the youngest and the oldest employees and for labourers and clerical workers. Mortality from motor vehicle injury was twice that expected from population rates (SMR = 209, 95% confidence interval (95% CI) 176-244). There was a 67% fall in the age adjusted mortality from occupational injuries in the study period. CONCLUSION: The healthy worker effect in this cohort was greater than that commonly found in studies of occupational groups in developed countries, probably because of a greater socioeconomic gap between employed and unemployed populations in Brazil, and unequal distribution of health care resources. Mortality was especially high for motor vehicle injuries. The fall in mortality from occupational injuries during the study period was probably due to improvement in safety standards, increased automation, and better medical care. There is a need to investigate risk factors for unintentional injuries among steel workers, especially those due to motor vehicle injuries. Prevention of occupational and nonoccupational injuries should be a main priority in Brazil.     

Under-reporting of work-related disorders in the workplace: a case study and review of the literature

Accurate reporting of work-related conditions is necessary to monitor workplace health and safety, and to identify the interventions that are most needed. Reporting systems may be designed primarily for external agencies (OSHA or workers' compensation) or for the employer's own use. Under-reporting of workplace injuries and illnesses is common due to a variety of causes and influences. Based on previous reports, the authors were especially interested in the role of safety incentive programmes on under-reporting. Safety incentive programmes typically reward supervisors and employees for reducing workplace injury rates, and thus may unintentionally inhibit proper reporting. The authors describe a case study of several industrial facilities in order to illustrate the extent of under-reporting and the reasons for its occurrence. A questionnaire and interview survey was administered to 110 workers performing similar tasks and several managers, health, and safety personnel at each of three industrial facilities. Although less than 5% of workers had officially reported a work-related injury or illness during the past year, over 85% experienced work-related symptoms, 50% had persistent work-related problems, and 30% reported either lost time from work or work restrictions because of their ailment. Workers described several reasons for not reporting their injuries, including fear of reprisal, a belief that pain was an ordinary consequence of work activity or ageing, lack of management responsiveness after prior reports, and a desire not to lose their usual job. Interviews with management representatives revealed administrative and other barriers to reporting, stemming from their desire to attain a goal of no reported injuries, and misconceptions about requirements for recordability. The corporate and facility safety incentives appeared to have an indirect, but significant negative influence on the proper reporting of workplace injuries by workers. A variety of influences may contribute to under-reporting; because of under-reporting, worker surveys and symptom reports may provide more valuable and timely information on risks than recordable injury logs. Safety incentive programmes should be carefully designed to ensure that they provide a stimulus for safety-related changes, and to discourage under-reporting. A case-control study of similar establishments, or data before and after instituting safety incentives, would be required to more clearly establish the role of these programmes in under-reporting.     

An evaluation of surveillance of malaria at primary health care level in Kenya

As less than twenty five per cent of persons suffering from malaria seek formal treatment in most of sub-Saharan Africa, Facility-based morbidity statistics are inadequate for monitoring malaria control programmes. This explorative study assessed whether a health centre equipped with a microscope and trained personnel could monitor malaria transmission within its catchment area. The study was conducted at Chemase Health Centre in Nandi District in Kenya, an area holoendemic for malaria with Anopheles gambiae as the main vector and Plasmodium falciparum as the commonest cause of malaria. From first August to 31 October 1991, first seven children under five years of age on each working day accompanied by their mothers to the maternal and child health clinic were studied. A general examination was performed by a Registered Clinical Officer (Medical Assistant) and thin and thick blood smears made, stained with Giemsa stain and examined for malaria parasites by a Medical Laboratory Technologist. Mothers were interviewed by enrolled community nurses on antimalarial measures they were using in their homes. Four hundred and fifty five children mostly under five years of age, consisting of 48.1% males and 51.9% females, were studied. Malaria parasites were present in 209 (45.9%) blood smears of the children. The percentage of blood smears positive for malaria parasites was high in children below 36 months of age. There was a tendency for low percentage of blood smears positive for malaria in children whose mothers reported using mosquito nets or insecticide sprays. The study did not interrupt the routine of the health centre. Periodic monitoring of new malaria illnesses. and percentage of blood smears positive for malaria parasites in children aged 0 to 35 months should be introduced into health centre practice in Kenya. This catchment area approach could be used to monitor malaria control programmes as well as predicting malaria epidemics.     

Anti beta 2glycoprotein I antibodies and lupus anticoagulant in patients with recurrent pregnancy loss: prevalence and clinical significance

Over 2000 electrocution deaths were identified among U.S. construction workers from 1980 to 1991, with the highest mean annual crude mortality rate (2.5 per 100,000 people), and second highest mean age-adjusted rate (2.7 per 100,000 people) of all industries. Although the crude fatality rates showed a downward trend, construction workers are still about four times more likely to be electrocuted at work than are workers in all industries combined. Nearly 40% of the 5083 fatal electrocutions in all industries combined occurred in construction, and 80% were associated with industrial wiring, appliances, and transmission lines. Electrocutions ranked as the second leading cause of death among construction workers, accounting for an average of 15% of traumatic deaths in the industry from 1980 to 1991. The study indicates that the workers most at risk of electrical injury are male, young, nonwhite, and electricians, structural metal workers, and laborers. The most likely time of injury is 11 a.m. to 3 p.m. from June to August. Focusing prevention on these populations and characteristics through better methods of worker and supervisor electrical safety training, use of adequate protective clothing, and compliance with established procedures could minimize the average annual loss of 168 U.S. construction workers.     

Mandibular fractures following third molar extraction. A retrospective clinical and radiological study

Health care workers (HCW) are at risk of occupationally acquiring Mycobacterium tuberculosis (TB) infection. The Centers for Disease Control and Prevention has published guidelines for health care facilities to protect HCW. One of the recommended elements is TB infection surveillance among HCW using purified protein derivative (PPD) skin testing and analysis of the data by occupational group and work location to determine areas of increased risk of infection. At the military medical center (MMC) we studied, occupational groups with statistically significant (p < 0.05) above-average PPD conversion risk (> 1.1%/year) included respiratory therapists (15.6%/year), nursing technicians (2.3%/year), and military personnel (1.6%/year). Maintenance and engineering workers (2.6%/year), food service workers (2.5%/year), laboratory workers (2.0%/year), custodial workers (1.8%/year), and practical nurses (1.7%/year) had above-average, but not statistically significant, risk. The fourth floor of the MMC had 39% (21/54) of the converters. The surveillance program also uncovered 235 individuals who had not completed adequate prophylactic therapy, and a case of active TB in a laboratory worker.     

Temp-to-permanent employees: A longitudinal study of stress and selection success.

Temp-to-permanent employees are temporary workers who have the opportunity to become permanent employees after a specific amount of time (e.g., generally after a 3- to 12-month period of trial work). The authors predicted that temporary worker individual differences, self-monitoring, tolerance for ambiguity, and role adjustment are related to temporary worker physiological stress and to whether temporary employees are offered permanent employment. Longitudinal data collection (pre- and postentry) resulted in data from 136 temp-to-permanent employees. Tolerance for ambiguity and role adjustment were found to be related to temporary worker stress and selection success. Self-monitoring was related to selection success for workers in an extended probationary period. These results suggest the need for further exploration and application of models of stress in understanding factors related to temporary worker success. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Burnout as a clinical entity--its importance in health care workers

Burnout, viewed as the exhaustion of physical or emotional strength as a result of prolonged stress or frustration, was added to the mental health lexicon in the 1970s, and has been detected in a wide variety of health care providers. A study of 600 American workers indicated that burnout resulted in lowered production, and increases in absenteeism, health care costs, and personnel turnover. Many employees are vulnerable, particularly as the American job scene changes through industrial downsizing, corporate buyouts and mergers, and lengthened work time. Burnout produces both physical and behavioural changes, in some instances leading to chemical abuse. The health professionals at risk include physicians, nurses, social workers, dentists, care providers in oncology and AIDS-patient care personnel, emergency service staff members, mental health workers, and speech and language pathologists, among others. Early identification of this emotional slippage is needed to prevent the depersonalization of the provider-patient relationship. Prevention and treatment are essentially parallel efforts, including greater job control by the individual worker, group meetings, better up-and-down communication, more recognition of individual worth, job redesign, flexible work hours, full orientation to job requirements, available employee assistance programmes, and adjuvant activity. Burnout is a health care professional's occupational disease which must be recognized early and treated.     

Factors affecting employment decisions about older workers.

Investigated effects of 2 factors on simulated employment decisions about older workers. 10 male and 38 female undergraduates made decisions about older workers in 2 hypothetical work situations. The design of the study was a 2 (absolute decision vs comparison decision)?×?2 (information vs no information) factorial with repeated measures on type of decision. Significant main effects were found for both type of decision and amount of information. No significant interaction effects were found. Increasingly favorable decisions were made about older workers when (a) the situation did not require a choice between an older worker and a younger worker and (b) behaviorally stated performance information about the older worker was provided. A separate study assessed the specificity of the factors' impact on older workers. 13 male and 35 female undergraduates made decisions about younger workers, using the same procedures used in the 1st study. These results indicate that, for younger workers, the effect of the type of decision depended on the amount of information. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes to the use of dummies in New Zealand; a qualitative study

AIMS: To explore experiences with, and attitudes to, the use of dummies (pacifiers). METHODS: Seven focus group discussions were held with groups of mothers and of health professionals. RESULTS: Most mothers and health care workers had a generally negative view of dummy use. This related particularly to dislike of toddlers with them and practical issues such as getting lost or dirty. All would allow their use in a very unsettled baby. No mothers had personally experienced problems with breastfeeding due to the use of a dummy, but concern about this possibility was expressed by some health care workers. Recommendations varied about the length of time that dummies need to be avoided. CONCLUSIONS: Mothers in New Zealand use dummies selectively for their infants and were concerned with issues of weaning the baby from the dummy, keeping it clean and not losing it. In analysing the relationships between dummy use and breastfeeding it is important to take into consideration the context of dummy use.     

Impact of material flow policies and goals on job outcomes.

A manual production line was examined for effects of 2 different material flow policies and 3 different goal-setting policies. The line used a push system, where workers work at their own pace (assuming available work) and pass work to the next station as soon as the work is completed, and a pull system, where workers pass work only when the next worker needs it. Three different goal-setting policies involved no specified goals, individual goals, or group goals confounded with monetary incentives and feedback. Measurements were taken from unobtrusive videotaping and worker questionnaires. Analyses indicated productivity increased approximately 25% when group goals were matched to a pull policy (compared to a push policy with no specified goals). Other results relating to productivity and job satisfaction are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Situational influences on the use of power.

Varied kind of subordinate problem encountered and number of subordinates supervised in a study of the use of supervisory power. Ss were 48 male undergraduates appointed to oversee the production of simulated workers. It was found that problems of discipline evoked Ss' use of coercive powers, while problems of ineptness evoked Ss' use of expert powers. Variations in the number of subordinates supervised influenced the amount of attention Ss could give to any 1 worker. This resulted in less time spent with poor workers and fewer pay raises given to satisfactory workers, when Ss were supervising large numbers of workers. Ss with little confidence in their leadership ability relied mainly on formally proscribed powers to correct poor performance, while more confident Ss used both informal persuasion and formally proscribed powers. It was also found that the nature of the problem manifested by a problem worker influenced the frequency of pay raises given to satisfactory workers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social inequality and general practitioner utilisation: assessing the effects of financial barriers on the use of care by low income groups

AIMS: To evaluate the extent to which financial barriers are still important deterrents to the utilisation of primary care by low income groups and to examine whether the willingness of patients to switch doctors is associated with ability to pay. METHOD: A practice and a population survey was used to compare the importance of price barriers, patient satisfaction and utilisation rates in two low income areas of Christchurch. Comparisons are made on the basis of gender, age, perceived health status, housing tenure, benefit status, income and ethnicity. RESULTS: Despite the introduction of the Community Services Card, delays in using services because of the cost of care remain significant for many groups of patients, including cardholders themselves. The removal of price barriers at the free clinic raised utilisation rates for all groups. Patterns of use at the free clinic show a consistent inverse relationship between income and consultation rates. However, this was not evident among patients in the population sample who continued to use fee-for-service providers. Further, the results do not support arguments that patients are insensitive to price when changing their doctors. CONCLUSIONS: Despite the removal of part-charges for children, financial barriers remain significant for many low income adults. To a large extent these barriers reflect the nature of welfare reform, particularly the detrimental effects of pro-market housing policies in limiting the disposable incomes of poorer New Zealanders.     

Screening for hepatitis C of hospital personnel at the Szent László Hospital of Budapest

The health-care workers are known to be at risk of occupational transmission of blood-borne viruses. The goal of the investigation was to determine the prevalence of hepatitis C virus (HCV) antibody and the occupational risk of HCV transmission among personnel at the Central. Hospital for Infectious Diseases, Budapest, Hungary. Serum samples of 409 health-care workers were tested for antibody to HCV with second and third generation ELISA-s and anti-HCV positive samples were confirmed with Western Blot Line EIA. A total of 10 (2.4%) of the health-care workers were confirmed to be anti-HCV positive. The prevalence of anti-HCV increased with advancing age: zero under 20 yr age group (N = 0/15), 0.9% in 21-30 yr age group (N = 1/112), 1.8% in 31-40 yr age group (N = 2/111), 3.1% in 41-50 yr age group (N = 3/96) and 4.0% in above 50 yr age group (N = 3/75). We found anti-HCV positive hospital worker in 9 out of 17 departments. The prevalence of hepatitis C antibody was 7.1-1.9% among the personnel of internal departments, pathology, intensive care unit and pediatric departments. No anti-HCV positive health-care worker was found in the surgery and laboratories. None of the physicians tested was seropositive for HCV. Eight of the nurses, one of the sanitary personnel and one pathological technician were seropositive for HCV. Two nurses developed a chronic C hepatitis after a needlestick accident. CONCLUSIONS: 1. The hospital personnel is at risk for HCV infection. 2. The occupational risk of HCV infection increases with age but the risk is considerable lower than that of hepatitis B infection. 3. The occupational risk is highest among the workers of the chronic internal department, pathology and intensive care unit. 4. The nurses are at higher risk of HCV infection than the physicians. 5. The needlestick injury is associated with an increased risk for acquiring HCV infection.     

Prevention of nosocomial transmission of Mycobacterium tuberculosis

The recent resurgence of TB together with the ongoing HIV epidemic has resulted in a larger number of infectious TB patients being admitted to US health care facilities. These patients have become a source for both nosocomial (patient-to-patient) and occupational (patient-to-health care worker) M. tuberculosis transmission. Infectious MDR-TB patients serve as even greater potential infectious sources because they often remain AFB smear and culture positive for months to years. The keys to the prevention of nosocomial and occupational transmission of M. tuberculosis is conducting a risk assessment for each area of the facility and instituting appropriate control measures, having a high index of suspicion by clinicians for infectious TB in those who present with consistent signs and symptoms, rapid triage of such patients to isolation areas and their appropriate clinical work-up, and the institution of effective antituberculous therapy. Infection control personnel should ensure that infectious TB patients are isolated in appropriate isolation rooms (i.e., negative pressure, greater than or equal to 6 ACH, and direct external exhaust of the room air). Health care workers with infectious TB patient contact should be instructed in the epidemiology of M. tuberculosis transmission, the role of respirators in protecting the health care worker from airborne inoculation, and the importance of periodic health care worker TST. The nosocomial TB outbreaks in the 1980s and 1990s document that M. tuberculosis can be transmitted to both patients and health care workers in US health care facilities when appropriate infection control measures are not fully implemented. Follow-up studies at some of these institutions, however, document that when infection control measures similar to the 1990 or 1994 CDC TB Guidelines are fully implemented, M. tuberculosis transmission to both patients and health care workers can be reduced or eliminated. Protection of both patients and health care workers from M. tuberculosis infection is dependent on an understanding and full implementation of the 1994 CDC TB Guidelines.     

A case of Rathke''s cleft cyst with apoplexy

OBJECTIVE: To develop and evaluate a model of integrated primary dental and medical care. DESIGN: 3-year prospective study. SETTING: A general dental practice and a general medical practice occupying the same building in Glasgow. INTERVENTION: Regular staff meetings, joint use of patient records systems and information derived from patient questionnaires. Dentistry was included in established screening programmes such as child health surveillance and care of elderly. Staff were encouraged to participate in joint work practices and joint consultations were carried out. MAIN OUTCOME MEASURES: Patient registration, avoidance of discrepancies in information, reduction of secondary referrals, joint work practices. RESULTS: The number of registered joint patients attending both medical and dental practices increased by 90%. The joint use of patient record systems avoided discrepancies in patient information which would have affected the quality of patient care. Including dentistry in child health surveillance and care of elderly screening programmes resulted in an increase in 0-5 year olds registering with dentists from 36% to 68% (P < 0.001) and with > 75 year olds from 47% to 71% (P < 0.001). Joint consultations reduced the need for secondary referrals. CONCLUSIONS: This model of health care demonstrated the potential for coordination and integration of functions between the dental team and the primary care team. Integrated primary dental and medical care requires attitudinal change in health care professionals and requires greater emphasis in education and training of health care professionals in the future.     

Cholinesterase activities of workers exposed to organophosphorus insecticides in Pakistan and Haiti and an evaluation of the tintometric method

Five reference laboratories were established in Pakistan for monitoring cholinesterase (ChE) activities of workers exposed to organophosphorus compounds. ChE activities were determined by the Michel and tintometric method. Observations of ChE activities were made during two malaria seasons. The first season showed that although a significant depression of cholinesterase occurred among some of the workers, the ChE activities of workers were within the normal range during the following season. The reason for the difference is discussed. Similar studies were undertaken in Haiti. Mean and standard deviations (SD) were calculated for comparison of the tintometric versus the Michel method. The data show a correlation between the methods. For further evaluation of the tintometric method, organophosphorus and oxon analog inhibition of cholinesterase were determined in vitro. The tabulated data show that the tintometric method is adequate for determining whether a worker is exposed to dangerous amounts of insecticides.     

Tuberculosis among urban health care workers: a study using restriction fragment length polymorphism typing

Cases of tuberculosis identified during 1992-1994 through an active tuberculosis surveillance network among six hospitals that serve New York City (the TBNetwork) were analyzed according to the occupational status of the patients. Clinical data were obtained by review of medical records, and restriction fragment length polymorphism (RFLP) typing of Mycobacterium tuberculosis isolates was performed. No known nosocomial outbreaks of tuberculosis occurred at these hospitals in the study period. Occupational status was known for 142 of 201 patients whose isolates were available for strain typing. Patients infected by organisms with a clustered strain typing pattern, as determined by RFLP analysis, were presumed to have recently acquired disease. RFLP typing revealed that isolates from 13 (65%) of 20 health care workers and 50 (41%) of 122 non-health care workers had a clustered RFLP pattern. The strains infecting eight (89%) of nine health care workers seropositive for human immunodeficiency virus (HIV) had a clustered RFLP pattern. Multivariate analysis of 75 patients with known HIV and occupational status revealed that HIV status (P = .03) and health care worker status (P = .02; RR = 2.77) were independent risk factors for a clustered RFLP strain. These findings suggest that many of the apparently sporadic cases of tuberculosis among health care workers may be due to unrecognized occupational transmission.