Background: Occupational exposure to solvents, such as perchloroethylene has been associated with neurotoxicity. Within the dry-cleaner population, several technological advances have reduced exposure to solvents, however little research has been conducted to ensure that workers are adequately protected. Therefore it is important to determine the prevalence of central nervous system (CNS) toxicity symptoms in a recent dry-cleaner worker population. It is also necessary for workers to engage in safe work behaviors to further reduce exposure to solvents. Hence, an understanding of predictors that promote engagement in safe work behavior is important.

Objective: The aims of this research were: 1) summarize existing research on CNS toxicity symptoms that are associated with perchloroethylene exposure below 100 parts per million. 2) assess the prevalence of CNS toxicity symptoms in dry-cleaners exposed to organic solvents. 3) identify predictors of safe work behavior among dry-cleaners.

Methods: Articles for the literature review were primarily selected from three search engines of peer-reviewed literature. Secondary analysis of an existing cross-sectional dataset of a convenience sample of198 dry-cleaner workers, working primarily in the Midwestern United States. Data collection included self- reported information regarding personal and work-place characteristics, personal beliefs regarding health effects and sources of solvent exposure, symptoms experienced within the prior twelve month period use of personal protective equipment (PPE) and engagement in personal protective behavior (PPB).

Results: In total 14 of the 15 articles reviewed found perchloroethylene exposure below 100 ppm was associated with at least one symptom of CNS toxicity. Symptoms associated with perchloroethylene exposure included: visual impairment, dizziness, motor-coordination deficits, impaired memory and attention deficits. The secondary data analysis revealed that, controlling for use of PPE, workers in the high exposure group were four times more likely (prevalence risk [PR]=4.2; 95%CI 0.9-19.6) to report memory loss and three times more likely (PR= 3.4; 95%CI 1.1-10.7) to report loss of visual perception compared to their counterparts in the low/ moderate-exposure group, however, being an owner was the strongest predictor for CNS toxicity symptoms. In regards to engaging in safe work behavior, receiving safety training and working in high exposure group predicted PPB with the final model explaining 30% (p<.001) of variance. Being an owner, male, having a lower perceived exposure score, and using an alternative solvent to perchloroethylene predicted PPE use, explaining 32% (p<.001) of variance.

Conclusion: Both the literature review and the descriptive study highlight the need for more rigorous research to better understand the risk of CNS toxicity and predictors of safe work behavior in the current dry-cleaner workforce exposed to solvents. Future interventions to increase engagement in safe work behavior should focus on increasing personal protective equipment use among dry-cleaners, especially those who use Perchloroethylene.

Background: Workplace violence in healthcare settings has been recognized globally as a major barrier to the provision of safe and effective health care services. In California, the Workplace Violence Prevention in Health Care standard (Title 8, Section 3342) requires hospitals to develop violence prevention plans and report incidents where force was used against workers to the California Occupational Safety and Health Administration (CalOSHA) through the web-based Workplace Violent Incident Reporting System for Hospitals (WVIRS). Methods: This dissertation study used data (N=27,968 incidents) reported through the WVIRS by California’s acute care and psychiatric hospitals (N=413) from July 2017-June 2020. Additionally, qualitative data from interviews and site visits were collected by the dissertation investigator from six hospitals/hospital systems during 2019-2020. Results: Analysis of the WVIRS’ first 15 months of data found that behavioral health units had 1.82 times the odds of the reported incident resulting in physical injury compared to inpatient medical units, and investor-owned facilities had 2.43 times the odds of the reported incident resulting in physical injury compared to city or county-owned facilities. From July 2017 – June 2020, hospitals reported between zero and six incidents per staffed bed. Sixteen (3.9%) out of 413 facilities reported two or more incidents per staffed bed while the rest reported fewer than two incidents. Thematic analysis of qualitative data revealed that leadership roles and reporting procedures differed between facilities, potentially impacting whether less-serious incidents ultimately appear in the WVIRS. Conclusion: The WVIRS provides important insight into the epidemiology of workplace violence in California’s hospitals and has the potential to inform future workplace violence prevention efforts.

Background: Work-related musculoskeletal disorders among direct care workers have been a major concern in long-term care facilities worldwide. However, many work-related musculoskeletal disorders went unreported due to perceived barriers of direct care workers. Workers are encouraged to report even minor injury or near misses to their managements in many countries, but in Korea, the injury reporting responsibility of workers is not defined or described.Methods: This dissertation study used cross-sectional survey data from 377 direct care workers in 19 long-term care facilities in South Korea from May 2022 ~ August 2022. Long-term care facilities included long-term care hospitals and nursing homes in three cities in Gyeonggi, which is one out of eight provinces and represents 26% of Korean population. In the study, direct care workers refer to trained care staffs providing the most direct personal care such as feeding, bathing, dressing, and toileting regardless of the certification. Direct care workers who were employed for at least three months or longer in their current job, and able to read, write, and understand Korean were eligible to participate in the study. Results: A systematic review showed a high level of underreporting of work-related injuries or illnesses to management or Workers’ Compensation programs, ranging 20%-91% in the United States and identified contributing factors and reasons for underreporting of work-related injuries or illnesses. Analysis of the survey data from direct care workers in long-term care facilities showed that more than half of direct care workers had a work-related musculoskeletal disorder in the past 12 months, but only 13.5% of them reported it to their management. Also, half of direct care workers had no intention to report their symptoms. Direct care workers’ reporting behavior was associated with their attitudes toward reporting, safety climate, symptom severity, and witnessing injury reporting of others. Direct care workers’ reporting attitudes were associated with duration of work, work arrangement, safety training, safety climate, experience of work-related musculoskeletal disorders, and frequency and severity of symptoms. Direct care workers having positive reporting attitudes were more likely to have intention to reporting and actual reporting of work-related musculoskeletal disorders. Conclusion: This study provides important insight into workers’ reporting behaviors and attitudes of work-related musculoskeletal disorders and informs future efforts to reduce underreporting and underestimation of occupational health problems.

Background

More than one quarter of US working adults are obese. Obesity increases risk for chronic disease and injury. Work-related factors contributing to obesity may be modified to assist in health promotion.

Objectives

This dissertation examines occupational stress and obesity among hospital-working female registered nurses (RNs). The objectives are to summarize the evidence to-date; to describe shift work, work hours, meal break practices, occupational stress, sleep quality, and obesity among female RNs; to develop and evaluate a conceptual model that occupational stress is associated with adiposity, and mediated by stress-induced eating behaviors.

Methods

A cross-sectional web survey collected data from members of the Academy of Medical/Surgical Nurses. Occupational stress was measured with the Effort Reward Imbalance (ERI) short form. An ERI >1 indicates high effort and low reward indicative of occupational stress. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Scores can range from 0-21, and >5 indicates poor sleep quality. Descriptive statistics summarized the results, and Pearson’s correlations tested associations between sleep quality, occupational stress, and body mass index (BMI). The associations between occupational stress, adiposity, and mediating pathways were assessed using structural equation modeling (SEM).

Results

A total of 256 participated. The RNs’ mean age was 46 (±11.9) years, the majority were White (76%). Over half (58%) of the RNs worked more than 40 hours per week, and one third (33%) were never able to take a meal break during their shifts. The majority (77%) reported high occupational stress with an ERI>1, poor sleep quality (78%), and over one-third (35%) were obese. Worse sleep quality correlated with higher BMI and higher occupational stress. SEM showed a significant indirect effect of occupational stress on adiposity mediated by eating behaviors (p<0.001). The direct effect of occupational stress on adiposity was negative, and non-significant.

Conclusions

These findings indicate that RNs are experiencing occupational stress and not getting adequate rest; interventions are needed to reduce occupational stress, improve rest, meal-breaks, and sleep. For individuals with stress-related eating behaviors, occupational stress may increase obesity risk. Interventions to reduce stress-related eating behaviors included in wellness programs need to be evaluated.

Abstract Page

Factors Associated With Sharps Injury Rates in California Hospitals in 2001

Mary E. Foley MS, RN

Among the hazards to healthcare workers are percutaneous injuries (PI) caused by devices such as needles, scalpels, and suture needles (often categorized as sharps) capable of cutting or penetrating the skin. Hospitals are the largest employer and highly technological hospital care frequently exposes workers to a variety of devices capable of causing injury. Aims: The objective of the study was to examine the relationship between hospital, market, and population characteristics that may be associated with sharps and needlestick injury rates in hospital-based healthcare workers in California hospitals in 2001. Methods: A cross-sectional secondary data analysis was performed to examine the relationships between factors which may be associated with sharps injury rates in hospital staff and nurses working in California acute care hospitals in 2001. Two analyses were performed 1) Sharps Injury Rates in All Staff (n=207) and 2) Sharps Injury Rates in Nurses (RN and LVN) (n=160). Analysis included correlations, non-parametric testing, and multiple regression. Results: In the all staff model, the R² was .412 (F13, 193) = 10.395; p = <.0005), with an adjusted R2 for .372, indicating that approximately 41% of the variance in rate in injuries to all staff was accounted for by the combination of the independent variables. Three of the 12 independent variables (percent of discharges by Medi-Cal, Medicare, and daily hospital expenses) provided a significant, unique contribution to the model. The second analysis, Sharps Injury Rates in Nurses, had a R² for the overall model of .284 (F10, 149)=5.917 ; p <.0005), with an adjusted R² of .236, indicating that approximately 28% of the variance in needlestick and sharps injury rates reported in nursing staff in 2001 was accounted for by the combination of predictor variables. Two of the variables (hospitals that received greater levels of reimbursement from Third Party sources as contrasted with those that received Medicare as the major source and higher RN productive hours) provided a significant, unique contribution to the model.

Background: Cigarette smoking creates great challenges for blue-collar workers who are more likely to smoke, smoke more heavily, and are less likely to quit smoking compared to white collar workers. It is important to identify not only individual factors but also social and work environments that influence smoking behavior in order to reduce the occupational disparity in smoking behavior. Little is known about the combined effect of various factors that influence smoking behaviors among blue-collar workers.

Purpose: The aims of this dissertation were: 1) to estimate the contribution of occupational factors to current smoking; 2) to identify the determinants associated with heavy smoking, focusing on individual, interpersonal, and occupational factors; 3) to assess the impact of individual, interpersonal, and occupational predictors of quitting smoking among building trades workers.

Methods: The data was drawn from the MassBUILT smoking cessation intervention study. The first study included a total of 1,817 building trade apprentices and the second study included 763 current smokers at baseline. The third study used baseline data with follow-up data. Data collection included information about smoking behaviors, individual (e.g., sociodemographic), interpersonal (e.g., household smoking), and occupational factors (e.g., exposure to occupational hazards) obtained through self-report questionnaires.

Results: The first study found that current smoking was significantly associated with union commitment, exposure to dust and chemicals, and concern about exposure to occupational hazards. The second study revealed that heavy smoking was significantly associated with older age, male gender, poorer health status, higher nicotine dependence, earlier age of smoking initiation, higher temptation to smoke, greater perceived benefits of smoking, household smoking or living alone, trade type, and job satisfaction. The third study demonstrated that older age, higher educational attainment and higher household income level, fewer number of cigarettes smoked per day, and more concern about exposure to occupational hazards were significant predictors of quitting smoking.

Conclusion: Blue-collar workers' smoking behavior is influenced by various types of factors. The findings suggest that cessation interventions for this group may need to develop a comprehensive approach that addresses each type, rather than focusing on a single aspect of influence.

Background: Blue-collar workers are at high risk for cardiovascular disease (CVD) due to shift and overtime work, and job stress. Despite the increased risk of CVD and the rising compensation for it in Korean blue- collar workers, little is known about the actual risk of CVD, risk perception, and risk reduction behavior in this group. The purpose of this study was to investigate the contribution of actual and perceived risks of CVD and individual, psychosocial, and work-related factors as predictors of CVD risk reduction behavior.

Methods: This is a cross-sectional study with a sample of 238 Korean blue-collar workers, aged 18 years or older, who worked in small companies. Data collection included the Health Promoting Lifestyle Profile II, Knowledge of CVD risk, Risk Perception Index, Family APGAR, Job Contents Questionnaire, and Effort-Reward Imbalance; anthropometric and blood pressure measures; and blood sampling for lipid levels and glucose.

Findings: A multiple regression model showed that individual, psychosocial, and work-related factors, with risk perception for CVD, explained 33% of the variance in actual risk of CVD and that those individual, psychosocial, and work-related factors, with CVD actual risk, explained 28 % of the total variance in CVD risk perception. Waist-hip-ratio was found to be the strongest predictor of CVD actual risk. Finally, multiple regression analyses showed that the model explained 30% of the variance in risk reduction behavior. The significant predictors of risk reduction behavior included higher education, better perceived general health, greater family function, higher social support, better job control, and non-shift work. Actual risk of CVD and risk perception did not predict risk reduction behavior.

Conclusions: CVD risk reduction behavior is influenced more by psychosocial and work-related factors than individual factors. Efforts to improve social support, job control, and shift work are important; enhancing workers' perceived general health and family function are also important strategies for cardiovascular health promotion. Further study is needed to support these results and to explain the lack of relationships of actual and perceived risk to risk reduction behaviors in blue-collar workers at elevated risk of CVD.

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CARDIOVASCULAR RISK FACTORS IN CAREER FIREFIGHTERS

Background: Sudden cardiac death is the leading cause of on-duty death among career firefighters. Limited literature as to the etiology of on-duty sudden cardiac death in firefighters is available. Cardiovascular risk profiles of firefighters are similar to those of the general population. Firefighters seem not to be protected from the national obesity epidemic; and hypertension and/or hypercholesteremia are often not diagnosed, or are under treated.

Methods: Accurately assessing cardiopulmonary capacity in career firefighters is critical to duty assignment and prevention of sudden cardiac death. Eighty-three male career firefighters performed maximal exercise treadmills (per the revised 2008 Wellness-Fitness Initiative (WFI)) and direct VO2max assessments to determine the accuracy of WFI estimates of VO2max and maximal heart rate.VO2 and heart rate at ventilatory threshold and at maximal exercise were measured. They then wore Holter monitors and were asked to record their activities for 24 hours on duty. Subsequently, 63 career firefighters completed a sub-maximal exercise treadmill for comparison to the direct measure VO2max and historical estimates.

Results: The WFI maximal exercise treadmill test overestimated ~ 1.16 METs; the initial WFI sub-maximal estimation over-estimated ~ 2.23 METs; and the revised WFI sub-maximal estimation was found to accurately estimate VO2max when compared to directly measured VO2max. Maximum heart rates on duty were analyzed to determine if measured maximal heart rate, or heart rate at ventilatory threshold, were reached. About 18% exceeded their measured maximal heart rate, 51% exceeded their measured heart rate at ventilatory threshold, and 20.5% had an episode of tachycardia while on duty. The most common activity at peak 24-hour heart rate was exercising (32.5%), followed by performance drills (28.9%), pack tests (14.5%), fire suppression and overhaul (10.8%), responding to other calls (9.6%), and other (3.7%). About 90% of the participants experienced elevated heart rates while being monitored. The range of maximum METs demonstrated on duty was 4.8 to 17.0.

Implications: Excessive heart rates and work demands may contribute to cardiac compromise if there is underlying cardiovascular disease. Occupational health practitioners should advocate for accurate cardiopulmonary testing and treatment of underlying cardiovascular risk factors in career firefighters.

Introduction. Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with debilitating symptoms. Physical activity has been studied as a means of improving physical function and symptoms in adults with RA for over thirty years, however, rates of physical activity in RA patients remains below that of patients with other chronic diseases. Yoga has been gaining popularity nationally and may be an acceptable form of physical activity in this population. The primary aim of this dissertation was to describe the physical activity of yoga and its role in symptom management and physical function for adults with RA. A review of the literature, a quantitative study, and a qualitative study were performed to meet this dissertation aim.

Methods. In the first study a review of the literature was performed to survey the literature on physical activity interventions in adults with RA to determine which exercises were effective for improving physical function and symptoms in adults with RA. In the second study cross-sectional analysis of secondary data from 369 adults with RA was performed. This quantitative study investigated whether participation in yoga was associated with less RA symptomatology and better physical function scores in adults with RA compared to adults with RA who did not participate in yoga. The third study is a qualitative analysis exploring self-selected community yoga practice in adults with RA. This qualitative study used open-ended interview questions to explore benefits, barriers and facilitators of yoga practice.

Findings. The literature demonstrated that physical activities with an aerobic and strengthening component, like yoga, are effective for improvement in physical function and relief of pain, depression and fatigue. In the cross-sectional quantitative study yoga participation was associated with less pain and better physical function.

The qualitative exploration highlighted the dynamic nature of yoga as an appropriate physical activity for the dynamic needs of adults with RA. The yoga participants reported benefits of RA symptom relief and increased coping abilities.

Summary. Yoga is a dynamic exercise that is beneficial for symptom and physical function improvement. Investigations into practice components may improve yoga practice recommendations for adults with RA.

Background

Methods

Results

Conclusions