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Exposure assessment for a large epidemiological study of aircraft manufacturing workers.

Methods were developed to assess exposure to a wide variety of chemicals for nearly 80,000 workers involved in manufacturing aircraft since 1928. The facilities, now closed, consisted of four major plants, over 200 buildings, and a changing workforce during 60 years of operation. To access chemical exposures by specific jobs and calendar years, we reviewed complete work histories, examined detailed job descriptions available going back to 1940, interviewed long-term employees, conducted walk-through visits of aircraft manufacturing plants, reviewed comprehensive environmental assessment reports and industrial hygiene surveys on the facilities, and built on experience gained in previous studies of the aircraft industry. Using computer-based imaging systems, we examined and evaluated the complete work histories found on service record cards for the cohort and abstracted detailed information on all jobs held among the factory workers who had been employed for at least one year. Jobs were classified into one of three exposure categories related to the use of specific chemicals: routine, intermittent, and none, and these classifications were subsequently used in the epidemiological analyses. The approach to exposure assessment began with the most general categorization of employees (i.e., all workers) and then became progressively more specific, that is, factor workers, job families (similar activities), job titles, and jobs with chemical usage (exposure potential). Because exposure surveys were limited or absent during the early years of plant operations, we did not assign quantitative measures of exposure to individual job activities. Instead, we used as our exposure metric, the length of time spent in jobs with potential exposure to the chemical. Important occupational exposures included chromate-containing compounds such as used in paint primers, trichloroethylene and perchloroethylene used as vapor-state degreasing solvents, and a broad range of other solvents.

Adult↗

Ototoxic occupational exposures for a stock car racing team: I. Noise surveys.

The National Institute for Occupational Safety and Health (NIOSH) surveyed noise exposure for a professional stock car team at their race shop and during two races at one racetrack. At the team's shop, area sound pressure levels (SPLs) were measured for various work tasks. Equivalent levels (Leqs) ranged from 58 to 104 decibels, A-weighted (dBA). Personal noise dosimetry was conducted for at least one employee for each job description in race car assembly (n = 9). The Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) of 90 dBA for an 8-hour, 5-dB exchange rate time-weighted average (TWA) was never exceeded, but in two instances values exceeded OSHA's action level of 85 dBA for hearing conservation implementation. The NIOSH recommended exposure limit (REL) of 85 dBA for a 3-dB exchange rate Leq was exceeded for five of the measured jobs. During the races, SPLs averaged above 100 dBA in the pit area where cars undergo adjustments/refueling, both before and during the race. Peak levels reached 140 dB SPL. NIOSH REL was exceeded for every personal noise dosimetry measurement. Recommendations for hearing protection and communication are presented.

Automobiles↗

Cognitive processes in self-report responses: tests of item context effects in work attitude measures.

Much applied research relies on multi-item, self-report instruments. Drawing from recent cognitive theories, it was hypothesized that the items preceding a self-report item, its item context, can generate cognitive carryover and prompt context-consistent responses. These hypotheses were tested in 2 investigations: a field experiment involving 431 employees of a nonprofit urban hospital and a laboratory replication involving 245 undergraduate business students who held full- or part-time jobs. In both studies, evaluatively neutral items were placed in specially arranged blocks of uniformly positive, uniformly negative, or randomly mixed items on 3 modified Job Descriptive Index scales. Responses to the neutral items differed across the 3 forms, but scale-level psychometric properties remained unchanged. The implications of these item- and scale-level results for a variety of self-report measures in organizations are discussed.

Adult↗

Evaluation of the quality of coding of job episodes collected by self questionnaires among French retired men for use in a job-exposure matrix.

BACKGROUND: and AIMS: The ESPACES study was intended to identify retirees who may have been, according to their job descriptions, exposed to asbestos during their working lives. As part of this study, we analysed the quality of the occupation and activity sector coding as well as its effect on the subjects' exposure status. METHODS: The occupation and activity sector for a sample of 450 retired men were coded twice (with the second coder blinded to the first result), according to the international codes for industries (ISIC-1975) and occupations (ISCO-1968). For each series, linking the information about a job episode (dates, ISIC code, ISCO code) with the matrix allowed attribution of a probability of asbestos exposure to each episode and each subject. The asbestos exposure in the two series was compared by the kappa reproducibility coefficient. RESULTS: The analysis concerned 425 questionnaires. There was at least one difference in the code for either activity sector (ISIC) or occupation (ISCO) in half the episodes (50.2%). The exposure status estimated by the job-exposure matrix did not change between the series for 84.7% of the subjects. The kappa coefficient was 0.64 for all questionnaires, 0.70 when the questionnaire was coded twice by the same coder, and 0.62 when coded by two different coders. CONCLUSIONS: Despite intra- and inter-differences between coders, the coding of job episodes for the ESPACES study appears satisfactory and hence indicates that the assessment of the subjects' asbestos exposure was assessed without major distortions. This study underlines the usefulness of employing coders specifically trained for this technique.

Asbestos↗

Training the physician-scholar in otolaryngology-head and neck surgery.

The Resident Education Committee of the Society of University Otolaryngologists constructed a questionnaire for young academic otolaryngologist-head and neck surgeons to better understand their training background and to garner their opinions concerning adequacy or deficiencies in various aspects of that training. The questionnaire was mailed to 145 individuals who were in academic posts for 5 years or fewer in 1997. There was an overall response rate of 88.3%. Of the 128 respondents, 89% identified additional training, most commonly a clinical fellowship, in preparation for an academic career. The median number of hours per week devoted to professionally related activity was 61, of which two thirds was spent in direct patient care. The most common source of funds to pursue research activities was intradepartmental resources. Most individuals were satisfied with their jobs, although one quarter were considering leaving academic practice within the year. The single most important reason motivating selection of an academic career was a desire to teach. Details of the specific training and competencies and recommendations for improvement in resident training were obtained. Specific recommendations were generated for improving the training of future academic otolaryngologists; these recommendations include clarity of job description, a single track for clinical training for academicians and nonacademicians, more training in pertinent skills including research training, protected time for research, and amelioration of some of the downsides of academic life.

Adult↗

Productivity of the clinical dietitian: measurement by a regression model.

Productivity of 283 clinical dietitians employed in 40-bed to 1,200-bed medical centers and community and general hospitals nationwide was measured from a survey. Stepwise multiple linear regression statistical analyses were used to analyze data. Five measures of productivity were developed; hours in non-patient care divided by total hours worked and the activity level in activities nonproductive in relation to the job description activities produced the better models for measuring productivity of the clinical dietitian. Activity levels measured in the study showed high-level task activities (consuming a large amount of work time) were conducting individual diet instructions, conducting nutrition assessments, reviewing and recording in medical records, and supervising support personnel. Taking anthropometric measurements, participating in medical rounds, attending professional conferences, and purchasing and dispensing specialized products were found to be low-level task activities (consuming little work time). The average amount of time spent on the job per week was 42.7 hours with a mean of 20.4 hours spent in direct patient care, 13.6 hours in indirect patient care, and 7.3 hours in nonpatient care.

Dietary Services↗

Emergency nursing: historical, current, and future roles.

Building upon a historical context, the current and future roles of the clinical emergency nurse are reviewed. For several reasons, emergency nurse availability is expected to be insufficient to meet staffing demands in the near future. Emergency physicians can partner with emergency nurses and hospital administrators to pursue the following strategies for addressing the nursing shortage: (1) improve the workplace environment by improving nurse-to-patient ratios and avoiding the boarding of admitted patients in the emergency department (ED); (2) refocus the emergency nurse job description to patients and their families; (3) promote mutually supportive relationships and comradeship between emergency nurses and physicians; (4) create an environment that allows unique solutions to staff scheduling and accommodates shiftwork; (5) increase nursing wages, and recognize special contributions of emergency nurses with financial reward; (6) identify and promote the personnel of the hospital ED as members of an elite unit; (7) develop preceptorships and internships for nurses new to emergency nursing and invest in clinical specialists or nurse-mentors to assist in "on-the-job" instruction of nurses with previous experience; and (8) invest in nursing education. Taking these steps today will strengthen the ED health care safety net for decades to come.

Clinical Competence↗

Emergency nursing: historical, current, and future roles.

Building upon a historical context, the current and future roles of the clinical emergency nurse are reviewed. For several reasons, emergency nurse availability is expected to be insufficient to meet staffing demands in the near future. Emergency physicians can partner with emergency nurses and hospital administrators to pursue the following strategies for addressing the nursing shortage: 1) improve the workplace environment by improving nurse-to-patient ratios and avoiding the boarding of admitted patients in the emergency department (ED); 2) refocus the emergency nurse job description to patients and their families; 3) promote mutually supportive relationships and comradeship between emergency nurses and physicians; 4) create an environment that allows unique solutions to staff scheduling and accommodates shiftwork; 5) increase nursing wages, and recognize special contributions of emergency nurses with financial reward; 6) identify and promote the personnel of the hospital ED as members of an elite unit; 7) develop preceptorships and internships for nurses new to emergency nursing and invest in clinical specialists or nurse-mentors to assist in "on-the-job" instruction of nurses with previous experience; and 8) invest in nursing education. Taking these steps today will strengthen the ED health care safety net for decades to come.

Career Choice↗

An effective workplace stress management intervention: Chicken Soup for the Soul at Work Employee Groups.

Stress is a costly and significant source of health problems and mental distress--with work cited as a primary stressor. This pilot study supports the effectiveness of a new workplace stress intervention: Chicken Soup for the Soul at Work Employee Groups. In this program, employee-participants met during nine weekly meetings to read inspirational workplace stories, comment, and share their own stories. A leader, chosen from and by the group, guided meetings. Utilizing a wait-list control group design, participants were randomly assigned to an experimental or wait-list group. Participants completed pretests and posttests (Coping Resources Inventory, Occupational Stress Inventory-Revised, Job Descriptive Index, Pressure Management Indicator, survey). Statistical interaction effect for subtests was evaluated using a two-way repeated measures analysis of variance. Participants exhibited improved total coping resources, cognitive/rational coping, state of mind, confidence and home/work balance. Participant comments and their continued participation in a similar company-sponsored program bolster these empirical results.

Humans↗

Improving nursing documentation for private-duty home health care.

Private-duty, home health care agencies have struggled in assuring compliance with accurate and complete nursing documentation. In this descriptive study, the author reports on an improvement and innovation project in a private-duty, home health care agency aimed at improving nursing documentation, as measured in chart review audits. Initial strategies were directed toward revising the documentation system, with implementation of a flow record, and conducting group nurse education. These efforts had a minimal effect on improving documentation compliance. A major, multifocus strategy was then implemented. The educational component stressed pre- and posttest. The chart audit tool was revised to track individual nurse behaviors. Nurses were mentored when documentation did not meet standards. Lastly, the nurse job description and corresponding performance appraisal document were revised to clarify nurse responsibility and strengthen nurse accountability; progressive discipline was initiated when warranted. Significant and sustained improvement was subsequently realized.

Documentation↗

Validation of expert assessment of occupational exposures.

BACKGROUND: Assessment by experts may be the best method available for retrospective occupational exposure measurement in community-based studies. This study was undertaken to examine the validity of occupational exposure assessment by comparing the ratings of experienced raters with previously recorded industrial hygiene measurements. METHODS: We obtained 50 measurements from industrial hygiene records, covering a variety of jobs and substances and created 47 job descriptions around these measurements. Three raters were asked to assess exposure to a checklist of 19 substances (including those substances which had been measured). We estimated the sensitivity of the raters in correctly detecting those substances known to have been present. RESULTS: Using a liberal criterion for the ratings, the average sensitivity among the raters was 90%. Using a more stringent criterion, the average sensitivity was 73%. Among substances coded as present, the raters were quite accurate in rating the relative concentration and frequency of exposure. CONCLUSIONS: This trial demonstrated that a team of experienced raters could successfully characterize jobs in which important exposures occurred.

Air Pollutants, Occupational↗

Staff pharmacists' job attitudes and job performance.

An instrument was developed and used to evaluate job performance of staff pharmacists, and the relationship between performance and job satisfaction was examined. In designing the performance rating instrument (PRI), 23 measurable work-related behaviors of hospital staff pharmacists were identified through interviews with pharmacy directors. For each of the 15 behaviors ranked most important by hospital pharmacy directors, a four-point scale of performance was defined. Job satisfaction was measured using the job descriptive index (JDI) augmented by questions specific to hospital pharmacy practice. Staff pharmacists at eight hospitals completed the JDIs, and their directors completed the corresponding PRIs. Of 66 sets of PRIs and JDIs distributed, 38 pairs of usable responses were returned. There were a number of significant correlations between individual items on the PRI and JDI, but the correlation between the composite scores for the two scales was not significant. JDI and PRI scores decreased with age and years of practice, but the decrease was not significant. The PRI is a short, understandable method of quantifying hospital staff pharmacist performance. No significant correlation between job satisfaction and performance was found.

Attitude of Health Personnel↗

Considerate job interviews enhance institution's image.

A well-planned, considerate interview process for executive and middle-management job candidates leaves applicants with a favorable impression of the organization. Actions the recruiter can take to ensure a candidate's positive attitude include: Sending the out-of-town candidate a packet that includes a city map and information about the city, the facility's employment policies, and a job description; Planning activities for a spouse accompanying a candidate; Providing an opportunity for relaxed conversation by taking the candidate to dinner the night before the interview; Limiting interviews to three or four; Reimbursing the candidate for travel and lodging; Giving the candidate a tour of the facility. In addition, the recruiter should coach those conducting interviews to promote a relaxed interchange and allow candidates to ask questions.

Interviews as Topic↗

The effects of applicant's health status and qualifications on simulated hiring decisions.

The effects of having diabetes or obesity on simulated job decisions was evaluated in a two (qualifications, high v. marginal) by three (diabetes, mildly obese, or normal) design. Subjects were 295 adults, averaging 5.02 years of full-time employment in white-collar settings, recruited in advanced level graduate or undergraduate business classes. Each subject examined a job description and a resume of the 'applicant' and viewed a 5-minute videotape. The applicant's face was never seen and an off-camera voice, constant across all conditions, was dubbed in for the applicant's responses to the interviewer's questions. Subjects were then asked to rate the applicant's qualification level and demeanor during the interview and to recommend whether or not to hire the individual. Subjects were also asked to make ratings about the applicant's work habits, work reliability and absenteeism, and interpersonal skills (e.g. emotional problems, likeability). Results indicated that level of quantification affected decisions to hire the applicant in the predicted direction. However, the obese applicant was rated as less qualified for the job, and both the diabetic and obese applicant were less likely to be hired, although they were rated similarly on personal appearance, attitude during the interview, and communication skills. Additionally, both the obese and the diabetic applicant were viewed as having poorer work habits. The diabetic was rated as much more likely to have medically-related job absences, whereas the obese applicant was rated as more likely to have other absences (e.g. abusing company privileges by feigning illness) and to have emotional and interpersonal problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The descriptive profile of low back pain patients of field practicing chiropractors contrasted with those treated in the clinics of west coast chiropractic colleges.

OBJECTIVE: To compare the demographic and clinical characteristics of low back pain patients from chiropractic college clinics and private practice settings on the west coast of the United States. DESIGN AND SETTING: A survey analysis of consecutive new patients in a specified time frame from multiple private office settings contrasted with a previous survey of consecutive new patients in a similar time frame from chiropractic college clinics. PATIENTS: In the private practice setting, new patients were selected on a consecutive basis as subjects for the study. Selection was limited to low back pain patients. INTERVENTIONS: None. This was a self-report survey only. MAIN OUTCOME: There is a strong similarity of the two low back pain patient groups, with the exception of higher levels of income, work time loss, severity and functional disability reported in the private practice setting. RESULTS: Similarities between the two low back pain patient groups were found in the distribution of gender, age, job description and education. Statistical significances were not determined due to variations in data collection. CONCLUSIONS: The two patient populations are reasonably comparable in sociodemographic variables, but clinical variation does exist. These results suggest the need to consider clinical findings when extrapolating research findings in a college clinic setting to the chiropractic profession in general.

Adult↗

Strategic planning for research use in nursing practice.

BACKGROUND/OBJECTIVE: To prepare for a culture change to integrate research utilization into daily nursing practice, the authors conducted a descriptive survey of all registered nurses (RNs) in an integrated healthcare delivery system. The purposes of this study were to assess RNs' knowledge, attitudes, and practices (KAP) of nursing research activities, assess factors that support a research environment, and determine facilitating and challenging factors related to conducting regional nursing research. METHODS: A 33-item survey based on the Iowa Model for Evidence-Based Practice was developed, validated, and determined to be reliable by the authors. Site coordinators organized and managed the orientation, administration, and collection of data from the 2,736 registered nurses who worked in 6 hospitals, 65 affiliated clinics, and 3 business units. Narrative notes taken by study investigators were analyzed for themes to determine challenging and facilitating factors for conducting regional research. RESULTS: Education and job title significantly predicted knowledge and ability to perform research activities but was not related to willingness to engage in research activities. Several environmental factors were associated with knowledge of, willingness to engage in, and ability to perform research utilization activities. Challenging and facilitating factors to conducting regional research were identified. CONCLUSIONS/IMPLICATIONS: Our research environment is changing to value research as shown in the philosophy, conceptual framework, and bylaws for the professional nursing staff. Novice-to-expert research utilization expectations are included in the promotional model for nursing. All RN job descriptions and the annual performance tool were revised to include responsibilities related to research activities. The Iowa Model for Evidence-Based Practice was adopted as the method for creating practice validation and change. Train-the-trainer educational and experiential sessions are being designed for nurse leaders; all new RN employees complete a self-assessment tool of research utilization knowledge and the nursing division strategic goals incorporate research utilization expectations. The elements of this plan may be useful for nurse executives. Healthcare systems are restructuring throughout the world and within the United States. These changes are occurring to better meet the evolving healthcare needs of the population through cost-effective approaches. Within the United States, emerging organized healthcare systems require research related to patient care outcomes and the health systems that can best address them.

Adult↗

Comparing questionnaire-based methods to assess occupational silica exposure.

BACKGROUND: Epidemiologic assessment of occupational exposure to silica is typically limited to long-term work in the dusty trades, primarily in jobs held by men. We compared alternative questionnaire-based methods to assess silica exposure in a recent case-control study of 265 patients with systemic lupus erythematosus (mostly women) and 355 controls randomly selected from state driver's license registries and frequency-matched by age and sex. METHODS: In-person interviews included a job history (all jobs held at least 12 months) and checklist of silica-related jobs and tasks (work of at least 2 weeks). Three industrial hygienists reviewed job descriptions without knowing case-control status. Potential high- or moderate-intensity exposures were confirmed or revised based on follow-up telephone interviews. RESULTS: In the full assessment including all work of at least 2 weeks, 9% of cases and 4% of controls were classified as medium or high silica exposure (odds ratio of disease = 2.9; 95% confidence interval = 1.3-6.4). In contrast, only 4% of cases and 9% of controls were identified by the standardized code groups index as having worked in silica-related industries or occupations for at least 12 months, providing a much lower risk estimate for disease (0.4; 0.2-0.9). CONCLUSIONS: Specific task-based questions must be included to assess the full potential of occupational silica exposure. These findings highlight the limitations of using standardized code groups to define exposure or to select jobs for industrial hygienist review.

Adult↗

Technicians and the future of pharmacy.

Ways in which pharmacists and pharmacy technicians can grow professionally to fulfill pharmacy's fundamental responsibility for appropriate drug use in patients are described. From the 1985 "Hilton Head Conference" on directions for clinical practice in pharmacy, the idea grew that pharmacists' traditional functions should be melded with a clinical orientation to provide pharmacy's maximum contribution to patient care. When the focus shifts from discrete activities of individual pharmacists to overall responsibilities of the department, each pharmacist and technician can see his or her contribution to the clinical endeavor; technicians assigned with a pharmacist to a specific group of patients are likely to take a more active interest in their jobs. Instead of ratios, patient outcome and job satisfaction should be the determinants of staffing patterns. Delineation of roles as judgmental or nonjudgmental should be replaced by clear job descriptions and procedures and an understanding of the complementary roles of pharmacists and technicians. Important elements in technician training include seminars presented by professional staff members and planned jointly by pharmacists and technicians, departmentwide seminars, policies that encourage technicians to join and participate in professional organizations, and liberal tuition-reimbursement policies. For career advancement, the pharmacy organizational structure might contain three levels: technician trainee, technician, and technician specialist. Pharmacists and technicians can overcome barriers between them by realizing the enormous growth potential and value of the services that both provide.

Job Satisfaction↗