Health professional students' occupational exposures to blood-borne pathogens: primary and secondary prevention strategies

Health science students, along with the health professionals they hope to become, are at increased risk for certain occupational injuries and illnesses. One of these risks is occupational exposure to blood-borne pathogens, such as human immunodeficiency virus (HIV) and hepatitis, which may result in severe illnesses or even death. Two case studies demonstrate postexposure care of exposed individuals at the University of Texas Medical Branch Student Health Services before and after policy changes and prevention strategies were strengthened in response to exposure incidents.     

Patients' Evaluations of the Mental Health Service at a Health Sciences Campus

Abstract

Health science students, along with the health professionals they hope to become, are at increased risk for certain occupational injuries and illnesses. One of these risks is occupational exposure to blood-borne pathogens, such as human immunodeficiency virus (HIV) and hepatitis, which may result in severe illnesses or even death. Two case studies demonstrate postexposure care of exposed individuals at the University of Texas Medical Branch Student Health Services before and after policy changes and prevention strategies were strengthened in response to exposure incidents.     

Condom Use,Condom Refusal,and Substituted Sexual Behaviors Among Youth at Higher and Lower Risk for HIV Infection

ABSTRACT

The purpose of this study was to describe sexual behaviors that youth substitute for protected intercourse when a partner refuses to use a condom or a condom is not used. Participants included: (a) 120 adolescents (mean age 17.2 years) undergoing substance abuse treatment and (b) 171 university students (mean age 21.3 years). The treatment sample reported significantly higher levels of discrete risk factors for HIV exposure. While only a small proportion of each sample experienced outright refusals by partners to use condoms, the majority of participants in each sample used condoms inconsistently with main partners. The university sample reported more substituted behaviors (lower risk and total) when partners did not want to use condoms. Yet, substantial proportions of participants in each sample engaged in unprotected intercourse. Implications for social work and health promotion efforts directed toward youth at risk for HIV/STD exposures are discussed.     

Collaborating for consensus: Considerations for convening Coalition stakeholders to promote a gender-based approach to addressing the health needs of sex workers

Women involved in sex work experience myriad challenges, such as poverty, illiteracy, low social status and gender inequity, as they struggle to access healthcare. These challenges place them at high risk for poor health outcomes. The purpose of this article is to describe the formation of a strong cross-system Coalition representing both the criminal justice and healthcare systems to address the health needs of sex workers in Delaware. The Delaware Coalition for Health and Justice implemented a Coalition-building strategy to design interventions and streamline systems to promote health and reduce criminal justice contact for sex workers. The sequential intercept model was utilized to organize Coalition membership and build consensus among varied stakeholders. The model assisted the Coalition in understanding differing primary objectives for key system programs, recognizing the limitations and barriers of each stakeholder group, sharing findings and discovering opportunities for partnership, and engaging stakeholders in designing and providing a comprehensive “systems” approach. This work suggests that aligning the criminal justice, healthcare, and community social services in a systemic process to build consensus can result in the implementation of effective systems change initiatives that address gender disparities and promote the health of justice-involved women.     

Teaching Note—Asserting Social Work’s Role in Developing an Interprofessional Education Project

ABSTRACT

Interprofessional (IP) education is an essential component of today’s health care education. IP education has been recognized and supported for its potential to educate workforce-ready health care clinicians with the knowledge and skills, necessary to collaboratively deliver high-quality, client-centered care. While social work’s reflective, patient-centered, and holistic approach to care is invaluable in addressing healthcare challenges at all levels, social work’s lack of involvement in IP health care team practice is evident in the development of IP education curriculum with other health care disciplines. This article describes how one School of Social Work at a regional public university became part of a longitudinal IP education project in collaboration with a large R-1 research university, creating an IP opportunity for Master’s in Social Work (MSW) students. It also discusses the process taken for social work inclusion in the IP project, an experiential elective course designed to supplement the project, as well as Transformative Learning Theory, the conceptual framework used.     

Can healthcare providers at a university health clinic predict patient satisfaction?

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

New working conditions and consequences on activity of home healthcare workers

Home healthcare is steadily growing in Europe. There are a number of reasons for this development: aging population, rising hospital costs, preference to stay in one's own home. Nevertheless, it has been known that home healthcare workers are frequently exposed to a variety of potentially serious occupational hazards. Furthermore, emotional labor is frequently high in this profession. This paper describes an ergonomic study conducted at a home healthcare service. The research focuses on analyzing working conditions of home healthcare aides and nurses, as well as the impacts of their work in terms of job satisfaction, well-being, emotions at work, relationships with the others and occupational stress. The study show that employee strategies are specifically centered around preserving the relationship between patients and workers and coping with the job demands. This paper also shows that home healthcare workers express emotions and conceal them from others. Finally, recommendations discussed with the manager and workers to improve working conditions in this sector led to practical proposals: for example, implementing certain equipment items better suited to difficult care, encouraging assistance between healthcare workers when operations require this through adequate organizational measures, extending work emotion-focused discussion groups with management involvement.     

Knowledge,attitudes and experiences of Macao's casino workers with regard to second-hand smoke exposure at work

This study investigates the knowledge, attitudes and experiences of casino workers in Macao with regard to exposure to second-hand smoke (SHS) in the workplace through structured face-to-face interviews with 377 workers. The results indicate that the majority of casino workers dislike SHS exposure at work, recognise that such exposure is harmful to their health, support the establishment of separate smoking and non-smoking areas for customers and would like greater restrictions than those that exist at present. The survey also found that there are statistically significant differences in knowledge, attitudes and experiences among workers of different smoking status. The findings of this study support the need for more comprehensive smoke-free legislation in casinos in Macao. The results also add to the existing evidence for smoke-free legislation across casinos worldwide.     

Sociodemographic Determinants of Occupational Risks of Exposure to COVID‐19 in Canada

The activities performed by Canadian workers in some occupations may increase the risk of exposure to infectious diseases such as COVID‐19. This research note explores how occupational exposure risks vary by labor force characteristics using publicly available Canadian data in combination with a data set providing information on the level of physical proximity and frequency of exposure to infections or diseases faced by workers in different occupations. The results show important sociodemographic differences. First, women work in occupations associated with significantly higher average risks of exposure to COVID‐19 than men. This is driven by their overrepresentation in high‐risk broad occupational categories such as health occupations. Second, older workers (65 years or more), a group vulnerable to COVID‐19, appear to work in occupations requiring performing activities characterized by a lower level of physical proximity than their younger colleagues, with minimal differences in the frequency of exposure to diseases or infections. Finally, workers in low‐income occupations are employed in occupations that put them at greater risk of exposure to COVID‐19 than other workers. This is especially the case for women, immigrants, and members of visible minority groups in low‐income occupations. More broadly, this research note provides insights into the health‐related dimension of the literature on occupational tasks and labor market stratification.     

Influences of mechanical exposure biographies on physical capabilities of workers from automotive industry - a study on possible dose-response relationships and consequences for short and long term job rotation

This paper describes a field study in production areas of a vehicle manufacturing plant, where 106 male workers (aged from 20 to 63 years) were examined and interviewed by the authors. Aim of study was to identify relationships between specific physical worker capabilities and doses of mechanical exposures using self-developed standardized questionnaires as well as a battery of work-specific tests. The dependent variables are different "physical capabilities", classified using a five-point rating scale with regard to the grade of limitation of the respective capability. Independent variables are "age" and specific "mechanical exposures". Several exposures were combined and multiplied with their respective durations in order to determine doses on three different body regions - back, shoulder-neck and upper limbs. There are significant positive correlations between "age" and "dose of mechanical exposure on back/shoulder-neck/upper limbs region". The analysis of the relationship between dose of exposure and different capabilities to lift or reposition loads (with variable weight) shows weak significant correlations for all three body regions. Data analysis shows no significant correlations between any dose of mechanical exposure and capabilities to work in awkward body postures.These results should be considered in age management programs when scheduling future employee assignments to workplaces, especially for production systems where manual handling tasks are dominant.     

Perceived Job Insecurity and Health: Do Duration and Timing Matter?

I examine whether the health penalties of perceived job insecurity are influenced by the duration of the experience and the age at which it is encountered. Analyses of a national panel data set of Americans (N = 1,065) reveal a decrease in health among workers reporting persistent exposure to the threat of job loss; however, these health penalties are experienced unevenly across age groups, with young workers (18–34) reporting the fewest health penalties in response to persistent insecurity. In contrast, while insecure middle‐aged and older workers report similar levels of psychological distress and self‐rated health, the former are more adversely affected with respect to their emotional well‐being. I discuss potential cohort and life stage interpretations for these age patterns in the stress of insecure work.     

Lost in translation? Communication challenges in minority families’ and healthcare workers’ interactions

A fundamental principal in the Norwegian welfare system is to provide equal access to healthcare services for all residents, regardless of their ethnicity, language, knowledge, function, or belief. However, many service recipients experience a gap between these ideals and everyday realities. In this article I investigate how this gap affects minority families of disabled children who do not master the majority language and healthcare workers. The data I use in my investigation draw on a qualitative study of minority families of disabled children and healthcare workers. The findings that emerge out of these data are categorized into: linguistic difficulties, expectations and assumptions, and culture-bound services. I use these findings to illuminate how language difficulties and stereotypical assumptions within the Norwegian healthcare system make it difficult for minority families to access healthcare services, and how healthcare services lack an effective way to meet minority families’ needs.     

Financing Rural New England University Health Services: A Pilot Study

Abstract

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

Exposure to Client Trauma,Secondary Traumatic Stress,and the Health of Clinical Social Workers: A Mediation Analysis

While it is widely acknowledged that providing services to traumatized populations may negatively impact the mental health of clinicians, little is known about the impact of exposure to traumatized clients and secondary traumatic stress on the physical health status of clinicians. As such, the twofold purpose of this study was to: (1) document the prevalence of STS in a national (US) sample of clinical social workers, and (2) to examine the relationships between exposure to client trauma, STS, and perceived health of clinical social workers. Specifically, we sought to determine if STS mediates the relationship between exposure to client traumas and perceived health. Results indicate clinicians experience intrusion symptoms most frequently, and a significant portion report arousal and avoidance symptoms. Mediation analyses revealed that exposure to traumatized client populations indirectly influenced clinical social workers’ physical health perceptions by way of secondary traumatic stress. Findings call for increased attention toward prevention and amelioration of secondary traumatic stress symptomology among direct service providers, given both its prevalence and potential impact on physical health. Directions for future research are discussed.     

Part II: the effect of long-term exposure to organic solvents on senso-motor skills: a cross sectional study

A heterogeneous population, with cultural and linguistic differences, could benefit from nonverbal assessment. This was the case with this research population, and in this constellation we felt that for continuity to cognitive evaluation of industrial painters we had to add at least two tests limited mainly to senso-motor aspects of human behavior. Moreover, this practical strategy decreased workers' tension regarding testing circumstances and yielded fewer possibilities for compensating an impaired function by use of other, unaffected ones. Reaction Time and Finger Tapping were the tests we chose because of their well-circumscribed elemental functional sensitivity to neurotoxic exposures. The research design was cross-sectional. Study population included 31 industrial painters who were exposed at work to organic solvents and 31 unexposed workers. Workers after long term exposure to organic solvents showed significantly higher response rate and decline in Finger Tapping scores in comparison to unexposed workers. The results showed a significant negative correlation between exposure index and number of finger tapping with dominant hand, non dominant hand and altering with both hands indicating that the higher the exposure index was the lower the number of finger tapping. It was also found that the affect of age on Reaction Time and Finger Tapping of dominant hand was significant among workers after long term exposure to organic solvents, whereas for the unexposed workers those basic functions were unaffected.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.     

Alcohol consumption among undergraduate social work students at a South African university

ABSTRACT

Alcohol consumption among tertiary level students is a public health problem that can adversely affect students’ performance at university. This study therefore investigated the drinking patterns; reasons for drinking; and the perceived impact of drinking on academic performance of undergraduate social work students at a South African university. Of the 145 students who completed a group administered survey questionnaire, 88% reported using alcohol mainly for social purposes and enjoyment, with two-fifths admitting to participating in binge drinking. Despite these findings, a high proportion (78%) reported not performing poorly on a test or exam due to alcohol consumption in the preceding 12 months. Recommendations are provided for the education and support of social work students as future healthcare professionals.     

Employment-based health benefits: analysis of the April 1993 Current Population Survey

The April 1993 CPS differs from the March 1993 CPS in a number of respects. The April 1993 CPS supplement surveys only workers, whereas the March CPS examines the noncash benefits received by all Americans. The April CPS asks workers about health coverage in the week in which the questions were fielded, whereas the March CPS asks about coverage in the preceding year. In April 1993, there were 112.5 million civilian American workers between the ages of 18 and 64 with jobs. Eighty-two million (73 percent) of them worked for an employer that sponsored a health insurance plan, and 65 million (58 percent of all workers) participated in their employer's health plan. About one-third of workers at firms with fewer than 10 employees had employers who offer health benefits; about one-quarter of all of the workers in these firms participated in their employer's plan. Conversely, 94 percent of workers at firms with more than 1,000 employees had an employer who sponsored health benefits, and over 77 percent of these workers participated in their employer's plan. There are 16.5 million American workers whose employers sponsored health benefits but who did not participate in these benefits. Over one-half of these workers (8.5 million) chose not to be covered. Another 36 percent of these workers (5.9 million) did not participate because they were ineligible or denied coverage. Over 66 percent of the ineligible workers did not participate because they were part-time, contract, or temporary workers. Another 26 percent had not yet completed a probationary period. Among the reasons that those who chose not to participate in their employer's coverage, the vast majority (75 percent) stated they were covered by another health care plan. Twenty-nine percent stated that they chose not to purchase coverage because it was too costly or that they did not need or want the coverage. In 1993, there were 16.7 million workers with no health insurance coverage. The vast majority of these workers (95 percent) were employed by private employers. Sixty-six percent of the workers with no health insurance coverage were self-employed or worked for firms with fewer than 100 employees.     

Overconfident health workers provide lower quality healthcare

While a growing body of evidence suggests that healthcare workers in low and middle-income countries often provide poor quality of care, the reasons behind such low performance remain unclear. The literature on medical decision-making suggests that cognitive biases, or failures related to the way healthcare providers think, explain many diagnostic errors. This study investigates whether one cognitive bias, overconfidence, defined as the tendency to overestimate one’s performance relative to others, is associated with the low quality of care provided in Senegal. We link survey data on the overconfidence of health workers to objective measures of the quality of care they provide to standardised patients – enumerators who pose as real patients and record details of the consultation. We find that about a third of providers are overconfident – meaning that they overestimate their own abilities relative to their peers. We then show that overconfident providers are 26% less likely to manage patients correctly and exert less effort in clinical practice. These results suggest that the low levels of quality of care observed in some settings could be partly explained by the cognitive biases of providers, such as overconfidence. Policies that encourage adequate supervision and feedback to healthcare workers might reduce such failures in clinical decision-making.     

Risk evaluation and exposure control of mineral dust containing free crystalline silica: a study case at a quarry in the Recife Metropolitan Area

During the production of aggregates at quarry sites, elevated quantities of micro-particulate mineral dust are produced in all stages of the process. This dust contains appreciable amounts of free crystalline silica in a variety of forms which, if maintained suspended in the air in the work environment, expose the workers to the risk of developing occupational silicosis, which causes reduced ability to work and potential shortening of lifespan. This study was conducted to qualitatively and quantitatively evaluate workers' exposure to mineral dust containing free crystalline silica at a midsized quarry in the Recife metropolitan area, in the State of Pernambuco. It involved evaluation of the industrial process, collection and analysis of representative dust samples, and interviews with the management team of the company with the intent to assess the compliance of the company with Regulatory Standard (NR) 22--Occupational safety and health in mining. In order to assist the company in managing risks related to dust exposure, three protocols were developed, implemented and made available, the first based on NR 22, from which the company was also given an economic safety indicator, the second based on the recommendations and requirements of Fundacentro to implement a Respiratory Protection Program and, finally, an assessment protocol with respect to the guidelines of the International Labor Organization to implement a health and safety management system. This study also showed the inadequacy of the formula for calculating tolerance limits in Brazilian legislation when compared with the more strict internationally accepted control parameters. From the laboratory results, unhealthy conditions at the quarry site were confirmed and technical and administrative measures were suggested to reduce and control dust exposure at acceptable levels, such as the implementation of an occupational health and safety management system, integrated with other management systems. From these assessments it is hoped that the proposals can assist the company in developing mechanisms for management and control of dust exposure risks that may improve environmental quality and the well-being of workers.