The effectiveness of intervention strategies used to educate clients about prevention of upper extremity cumulative trauma disorders

The increased prevalence of work-related cumulative trauma disorders (CTDs) of the upper extremity highlights the need for effective prevention programs. This paper examines the effectiveness of different intervention strategies used to educate workers about the prevention of upper extremity CTDs. The articles reviewed include primary prevention and reinjury prevention interventions in both clinical and workplace settings. The current research findings are inconclusive. Intervention strategies may include discussion, demonstration, or practice of proper posture and body mechanics. Practice of correct techniques may not be necessary to achieve improved hand-use patterns in assembly-line workers. However, practice with intensive feedback may be necessary to achieve the best performance of hand-wrist position, but not sitting posture, in computer operators. The effects of practice on correct hand use may depend on the type of job task. Further research is needed to clarify the role of practice and feedback in CTD prevention.     

Prevention interventions of alcohol problems in the workplace

The workplace offers advantages as a setting for interventions that result in primary prevention of alcohol abuse. Such programs have the potential to reach broad audiences and populations that would otherwise not receive prevention programs and, thereby, benefit both the employee and employer. Researchers have implemented and evaluated a variety of workplace alcohol problem prevention efforts in recent years, including programs focused on health promotion, social health promotion, brief interventions, and changing the work environment. Although some studies reported significant reductions in alcohol use outcomes, additional research with a stronger and integrated methodological approach is needed. The field of workplace alcohol prevention also might benefit from a guiding framework, such as the one proposed in this article.     

A comprehensive work injury prevention program with clerical and office workers: phase I

The risk for the development of musculoskeletal disorders and associated conditions in clerical and office workers is well documented. The majority of work injury prevention programs for this population were single-faceted (education, workstation redesign, or task modification) and yielded both positive and negative findings. This pilot study was conducted with 16 full-time clerical and office workers at a small private college. In a randomized control trial, the intervention group received four hours of individualized training through a multi-faceted injury prevention program. Between group differences in musculoskeletal symptom frequency and intensity and perceived stress and energy levels existed, although were statistically insignificant. There was a statistically significant decrease in Lower Back ache/pain from pre to post measures for the intervention group.     

A survey of current research studies on drug education programs in America

This article surveys recent research findings on drug education programs in America. Findings have been somewhat contradictory but a pattern of encouraging results seem to favor prevention programs that focus on resistance training. Research results were complimentary of D.A.R.E. (Drug Abuse Resistance Education) and S.A.P. (Student Assistance Program) which emphasizes intervention strategies. Experts noted that drug education programs require interagency collaboration among schools, communities, and families. Authorities appealed for a higher funding priority toward evaluating the effectiveness of drug education programs. The article also provides information about what parents, schools, students, and communities can do concerning drug prevention efforts.     

An assessment of drug testing within the construction industry

Drug testing in the workplace has gone from virtual nonexistence to widespread employer acceptance during the past two decades. This growth is particularly significant for the construction industry. High rates of alcohol and other drug use, coupled with the high-risk, safety-sensitive nature of the industry, have prompted the development of a variety of drug surveillance and prevention strategies. Despite this growing vigilance, no scholarly works have examined the impact of drug-related policies in the construction industry. To address this limitation, we investigate the efficacy of workplace drug-testing programs in reducing injury incident rates and workers' compensation experience-rating modification factors (MODs) within the construction industry. Analyses indicate that companies with drug-testing programs experienced a 51 percent reduction in incident rates within two years of implementation. Moreover, companies that drug test their employees experienced a significant reduction in their MODs. Policy implications are discussed in light of the current findings.     

An Evaluative Review of Outcome Research on Universal Mental Health Promotion and Prevention Programs for Higher Education Students

Abstract

Objective: This review is the first large-scale attempt to evaluate the effectiveness of universal promotion and prevention programs for higher education students on a range of adjustment outcomes. Participants/Methods: The current review examined 83 controlled interventions involving college, graduate, and professional students, with a focus on 3 main outcomes: social and emotional skills, self-perceptions, and emotional distress. Results/Conclusions: Skill-oriented programs that included supervised practice demonstrated the strongest benefits, thus showing promise as a successful mental health promotion and preventive intervention. In comparing different intervention strategies, mindfulness training and cognitive-behavioral techniques appear to be the most effective. Furthermore, interventions conducted as a class appear to be effective, suggesting the potential for exposing higher education students to skill training through routine curricula offerings. This review offers recommendations for improving the experimental rigor of future research, and implications for enhancing campus services to optimize student success in psychosocial—and thus ultimately academic—domains.     

A Review of Multicomponent Interventions to Prevent and Control Tobacco Use Among College Students

Abstract

Objective: Multicomponent tobacco control programs have been implemented at the state and community levels and have led to a reduction in tobacco use. The purpose was to review the public health research literature on tobacco prevention and control programs on college campuses and derive evidence-based implications for comprehensive program implementation. Methods: MEDLINE, PsycINFO, ERIC, and PubMed databases were used to search the research literature concerning tobacco prevention and control programs conducted on college campuses published between 2000 and 2009. Results: No studies were found that implemented all 5 recommended components of a comprehensive program. Tobacco control programs containing policy and prevention education were used the most and promotion of tobacco-free environments and banning sales of tobacco products were used the least. Conclusion: The review suggests that despite the recommendation of comprehensive tobacco control programs to reduce tobacco use on college campuses, few institutions have implemented and evaluated programs consisting of multiple components.     

Is there evidence to show that fetal alcohol syndrome can be prevented?

Fetal Alcohol Syndrome (FAS) is currently the major cause of mental retardation in the Western world. Since FAS is not a natural phenomenon and is created by mixing alcohol and pregnancy, the solution to decreasing the incidence of all alcohol-related birth defects is therefore entirely preventable. To date, little is known about the effectiveness of prevention programs in reducing the incidence of FAS. Therefore, it is the intention of this article to review the effectiveness of prevention programs in lowering the incidence of FAS. The present review revealed that prevention programs, to date, have been successful in raising awareness of FAS levels across the groups examined. However, this awareness has not been translated into behavioral changes in "high risk" drinkers as consumption levels in this group have decreased only marginally, indicating prevention programs have had minimal or no impact in lowering the incidence of FAS. Urgent steps must now be taken to fully test prevention programs, and find new strategies involving both sexes, to reduce and ultimately eliminate the incidence of FAS.     

Evaluation of community-based AIDS education and risk reduction projects in ethnic and racial minority communities: A survey of projects funded by the U.S. public health service

The purpose of this study was to describe proposed program evaluation methods used to determine effectiveness of selected federally funded AIDS education and risk reduction interventions focused on ethnic and racial minority populations. Funding for AIDS prevention programs has grown significantly since 1985, when the first allocation of $11 million was earmarked for general AIDS prevention and education. In 1987, funds specifically targeting minority populations were set aside from AIDS prevention and education programs. Nine agencies/divisions within the Department of Health and Human Services (DHHS) were identified as having funded AIDS prevention and education projects targeted toward ethnic and racial minority populations. The grants and contracts reviewed for this study were limited to those programs receiving Federal funding through DHHS. Few programs provided information within the broader context of sex education and drug education. The modification of needle-sharing behavior among IV drug users and unprotected sex with an IV drug user were the two most frequent risk factors targeted. All 63 programs used at least one formative evaluation method. The most frequently used formative techniques were monitoring achievement of project objectives and counting the number of people participating in program activities. Forty programs counted the amount of AIDS literature distributed. Thirty-three programs conducted a baseline assessment of AIDS knowledge, and 33 programs conducted a baseline assessment of risk behaviors for HIV infection. Results from this study support the National Academy of Sciences recommendation that while summative evaluation will ultimately be valuable, it would be premature to begin developing outcome evaluation strategies at the present time. It is incumbent upon program planners and evaluators to ensure that premature program evaluations are not made in an effort to eliminate direct federal funding of minority community-based strategies to stop the spread of HIV infection.     

Enhancing the validity of foster care follow-up studies through multiple alumni location strategies

While family-based placement prevention services, family reunification programs, subsidized guardianship, and aggressive adoption programs are reducing the numbers of children spending long periods of time in substitute care, a significant number of America's children will come of age in foster care. Agencies and policymakers should use research and evaluation to assess the effectiveness of foster care in nurturing healthy adults and to explore ways to improve services. Outcome studies that have focused on locating and interviewing young or middle-aged adults emancipated from foster care have been hampered by modest response rates, limiting the field's ability to evaluate the efficacy of foster care programs. This article describes a set of strategies that were used to achieve higher response rates in two recent follow-up studies.     

Health promotion and disease prevention: a look at demand management programs

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.     

Factors contributing to low back pain among professional drivers: a review of current literature and possible ergonomic controls

It is suggested that professional drivers are at an increased risk for low back pain and injury due to a variety of factors such as whole body vibration, prolonged sitting, awkward postures, lifting and carrying, and psychosocial issues. Ergonomics can play an important role in the reduction of risk of injury to the professional driver by implementing modifications to the work place (engineering controls), changes in administrative and management practice (administrative controls), and education of the worker (work practice controls). A review of the literature of the etiology of low back pain and injury among professional drivers is presented, and possible ergonomic controls have been recommended.     

A systematic review of education for the prevention of HIV/AIDS among older adults

Through a comprehensive literature search, the authors of this systematic review identified 21 articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. Three major challenges to providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk. Clinical guidelines for social workers, nurses, and physicians identified the importance of sharing information and assessing risk, considering cultural diversity, and devising creative delivery strategies. Three models of HIV/AIDS education include group education programs delivered by social workers or other health professionals, peer education models, and one-on-one early intervention models including HIV/AIDS testing. Additional outreach and research on HIV/AIDS prevention among older adults is needed.     

Minimizing stress in the workplace: Whose responsibility is it?

Work-related stress is pervasive in today's society. Its far-reaching effects on worker health, productivity, and organizational commitment have caused legislators and researchers alike to rethink stress prevention strategies that will best serve all systems involved. This article identifies the issues limiting the development of primary stress reduction programs in the workplace and provides insight as to the emerging global legislative initiatives that support this issue.     

Closing Remarks

This article is a reflective account of a three-year evaluation project completed in 1989 at Alys Key Family Care, a Melbourne-based family support and development agency. While there has been a pause in formal research activity within the agency, new studies are about to commence. Staff are currently looking back on the evaluation framework set in place during the service's Demonstration project and considering many issues and questions which will shape the next phase of research. It seems an appropriate time to review the initial evaluation structure and to share our thoughts with others embarking on the task of formal accountability programs. Detailed research findings are not outlined in this paper, with the emphasis instead being on the development of an evaluation structure within a casework setting, designed to address complex questions of service effectiveness with high-risk families.     

Perspectives on workplace disability management: a review of the literature

Work-related musculoskeletal injuries represent a major source of work disability. While many employers recognize the importance of workplace disability management approaches and are assuming greater responsibility for preventing and minimizing work-related disability, questions about the effectiveness of these interventions exist. The purposes of this article are to: 1) describe the essential components of workplace disability management programs related to musculoskeletal injuries; 2) review the literature on disability management practices based on research evidence by focussing on workplace-based interventions and the role of the workplace; and 3) provide recommendations for disability management in the prevention and reduction of disability, and the rehabilitation of injured workers with musculoskeletal work injuries. The literature suggests that employer participation, a supportive work climate and cooperation between labour and management are crucial factors in facilitating return to work. Given the complexity of the disability management process and the numbers of individuals involved, it is essential that all workplace parties work together to achieve the goal of safe and early return to work.     

When elevators were for pianos: an oral history account of the civilian experience of using wheelchairs in Canadian society. The first twenty-five years: 1945-1970

In 1945 Canadian World War II veterans with spinal cord injury were among the first Canadians to have access to medical rehabilitation programs, the Everest and Jennings folding, self-propelled wheelchair and automobiles with hand-controls. A previous paper, Going back to Civvy Street (Tremblay, 1996) described how the veteran pioneers used these new opportunities to return to full participation in civilian life. Drawing on oral history and archival research, this paper examines the experiences of Canadian civilians with spinal cord injury as they tried to follow the veterans' example. It discusses the strategies these pioneers used to overcome obstacles, such as stairs and curbs, as well as providing examples of their experiences in finding housing, education and employment. The paper reviews the responses individuals received from their fellow citizens and highlights the limited recognition of architectural barriers in an era when elevators were for pianos!     

A survey of occupational therapy in Australian work practice

While the prevention and management of work-related injuries are major areas of practice for Australian occupational therapists, there has been little research on occupational therapy's contribution in these areas. This study examined the characteristics of current Australian occupational therapy practice in the work arena. A postal questionnaire was sent to 355 occupational therapists employed in work practice from six of the eight state or territory Occupational Therapy Associations. The questionnaire enquired about demographic details, service provision in the prevention, assessment and rehabilitation areas and further education needs in these areas. The responses of 125 (35%) therapists were analysed and show the services commonly offered in prevention, assessment and rehabilitation. The most commonly offered services included job analyses, workplace assessment and suitable duties programs. The results also indicate high levels of service provision in the workplace. In presenting the findings of the survey, current trends in international and Australian occupational therapy work practice are discussed along with suggestions for directions in future education, practice and research.     

I'm going back to work: back injured clients' perceptions and experiences of their worker roles

This study aimed to elicit perceptions and experiences of facilitators and barriers that affected individuals who received back rehabilitation and their ability to resume their worker roles. Qualitative research methods were used in order to explore the research question. Participants were selected by means of simple random sampling and the data were collected by means of semi-structured focus groups. Some factors that were seen as facilitatory in maintaining the worker role of an individual who received back rehabilitation included injury management strategies, a positive work culture and having meaningful/satisfactory work experiences. Factors or barriers that prevented individuals from resuming their worker roles included physical and psychosocial stressors of the job, a lack of education by the employer and inadequate workplace policy. The results indicated that occupational therapists need to reassess their role within the wider context of the helping professions where they should become more involved in on-the-job evaluations, work placements and training of individuals who received back rehabilitation.     

Preventing workplace aggression and violence--a role for occupational therapy

Workplace aggression and violence is the fastest growing societal concerns in USA. The review of literature indicates that violence is a substantial contributor to occupational injuries and death. Preventative strategies for minimizing the risk of workplace violence include, cash-handling policies, physical separation of workers from customers, environmental modifications; good lighting, security devices, escort services, and employee training. Studies also suggest that as a preventive measure, employers will attract and retain the best workers if high-risk behaviors are discouraged and appropriate behaviors are supported. Proactive strategies reduce stress, increase productivity, and enhance creativity. A role for occupational therapy practitioners in the prevention of workplace violence is proposed.