Analytical Predictive Bayesian Assessment of Occupational Injury Risk: Municipal Solid Waste Collectors

Unlike other waste streams, municipal solid waste (MSW) is collected manually, and MSW collection has recently been found to be among the highest-risk occupations in the United States. However, as for other occupational groups, actual total injury rates, including the great majority of injuries not compensated and those compensated by other insurance, are not known. In this article a predictive Bayesian method of assessing total injury rates from available information without computation is presented, and used to assess the actual numbers of musculoskeletal and dermal injuries requiring clinical care of MSW workers in Florida. Closed-form predictive Bayesian distributions that narrow progressively in response to information, representing both uncertainty and variability, are presented. Available information included workers' compensation (WC) data, worker population data, and safety records for one private and one public collection agency. Subjective input comprised epidemiological and medical judgment based on a review of 165 articles. The number of injuries was assessed at 3,146 annually in Florida, or 54 +/- 18 injuries per 100 workers per year with 95% confidence. Further, WC data indicate that the injury rate is 50% higher for garbage collectors specifically, indicating a rate of approximately 80 per 100 workers. Results, though subject to uncertainty in worker numbers and classification and reporting bias, agreed closely with a survey of 251 MSW collectors, of whom 75% reported being injured (and 70% reported illness) within the past 12 months. The approach is recommended for assessment of total injury rates and, where sufficient information exists, for the more difficult assessment of occupational disease rates.     

Alcohol Use in Students Seeking Primary Care Treatment at University Health Services

Abstract

Objective: Given the high rate of at-risk drinking in college students, the authors examined drinking behaviors and associated factors in students being seen in student health services for primary care visits from October 30, 2004, to February 15, 2007. Methods: Analyses were based on a Health Screening Survey completed by 10,234 college students seeking general medical treatment. Results: Alcohol use was similar to other studies with 57% (n = 5,840) meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking. Twenty-six percent of the students reported smoking at least once in the last 3 months. Risk factors for at-risk drinking included young age, white males, drinking at a fraternity/sorority house, and use of tobacco. Conclusions: These findings support the widespread implementation of alcohol screening and intervention in university health services.     

Partnership,Service Needs and Assessing Competence in Post Qualifying Education and Training

Education and training must extend beyond initial qualifying courses into post qualifying professional development throughout a social worker's career if practice is to be most effective in meeting clients' needs. In the United Kingdom a Framework for Post Qualifying Education and Training was introduced from 1990. Revised frameworks have been put in place from autumn 2007 in each of the four home countries of the UK. This paper reflects on lessons learned in implementing these post qualifying frameworks in Northern Ireland. Within the overarching theme of relevance to practice, issues are drawn out under three main themes: (1) partnership working between employers and universities including the importance of leadership from policy makers and senior managers; (2) assessing competence including providing an Independent Assessment Route to increase access and to benchmark professional standards; and (3) meeting service needs including specifying learning outcomes to cover a range of practice contexts and accrediting employer-based programmes. Meeting service needs more closely is identified as a key issue driving the new Northern Ireland Post Qualifying Framework introduced in 2007.     

On the Use of the Cause Table in Handling Common Cause Events in System Analysis

A method is presented for applying the cause table concept to the problem of common cause events. This method can be regarded as an alternative to the approach in which these events are included directly into the system fault trees. In comparison with this approach, the cause table method offers the advantage of simple fault trees, convenient visibility of the contributions of causes, and the ability to truncate the numerical calculation conveniently by aggregating small terms into an "other" category. Generally speaking, the cause table method can be said to handle common causes at the level of arithmetic (i.e., numbers) rather than at the level of algebra (determining cutsets and frequency equations).     

Implementing a quality assessment program

It is difficult to imagine a more stressed organization than today's hospital. If the scope of change is not a sufficient challenge, the rate of the change is staggering, especially in quality assessment. Now we are poised for continuous quality improvement, whereby outcomes identified by quality assessment become the focus for system and process review and modification. It is imperative that a good quality assessment program be in place before implementing and integrating a continuous quality improvement process. The purpose of this article is to show how a quality assessment system can be implemented in a community hospital, regardless of size or scope of services. Key to the process is making all staff members part of the system's development and operation.     

Giving birth: Expectations of first time mothers in Switzerland at the mid point of pregnancy

Problem and background

Despite a generally affluent society, the caesarean section rate in Switzerland has steadily climbed in recent years from 22.9% in 1998 to 33.7% in 2014. Speculation by the media has prompted political questions as to the reasons. However, there is no clear evidence as to why the Swiss rate should be so high especially in comparison with neighbouring countries.

Exploring global recognition of quality midwifery education: Vision or fiction?

Background

Midwifery education is the foundation for preparing competent midwives to provide a high standard of safe, evidence-based care for women and their newborns. Global competencies and standards for midwifery education have been defined as benchmarks for establishing quality midwifery education and practice worldwide. However, wide variations in type and nature of midwifery education programs exist.