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T. L. Guidotti1, R. Bertera1, L. Abroms1, L. Ford2. 1George Washington University; 2(formerly) University of Alberta
ObjectivesThe Fort McMurray Demonstration Project in Social Marketing attempted to achieve mutually reinforcing effects from thematically coordinated educational and awareness efforts in the community as a whole and in the workplace and the inclusion of occupational safety within the framework of a community health promotion project.
MethodsThe project was conducted in a small, industrial city in northern Alberta and was modelled on several existing programs in Scandinavian cities. The project relied heavily on community‐based partners and participants coordinating safety promotion with workplace education and reinforcement of safe behaviours. Data on healthcare utilisation of selected preventable injuries were obtained from Alberta Health for the time period 1990 to 1996 for the Regional Health Authorities containing the communities of Fort McMurray (Northern Lights) and the city of Grande Prairie (Mistahia), a reference community.
ResultsLimited evidence suggested a possible sustained effect for fractures and a transient effect for dislocations but not other injury types. Preliminary data will also be shared on intermediate outcome measures associated with behavioural change. Process measures, by contrast, showed great impact on the community.
ConclusionThe Fort McMurray Demonstration Project in Social Marketing achieved an intensity of intervention and community participation that is unlikely to be sustainable in other communities. However, there is no evidence that the intervention changed safety‐related behaviour in the community. The community may already have achieved saturation in safety awareness or the project as implemented may have been too diffuse in presenting the safety message. The results closely replicate the experience of most similar demonstration projects initiated in the 1980s and 1990s, especially several in Scandinavia. Other methodological approaches are needed.
Key wordshealth promotion; safety; workplace
A. L. Schoenfisch1, L. A. Pompeii2, D. J. Myers1, H. J. Lipscomb1. 1Duke University Medical Center; 2University of Texas School of Public Health
ObjectivesWe report intermediate measures of program adoption at two hospitals that, as part of a stated policy shift to a “minimal‐manual lift environment”, allocated funds to provide patient lift equipment and training to staff.
MethodsQuantitative and qualitative data are from the first 2 years of an ongoing 4‐year evaluation of interventions aimed at reducing manual patient‐handling injuries among inpatient staff at a large medical centre and an affiliated community hospital. Baseline questionnaires asked about job tasks, patient‐handling injuries and work organisation. Monthly unit assessments tracked equipment use and supply availability. Focus groups with nursing staff, therapists and transporters provided insight into early program successes and challenges.
ResultsDifferences in program implementation and adoption by hospital were consistent with allocation of fewer resources for early program support at the community hospital. Compared to the medical centre, monthly total‐assist lift use during the first year was over 30% less at the community hospital; moreover, lift supplies were not consistently available. Variability by unit was seen at both hospitals. Over one‐third of questionnaire respondents reported at least one patient‐handling injury in the past 6 months; only 12% of injured respondents reported to workers' compensation. In focus groups, staff described demands of working under‐staffed shifts and with an increasingly sick and obese patient population. Lift use was often planned, requiring some level of problem solving. Some staff described moving patients with the equipment that they could not move otherwise. Time was a commonly‐mentioned but complex factor influencing use, incorporating equipment retrieval, coordination of help from others and user's efficiency. Patient acuity, space and a still‐present culture of manual lifting also influenced equipment use. Despite these interventions, challenges remain in creating a “minimal‐manual lift environment”: maintaining patients' goals during therapy, working with external caregivers and performing patient handling tasks for which currently‐available equipment is not practical. Furthermore, care‐giving by staff on restricted work duty was not facilitated by the availability of lift equipment.
ConclusionIn the fast‐paced acute care setting where competing initiatives are frequently introduced, program implementation is challenging. Intermediate measures that may predict sustained use and longer‐term measures of effectiveness are of interest.
Key wordspatient‐handling injuries; inpatient nursing units; intervention evaluation
I. J. Kant1, N. W. H. Jansen1, L. G. P. Van Amelsvoort1, R. Van Leusden2, A. Berkouwer2. 1Department of Epidemiology, Maastricht University; 2ABN AMRO Arbo Services
ObjectivesReduction of sickness absence and work disability is given high priority in The Netherlands by both employers and employees' organisations and the government. So far, treatment success and rehabilitation of employees on long‐term sick leave is rather limited. Therefore, a preventive approach aimed at screening and subsequent early treatment of employees before sickness absence actually occurs, may be more effective. The purpose of the current randomised controlled trial was to examine the efficacy of early intervention among employees at high risk for future prolonged sickness absence, in the prevention and/or reduction of sickness absence. The Balansmeter, a validated screening questionnaire, was used to reliably identify the employees at high risk for future sickness absence.
MethodsThe Balansmeter was sent out to 9863 bank employees. In total, 4668 employees (47.33%) responded. In the current prospective randomised controlled trial, employees at high risk for prolonged sickness absence, as identified by the Balansmeter, were randomised to an intervention group (n=163) or a control group (n=164). Participants in the intervention group received early treatment by their occupational physician. Early intervention could consist of various conventional treatments. The focus of the experiment was the timing of the intervention, that is, before sickness absence actually occurs, rather than the type of intervention. Participants in the control group were offered no research intervention. If the employee in the control group asked for help or in case of sickness absence, they received care as usual from the occupational health service. Sickness absence was assessed objectively through record linkage with the company registers on sickness absence over a 1‐year follow‐up period.
ResultsThe total number of sickness absence days over a 1‐year follow‐up period differed substantially and significantly (p=0.03) between the experimental (mean 17.9 days, SD 29.3) and control group (mean 27.8 days, SD 51.0), indicating a reduction of 35.6% in future sickness absence.
ConclusionEarly intervention by occupational physicians among employees at high risk for future prolonged sickness absence is successful in reducing total sickness absence.
Key wordsscreening; intervention; sickness absence
K. L. Mikkelsen, S. Spangenberg, P. Kines. National Research Centre for the Working Environment, Denmark
ObjectivesThe construction industry is one of the most injury‐prone industries worldwide, and there is a great need to supplement traditional injury prevention with new proactive safety methods. The traditional approach of measuring the effect of an intervention using injury rates as the effect outcome is not feasible in most epidemiological intervention settings due to the relatively small number of injuries. Instead, positive and proactive safety outcome measures (as opposed to injuries) are needed.
MethodsThis intervention study was designed to test the hypothesis that the extent to which safety is verbally communicated by foremen on a construction site (odds of safety communication) is reflected in the extent to which the construction workers engage in safety performances (odds of safe acts and safe conditions). The intervention involved coaching the construction site foremen to increase their verbal communications regarding safety. The odds for safety communications were hypothesised to increase the odds for safety performance. The strength of the association was expressed as the odds ratio between the odds for safety performance relative to the odds for safety communication, before and after the intervention, respectively.
ResultsThere was a strong and significant association between safety communication and safety performance. The intervention resulted in a significant increase in safety communication. The effect on safety performance was amplified above and beyond the effect anticipated by the increase in safety communication as the strength of the association between safety communications and safety performance also increased after the intervention. Thus, coaching was an effective means to improve safety communications and to increase the impact of safety communication on safety performance.
ConclusionThe two positive and proactive measures of safety, “safety communication” and “safety performance”, proved to be useful measures of the safety intervention effects. Measuring safety communication is simple and can be done without expert knowledge, whereas measuring safety performance is complex and requires expert knowledge. Measuring safety communication is suggested as a reliable proxy measure of the level of the safety performance at construction sites.
Key wordsproactive safety; safety communication; safety performance
J. H. Verbeek. Finnish Institute of Occupational Health
ObjectivesThere is a strong and valuable tradition of aetiological occupational epidemiology in the occupational health field. This has led to remarkable improvements in workers' health as demonstrated by the case of asbestos in the Western world. Even though knowledge of aetiology is paramount to preventing occupational diseases, it is not enough. In many cases, it is not immediately clear what are the most effective and efficient interventions. Therefore, we wanted to apply the methods elaborated by the Cochrane Collaboration to occupational health interventions to find out the most effective interventions.
MethodsThe Cochrane Collaboration has described the methods to find the best available evidence on the effectiveness of interventions in the Cochrane Handbook. It consists of formulating an appropriate question, formulating inclusion criteria for studies considered as evidence, extensive searching of the literature, critical appraisal of the quality of the studies found, data‐synthesis where appropriate and formulating implications for practice and research. The methods of the Cochrane Collaboration were applied to three important occupational health questions: Does advice on manual material handling prevent back pain? Does stress management intervention in health care prevent stress complaints? Do interventions prevent injuries in the construction industry?
ResultsFor manual material handling we found six RCTs and five cohort studies that could be considered the best available evidence. The results of all studies were negative in the sense that there was no statistically significant difference between the intervention and the control group. For stress management we found 19 RCTs with 1564 participants in the intervention arm and 1248 in the control arm. Two of the studies were qualified as being of high quality. We concluded that there was limited evidence that stress management decreases stress symptoms. For injuries in the construction industry we found five interrupted time series: three studied the effect of legislation and one the effect of a safety campaign and one of a drug‐free workplace program. Legislation did not show an effect while the other two interventions did.
ConclusionThe Cochrane methodology can be used in the occupational health field and shows which interventions are effective and which are not. Various study designs can be included as the best available evidence. This leads to serious implications for occupational health practice and research.
Key wordsintervention; injury; stress