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Perkison WB, Schaefer CM, Green-McKenzie J, Roy RW, Shofer FS, McCarthy RB. Outcomes for a Heat Illness Prevention Program in Outdoor Workers: A 9-Year Overview. J Occup Environ Med 2024; 66:293-297. [PMID: 38242542 DOI: 10.1097/jom.0000000000003051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To describe the outcomes effect of removing the medical surveillance component from a heat illness prevention program (HIPP) for outdoor workers from a Central Texas municipality. METHODS Heat-related illness (HRI) frequency and workers' compensation (WC) cost were assessed retrospectively in a cohort of 329 workers from 2011-2019. During 2011-2017, the HIPP included training, acclimatization, and medical surveillance. In 2018-2019, a modified (mHIPP) was implemented that included training and acclimatization, but without medical surveillance. RESULTS The HRI rate during HIPP averaged 19.5 per 1000 workers during the first 4 years, dropped to 1.01 per 1,000 workers over the next 3 years, (2015-2017), and increased during mHIPP, to 7.6 per 1,000 workers. DISCUSSION Although the case increase during the mHIPP was small, medical surveillance may be an important component in lowering workforce HRI.
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Affiliation(s)
- William B Perkison
- From the Department of Epidemiology, Human Genetics and Environmental Sciences, Southwest Center for Occupational and Environmental Health, University of Texas Health Science Center, Houston, School of Public Health, Houston, Texas (W.B.P., R.W.R.); Department of Management, Policy, and Community Health, University of Texas Health Science Center, Houston, School of Public Health, Houston, Texas (C.M.S.); Division of Occupational and Environmental Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (J.G.-M.); Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (F.S.); and Concentra, Medical Surveillance Services, Irwindale, California (R.S.M.)
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Tsourmas NF, Bernacki EJ, Hunt DL, Kalia N, Lavin RA, Yuspeh L, Leung N, Green-McKenzie J, Tao XG. Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers' Compensation System? A 10-Year Study of Workers' Compensation Claims From a Large Nationwide Workers' Compensation Insurance Carrier. J Occup Environ Med 2024; 66:280-285. [PMID: 38234200 DOI: 10.1097/jom.0000000000003044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population. OBJECTIVE To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers' compensation (WC). METHOD A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed. RESULTS The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement. CONCLUSIONS Undergoing an AM is associated with an increased risk of TKA in WC claimants.
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Affiliation(s)
- Nicholas F Tsourmas
- From the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (N.F.T., E.J.B., R.A.L., N.K., L.Y., N.L., X.T.); AF Group, Lansing, MI (D.L.H.); General Electric, Norwalk, Connecticut (N.K.); Corporate Administration Office, Strategy, Enterprise Risk, and Research, Louisiana Workers' Compensation Corporation, Baton Rouge, Louisiana (L.Y.); Texas Mutual, Workers' Compensation Insurance, Austin, Texas (N.F.T., N.L.). University of Pennsylvania, Philadelphia, Pennsylvania (J.G.-M.)
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Ezeilo CO, Green-McKenzie J. The Coronovirus-19 Pandemic and The Future of Work. J Occup Environ Med 2024:00043764-990000000-00536. [PMID: 38531821 DOI: 10.1097/jom.0000000000003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The "Future of Work" refers to workplace modifications projected to occur after pandemics, other large-scale events that affect the health and safety of broad sectors of the workforce, technological advancements, or shifts in the economy. This paper examines the influence of the COVID-19 pandemic on the Future of Work. METHODS The electronic databases PubMed, Google Scholar and Scopus were explored using search terms such as "post-pandemic", "working force" and "future of work" for papers published between 2000 to 2023. RESULTS The main characteristics of the future of work modification revealed are blurring of work-home boundaries, increase in telework and the gig economy, demand for artificial intelligence, smart-working, quiet hiring, diversity and inclusion, and algocratic governance. Needed skills include virtual collaboration capability, cross-cultural-competency, computational thinking, news media literacy, trans-disciplinarity, sense-making, and focusing on mental health and well-being. CONCLUSION Organizations are remodeling workforces to meet employee, employer, regulatory and market expectations to adapt to future workplace needs.
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Affiliation(s)
| | - Judith Green-McKenzie
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA
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Green-McKenzie J, Shofer FS, Lappin M, Cohen E, O'Connor D, Kuter BJ. Perceptions of the Availability of Personal Protective Equipment and Its Association With Burnout Among US Healthcare Personnel During the SARS-CoV-2 Pandemic, 2020-2021. J Occup Environ Med 2023; 65:e619-e625. [PMID: 37464275 DOI: 10.1097/jom.0000000000002926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The aim of the study is to explore associations among personal protective equipment (PPE) availability, workplace environment, and burnout among US healthcare personnel during the COVID-19 pandemic. METHODS The study used an online healthcare provider (HCP) survey (December 2020-February 2021) regarding PPE confidence, availability, burnout, and workplace environment. RESULTS Lack of appropriate PPE was reported by 27% of 799 US HCP surveyed. Burnout, reported by 77% of HCP, was more likely among females, those with fewer years of professional experience, and those with a higher desire to quit, and less likely for those who perceived PPE was adequate or their employer took all steps to minimize workplace risks. CONCLUSIONS This study suggests that lack of adequate PPE can lead to HCP burnout, which may result in employees quitting. A pandemic preparedness plan that includes adequate PPE is essential for HCP well-being, patient health, and employer fiscal health.
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Affiliation(s)
- Judith Green-McKenzie
- From the Division of Occupational Medicine, Department of Emergency Medicine, University of PennsylvaniaPerelman School of Medicine, Philadelphia, Pennsylvania (J.G.M., F.S.S., M.L., E.C., D.O.); Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (J.G.M.); Department of Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (F.S.S.); Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania (F.S.S.); and Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (B.J.K.)
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Green-McKenzie J, Shofer FS, Kruse G, Momplaisir F, Brennan PJ, Kuter BJ. COVID-19 vaccine uptake before and after a vaccine mandate at a major academic hospital: Trends by race/ethnicity and level of patient contact. Vaccine 2023; 41:5441-5446. [PMID: 37517911 DOI: 10.1016/j.vaccine.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To assess vaccine coverage rates before and after implementation of a COVID-19 vaccine mandate among Health care Personnel (HCP) and demographic characteristics associated with vaccine uptake Design, Setting, and Participants: Cohort study conducted among 10,889 hospital employees followed from Dec 16, 2020 - October 31, 2021, at a large academic hospital in Philadelphia. MAIN OUTCOME AND MEASURES Time to COVID-19 vaccination and vaccine series completion rates before and after implementation of a COVID-19 vaccine mandate based on age, gender, race/ethnicity, and level of patient contact/occupational group. RESULTS The vaccination series completion rate was 86.0% prior to mandate announcement, and increased to 98.7% after mandate implementation. Rates before mandate announcement were highest among Asians (96.2%), Whites (94.0%), males (89.7%), employees ≥ 65 years of age (95.2%), and employees with direct patient care (physicians, 99.0%, and nurses, 93.3%). Hospital educational initiatives (including Town Halls and discussions with Black and Hispanic employees with the lowest vaccination rates) appeared to improve uptake. The largest increase in series completion after mandate announcement occurred among Blacks, those of other/multiracial backgrounds, and Hispanics (35.6%, 22.4%, and 10.8%, respectively) as well as those with some or no direct patient contact (24.5% and 18.3%, respectively). Medical or religious exemptions were approved for 64 (<0.6%) employees and 38 (<0.4%) left their positions (8 voluntary, 30 involuntary) specifically due to the COVID-19 vaccine mandate. No clinically meaningful differences by age, gender, or race/ethnicity for those who were vaccinated under the mandate versus those who left their positions were noted. CONCLUSIONS AND RELEVANCE These results suggest that while mandates may be challenging to institutions and enforcement unpopular, they play an important role in reducing hesitancy and securing high vaccination rates among HCP, a group at high risk of COVID-19 given their employment and who can be a source of disease transmission to patients.
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Affiliation(s)
- Judith Green-McKenzie
- Professor & Chief, Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, United States; Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, United States.
| | - Frances S Shofer
- Director & Adjunct Professor of Epidemiology & Biostatistics, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, United States
| | - Gregory Kruse
- Associate Vice President of Strategic Operations, University of Pennsylvania Perelman School of Medicine, United States
| | - Florence Momplaisir
- Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, United States; Assistant Professor, University of Pennsylvania, Perelman School of Medicine, Department of Medicine, Division of Infectious Diseases, United States
| | - Patrick J Brennan
- Chief Medical Officer and Senior Vice President, University of Pennsylvania Health System, United States
| | - Barbara J Kuter
- Visiting Research Scientist, Vaccine Education Center, Children's Hospital of Philadelphia, United States
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Green-McKenzie J, Field-Flowers C, Peairs K, Barnes K, Shofer F, Kuter BJ. Best Practices for Implementation of an Employee Health COVID-19 Vaccine Clinic-A Model for Future Pandemic Preparedness. J Occup Environ Med 2023; 65:621-626. [PMID: 37043395 PMCID: PMC10417232 DOI: 10.1097/jom.0000000000002860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVES The aims of the study are to determine best practices from two large-scale, academic medical centers' employee coronavirus 2019 (COVID-19) vaccination clinics and to apply them to create scalable modules for rapid administration of 10,000 vaccinations. METHODS The weekly number of COVID-19 vaccine doses administered was captured. Processes were compared to determine best practices, which informed the scalable financial model. RESULTS Within the first 3 months, more than 60,000 COVID-19 vaccine doses were administered, and 70% of employees were fully vaccinated in 4 months with more than 95% by the vaccine mandate deadline. The estimated cost of delivering one dose was $29.95 ($299,505/10,000) compared with $35-$39 per dose when delivered by an on-site retail pharmacy. CONCLUSIONS Successful, safe, and rapid delivery of more than 60,000 COVID-19 vaccine doses in 3 months is practical and scalable. Learnings go beyond COVID-19 and can be applied to future outbreaks/pandemics.
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Lavin RA, Yuspeh L, Kalia N, Tsourmas NF, Leung N, Hunt DL, Green-McKenzie J, Bernacki EJ, Tao XG. Dose Escalations Among Workers' Compensation Claimants Using Opioid Medications-An 8 Year Postinjury Follow up Study. J Occup Environ Med 2023; 65:e558-e564. [PMID: 37231640 DOI: 10.1097/jom.0000000000002893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of the study is to determine the morphine equivalent dose in milligrams (MED)/day escalation trend after initial utilization. METHODS A total of 25,108 lost time claims filed between 1998 and 2007 were followed for 8 years from injury date. Claims were stratified by initial MED/day at 3 months after injury into four groups (0, 1 to < 15, 15 to < 30, and ≥30 MED/day). The slopes in MED/year of opioid dose escalation were determined for each initial MED/day group. RESULTS The slopes of MED/day escalation by initial MED categories were similar ( P ≥ 0.05) ranging from 5.38 to 7.76 MED annually. On average, MED/day increased in a liner pattern with a slope at 6.28 MED/year ( P < 0.01). CONCLUSIONS Opioid MED/day increased in a linear pattern, regardless of initial MED/day dose.
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Affiliation(s)
- Robert A Lavin
- From the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (R.A.L., L.Y., N.K., N.F.T., N.L., E.J.B., X.G.T.); Strategy, Enterprise Risk, and Research, Louisiana Workers' Compensation Corporation, Baton Rouge, Louisiana (L.Y.); Texas Mutual, Workers' Compensation Insurance, Austin, Texas (N.F.T., N.L.); General Electric, Norwalk, Connecticut (N.K.); Corporate Administration Office, AF Group, Lansing, Michigan (D.L.H.); and University of Pennsylvania, Perelman School of Medicine, Division of Occupational Medicine, Philadelphia, Pennsylvania (J.G.-M.)
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Kowalski-Mcgraw M, McLellan RK, Berenji M, Saito K, Green-McKenzie J, Thompson H, Hudson TW. Electronic Health Records and Occupational Data: A Call for Promoting Interoperability. J Occup Environ Med 2023; 65:e520-e526. [PMID: 37235451 DOI: 10.1097/jom.0000000000002888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Michele Kowalski-Mcgraw
- From the American College of Occupational and Environmental Medicine, Elk Grove, Illinois. This guidance paper was developed by ACOEM Work Group on Electronic Health Records and Occupational Data under the auspices of the Council on Government Affairs. It was approved by the ACOEM Board of Directors on May 8, 2023. ACOEM requires all substantive contributors to its documents to disclose any potential competing interests, which are carefully considered. ACOEM emphasizes that the judgments expressed herein represent the best available evidence at the time of publication and shall be considered the position of ACOEM and not the individual opinions of contributing authors
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Hunt DL, Bernacki EJ, Kalia N, Lavin RA, Yuspeh L, Tsourmas NF, Leung N, Green-McKenzie J, Tao XG. Marked Decreases in Time Lost From Work Among COVID-19 Claimants During the SARS-CoV-2 Pandemic: An Observational Study of Claims Filed at a Nationwide US Workers Compensation Insurance Carrier. J Occup Environ Med 2023; 65:e255-e260. [PMID: 36652455 DOI: 10.1097/jom.0000000000002800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To explore the long-term persistence of COVID-19-related impairment and the ability to work after the acute phase of the illness. METHOD The 19,101 COVID-19 workers' compensation claims filed between January 1, 2020, and December 31, 2021, with follow-up to May 31, 2022, were analyzed. RESULTS The average time lost from work decreased from 77 days in the first quarter of 2020 to 9.2 days in the fourth quarter of 2021, and the proportion of claims with 30 days or more of lost time decreased from 40.4% to 2.8 days in the same time frame. CONCLUSION COVID-19 indemnity claims filed in later quarters of the SARS-CoV-2 pandemic have much lower average time lost from work and lower proportions of workers' compensation claims with more than 30, 60, and 150 days of lost time compared with earlier quarters.
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Affiliation(s)
- Dan L Hunt
- From Corporate Administration Office, AF Group, Lansing, Michigan (D.L.H.); Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (E.J.B., N.K., R.A.L., N.F.T., N.L., J.G.-M., X.(G.)T., and L.Y.); General Electric, Norwalk, Connecticut (N.K.); Strategy, Enterprise Risk, and Research, Louisiana Workers' Compensation Corporation, Baton Rouge, Louisiana (L.Y.); and Texas Mutual, Workers' Compensation Insurance (N.L. and N.F.T.)
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Green-McKenzie J, Khan A, Redlich CA, Margarin AR, McKinney ZJ. The Future of Occupational and Environmental Medicine. J Occup Environ Med 2022; 64:e857-e863. [PMID: 35960857 DOI: 10.1097/jom.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Occupational and environmental medicine (OEM) is an ACGME-accredited preventive medicine specialty focused on work as a social determinant of health and population health. OEM providers recognize and mitigate workplace and environmental hazards, treat resultant injuries and illnesses, and promote the health, wellness and resiliency of workers and communities. Multidisciplinary residency training in clinical medicine, epidemiology, public and population health, toxicology, exposure and risk assessment, and emergency preparedness equips them with the skill set needed for leadership roles in diverse settings. These include clinical practice, academia, corporate settings, and governmental agencies. Despite robust job opportunities, a shortage of formally trained OEM physicians remains and is expected to worsen given a declining number of training programs. We examine root causes of the system-level issues impacting the supply of OEM physicians and potential solutions.
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Affiliation(s)
- Judith Green-McKenzie
- From the American College of Occupational and Environmental Medicine, ElkGrove, Illinois
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Browne SK, Feemster KA, Shen AK, Green-McKenzie J, Momplaisir FM, Faig W, Offit PA, Kuter BJ. Coronavirus disease 2019 (COVID-19) vaccine hesitancy among physicians, physician assistants, nurse practitioners, and nurses in two academic hospitals in Philadelphia. Infect Control Hosp Epidemiol 2022; 43:1424-1432. [PMID: 34538290 PMCID: PMC8503076 DOI: 10.1017/ice.2021.410] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare personnel (HCP) with significant clinical exposure to COVID-19 at 2 large, academic hospitals in Philadelphia, Pennsylvania. DESIGN, SETTING, AND PARTICIPANTS HCP were surveyed in November-December 2020 about their intention to receive the COVID-19 vaccine. METHODS The survey measured the intent among HCP to receive a COVID-19 vaccine, timing of vaccination, and reasons for or against vaccination. Among patient-facing HCP, multivariate regression evaluated the associations between healthcare positions (medical doctor, nurse practitioner or physician assistant, and registered nurse) and vaccine hesitancy (intending to decline, delay, or were unsure about vaccination), adjusting for demographic characteristics, reasons why or why not to receive the vaccine, and prior receipt of routine vaccines. RESULTS Among 5,929 HCP (2,253 medical doctors [MDs] and doctors of osteopathy [DOs], 582 nurse practitioners [NPs], 158 physician assistants [PAs], and 2,936 nurses), a higher proportion of nurses (47.3%) were COVID-vaccine hesitant compared with 30.0% of PAs and NPs and 13.1% of MDs and DOs. The most common reasons for vaccine hesitancy included concerns about side effects, the newness of the vaccines, and lack of vaccine knowledge. Regardless of position, Black HCP were more hesitant than White HCP (odds ratio [OR], ∼5) and females were more hesitant than males (OR, ∼2). CONCLUSIONS Although most clinical HCP intended to receive a COVID-19 vaccine, intention varied by healthcare position. Consistent with other studies, hesitancy was also significantly associated with race or ethnicity across all positions. These results highlight the importance of understanding and effectively addressing reasons for hesitancy, especially among frontline HCP who are at increased risk of COVID exposure and play a critical role in recommending vaccines to patients.
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Affiliation(s)
- Safa K. Browne
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen A. Feemster
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela K. Shen
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith Green-McKenzie
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Occupational and Environmental Medicine, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Florence M. Momplaisir
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Walter Faig
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Paul A. Offit
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barbara J. Kuter
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Green-McKenzie J, Shofer FS, Matthei J, Biester R, Deibler M. Clinical and Psychological Factors Associated With Return to Work Among United States Diplomats Who Sustained a Work-Related Injury While on Assignment in Havana, Cuba. J Occup Environ Med 2022; 64:212-217. [PMID: 34873135 PMCID: PMC8887843 DOI: 10.1097/jom.0000000000002450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine factors associated with return to work in US diplomats injured during a work assignment in Cuba. METHODS In this case series work ability was determined at each visit. Questionnaires used included the Symptom Score Questionnaire, Beck Anxiety Inventory, Beck Depression Inventory, Quality-of-Life Inventory, and Patient Health Questionnaire. RESULTS Of the 45 employees referred to Occupational Medicine, the mean age was 42.5 years, 60% were men, 68% were never out of work, 22% were out of work for some period, and 15% remain out of work. Vestibular, cognitive, hearing, sleep, and visual symptoms, and a higher initial symptom score were significantly associated with work inability while psychiatric symptoms were not. CONCLUSIONS This exposure resulted in prolonged illness with cognitive impairment and other clinical manifestations associated with work inability.
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Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine; Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Dr Green-McKenzie); Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine (Dr Shofer); SHARP Rees-Stealy Medical Group, San Diego, California (Dr Matthei);University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Dr Matthei); Department of Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Dr Biester); Rehabilitation Medicine Service, Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania (Dr Biester); The Center or Emotional Health of Greater Philadelphia, Philadelphia, Pennsylvania (Dr Deibler)
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Vanichkachorn G, Green-McKenzie J, Emmett E. Occupational Health Care. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mansfield B, Shofer FS, Green-McKenzie J. The Effect of Introduction of Motorized Stretchers on Hospital-Based Patient Transporter Injuries and Resultant Workers' Compensation Costs. J Occup Environ Med 2021; 63:1078-1080. [PMID: 34860204 DOI: 10.1097/jom.0000000000002319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Manual stretchers cause more injuries than hydraulic stretchers in workers who transport patients. OBJECTIVE To evaluate the impact of introducing motorized stretchers on transporter injuries and resultant workers' compensation costs. METHODS The number of transporters who sustained injuries related to stretcher manipulation, and associated workers' compensation costs, before and after the introduction of motorized stretchers, was determined. The Wilcoxon Rank Sum test was used to examine costs and lost and restricted workdays. RESULTS The number of injuries and restricted work days decreased after motorized stretchers were introduced. Transporters incurred less lost work days (median 24.5 vs 7 days, P = 0.050). CONCLUSIONS Motorized stretchers were associated with decreased injuries and lost work days.
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Affiliation(s)
- Blythe Mansfield
- Occupational Medicine at Kelsey-Seybold Clinic, Texas (Dr Mansfield); University of Pennsylvania Perelman School of Medicine, Philadelphia (Dr Mansfield); Epidemiology & Biostatistics, Department of Emergency Medicine at the University of Pennsylvania Perelman School of Medicine, Philadelphia (Dr Shofer); Division of Occupational Medicine and Residency Program, The University of Pennsylvania Perelman School of Medicine, Philadelphia (Dr Green-McKenzie)
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Green-McKenzie J, Shofer FS, Momplaisir F, Kuter BJ, Kruse G, Bialal U, Behta M, O’Donnell J, Al-Ramahi N, Kasbekar N, Sullivan P, Okala P, Brennan PJ. Factors Associated With COVID-19 Vaccine Receipt by Health Care Personnel at a Major Academic Hospital During the First Months of Vaccine Availability. JAMA Netw Open 2021; 4:e2136582. [PMID: 34851399 PMCID: PMC8637254 DOI: 10.1001/jamanetworkopen.2021.36582] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Importance Several COVID-19 vaccines have been authorized in the US, yet preliminary evidence suggests high levels of vaccine hesitancy and wide racial, ethnic, and socioeconomic disparities in uptake. Objective To assess COVID-19 vaccine acceptance among health care personnel (HCP) during the first 4 months of availability in a large academic hospital, compare acceptance with previously measured vaccine hesitancy, and describe racial, ethnic, and socioeconomic disparities in vaccine uptake. Design, Setting, and Participants This cross-sectional study included 12 610 HCP who were offered COVID-19 vaccination at a major academic hospital in Philadelphia between December 16, 2020, and April 16, 2021. Exposures For each HCP, data were collected on occupational category, age, sex, race and ethnicity (Asian or Pacific Islander, Black or African American [Black], Hispanic, White, and multiracial), and social vulnerability index (SVI) at the zip code of residence. Main Outcomes and Measures Vaccine uptake by HCP at the employee vaccination clinic. Results The study population included 4173 men (34.8%) and 7814 women (65.2%) (623 without data). A total of 1480 were Asian or Pacific Islander (12.4%); 2563 (21.6%), Black; 452 (3.8%), Hispanic; 7086 (59.6%), White; and 192 (1.6%), multiracial; 717 had no data for race and ethnicity. The mean (SD) age was 40.9 (12.4) years, and 9573 (76.0%) received at least 1 vaccine dose during the first 4 months of vaccine availability. Adjusted for age, sex, job position, and SVI, Black (relative risk [RR], 0.69; 95% CI, 0.66-0.72) and multiracial (RR, 0.80; 95% CI, 0.73-0.89) HCP were less likely to receive vaccine compared with White HCP. When stratified by job position, Black nurses (n = 189; 62.8%), Black HCP with some patient contact (n = 466; 49.9%), and Black HCP with no patient contact (n = 636; 56.3%) all had lower vaccine uptake compared with their White and Asian or Pacific Islander counterparts. Similarly, multiracial HCP with some (n = 26; 52.0%) or no (n = 48; 58.5%) patient contact had lower vaccine uptake. In contrast, Black physicians were just as likely to receive the vaccine as physicians of other racial and ethnic groups. Conclusions and Relevance In this cross-sectional study, more than two-thirds of HCP at a large academic hospital in Philadelphia received a COVID-19 vaccine within 4 months of vaccine availability. Although racial, ethnic, and socioeconomic disparities were seen in vaccine uptake, no such disparities were found among physicians. Better understanding of factors driving these disparities may help improve uptake.
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Affiliation(s)
- Judith Green-McKenzie
- Leonard Davis Institute, Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Frances S. Shofer
- Epidemiology and Biostatistics Research, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Florence Momplaisir
- Leonard Davis Institute, Department of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Barbara J. Kuter
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gregory Kruse
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Usama Bialal
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Maryam Behta
- University of Pennsylvania Health System, Philadelphia
| | - Judith O’Donnell
- Infection Control, Penn Presbyterian Medical Center, Division of Infectious Diseases, Clinical Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Nida Al-Ramahi
- Office of the Chief Medical Officer and Chief Quality Officer, University of Pennsylvania Health System, Philadelphia
| | | | | | - Philip Okala
- University of Pennsylvania Health System, Philadelphia
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Tustin A, Sayeed Y, Berenji M, Fagan K, McCarthy RB, Green-McKenzie J, McNicholas J, Onigbogi CB, Perkison WB, Butler JW. Prevention of Occupational Heat-Related Illnesses. J Occup Environ Med 2021; 63:e737-e744. [PMID: 34597285 DOI: 10.1097/jom.0000000000002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs.
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Affiliation(s)
- Aaron Tustin
- American College of Occupational and Environmental Medicine, Elk Grove, Illinois
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Momplaisir FM, Kuter BJ, Ghadimi F, Browne S, Nkwihoreze H, Feemster KA, Frank I, Faig W, Shen AK, Offit PA, Green-McKenzie J. Racial/Ethnic Differences in COVID-19 Vaccine Hesitancy Among Health Care Workers in 2 Large Academic Hospitals. JAMA Netw Open 2021; 4:e2121931. [PMID: 34459907 PMCID: PMC8406078 DOI: 10.1001/jamanetworkopen.2021.21931] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/15/2021] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Significant differences in hesitancy to receive COVID-19 vaccination by race/ethnicity have been observed in several settings. Racial/ethnic differences in COVID-19 vaccine hesitancy among health care workers (HCWs), who face occupational and community exposure to COVID-19, have not been well described. OBJECTIVE To assess hesitancy to COVID-19 vaccination among HCWs across different racial/ethnic groups and assess factors associated with vaccine hesitancy. DESIGN, SETTING, AND PARTICIPANTS This survey study was conducted among HCWs from 2 large academic hospitals (ie, a children's hospital and an adult hospital) over a 3-week period in November and December 2020. Eligible participants were HCWs with and without direct patient contact. A 3-step hierarchical multivariable logistic regression was used to evaluate associations between race/ethnicity and vaccine hesitancy controlling for demographic characteristics, employment characteristics, COVID-19 exposure risk, and being up to date with routine vaccinations. Data were analyzed from February through March 2021. MAIN OUTCOMES AND MEASURES Vaccine hesitancy, defined as not planning on, being unsure about, or planning to delay vaccination, served as the outcome. RESULTS Among 34 865 HCWs eligible for this study, 12 034 individuals (34.5%) completed the survey and 10 871 individuals (32.2%) completed the survey and reported their race/ethnicity. Among 10 866 of these HCWs with data on sex, 8362 individuals (76.9%) were women, and among 10 833 HCWs with age data, 5923 individuals (54.5%) were younger than age 40 years. (Percentages for demographic and clinical characteristics are among the number of respondents for each type of question.) There were 8388 White individuals (77.2%), 882 Black individuals (8.1%), 845 Asian individuals (7.8%), and 449 individuals with other or mixed race/ethnicity (4.1%), and there were 307 Hispanic or Latino individuals (2.8%). Vaccine hesitancy was highest among Black HCWs (732 individuals [83.0%]) and Hispanic or Latino HCWs (195 individuals [63.5%]) (P < .001). Among 5440 HCWs with vaccine hesitancy, reasons given for hesitancy included concerns about side effects (4737 individuals [87.1%]), newness of the vaccine (4306 individuals [79.2%]), and lack of vaccine knowledge (4091 individuals [75.2%]). The adjusted odds ratio (aOR) for vaccine hesitancy was 4.98 (95% CI, 4.11-6.03) among Black HCWs, 2.10 (95% CI, 1.63-2.70) among Hispanic or Latino HCWs, 1.48 (95% CI, 1.21-1.82) among HCWs with other or mixed race/ethnicity, and 1.47 (95% CI, 1.26-1.71) among Asian HCWs compared with White HCWs (P < .001). The aOR was decreased among Black HCWs when adjusting for employment characteristics and COVID-19 exposure risk (aOR, 4.87; 95% CI, 3.96-6.00; P < .001) and being up to date with prior vaccines (aOR, 4.48; 95% CI, 3.62-5.53; P < .001) but not among HCWs with other racial/ethnic backgrounds. CONCLUSIONS AND RELEVANCE This study found that vaccine hesitancy before the authorization of the COVID-19 vaccine was increased among Black, Hispanic or Latino, and Asian HCWs compared with White HCWs. These findings suggest that interventions focused on addressing vaccine hesitancy among HCWs are needed.
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Affiliation(s)
- Florence M. Momplaisir
- Division of Infectious Diseases, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Barbara J. Kuter
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Fatemeh Ghadimi
- Division of Infectious Diseases, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Safa Browne
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hervette Nkwihoreze
- Division of Infectious Diseases, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kristen A. Feemster
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ian Frank
- Division of Infectious Diseases, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Walter Faig
- Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Angela K. Shen
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Paul A. Offit
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Judith Green-McKenzie
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of Occupational and Environmental Medicine, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Abstract
Competency is defined as possession of sufficient physical, intellectual, and behavioral qualifications to perform a task or serve in a role which adequately accomplishes a desired outcome. Recognizing the need for defining competencies essential to occupational and environmental medicine (OEM) physicians, the American College of Occupational and Environmental Medicine developed its first set of OEM Competencies in 1998. Later updated in 2008, and again in 2014, the increasing globalization and modernization of the workplace, along with published research on OEM practice, required an update to ensure OEM physicians stay current with the field and practice of OEM. Delineation of core competencies for the profession provides employers, government agencies, health care organizations, and other health practitioners a solid context of the role and expertise of OEM physicians.
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Affiliation(s)
- Natalie P Hartenbaum
- From the American College of Occupational and Environmental Medicine, Elk Grove, Illinois
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Mahraj K, Chaiyachati KH, Asch DA, Fala G, Do D, Lam D, Miller A, Mannion N, Stoloff V, Halbritter A, Huffenberger AM, Shuttleworth J, O’Donnell JA, Green-McKenzie J, Patel K, Rosin R, Kruse G, Brennan P, Volpp KG. Developing a Large-Scale Covid-19 Surveillance System to Reopen Campuses. NEJM Catalyst 2021. [PMCID: PMC8208605 DOI: 10.1056/cat.21.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To open campuses safely, the University of Pennsylvania (Penn) and its health system (UPHS), with six hospitals and hundreds of outpatient practices, needed to develop an early warning system to identify the infected and exposed among Penn and UPHS campus members — 70,000 faculty, staff, and students who were at risk of transmitting severe acute respiratory syndrome coronavirus 2, or Covid-19. This warning system would help to minimize future spread by preventing individuals with concerning symptoms or recent exposures from coming into contact with others and, when necessary, streamline access to testing, self-isolation guidance, contact tracing, and medical care. The authors describe the challenges in designing, implementing, and continuously improving PennOpen Pass and the Red Pass Management System, a part-digital, part-human screening system. The lessons learned while developing and implementing PennOpen Pass provide key insights for the future of innovations in health care as we move toward improving the health of communities long after the pandemic.
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Affiliation(s)
- Katy Mahraj
- Director of Operations for the Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Krisda H. Chaiyachati
- Medical Director for PennOpen Pass, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - David A. Asch
- Executive Director for the Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Glenn Fala
- Associate Chief Information Officer, Software Development, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - David Do
- Assistant Professor of Clinical Neurology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Doreen Lam
- Medical Student, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amy Miller
- Information Technology Director, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy Mannion
- Interim Nurse Manager for PennLINKS at the Center for Connected Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Vanessa Stoloff
- Medical Director at University of Pennsylvania Student Health Service, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashlee Halbritter
- Director of Campus Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Marie Huffenberger
- Director of Operations for the Center for Connected Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Julie Shuttleworth
- University Operations Lead for PennOpen Pass, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Judith A. O’Donnell
- Professor of Clinical Medicine and Director of Infection Prevention and Control at Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Judith Green-McKenzie
- Professor of Medicine and Division of Occupational & Environmental Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Kash Patel
- Vice President and Chief Technology Officer, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Roy Rosin
- Chief Innovation Officer, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Greg Kruse
- Associate Vice President of Strategic Operations, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - P.J. Brennan
- Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Kevin G. Volpp
- Professor of Medicine and Director for the Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kuter BJ, Browne S, Momplaisir FM, Feemster KA, Shen AK, Green-McKenzie J, Faig W, Offit PA. Perspectives on the receipt of a COVID-19 vaccine: A survey of employees in two large hospitals in Philadelphia. Vaccine 2021; 39:1693-1700. [PMID: 33632563 PMCID: PMC7885691 DOI: 10.1016/j.vaccine.2021.02.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
Background Health care personnel have been identified by the ACIP as a priority group for COVID-19 vaccination. We conducted a survey in November-December 2020 at two large, academic hospitals in Philadelphia to evaluate the intention of hospital employees to be vaccinated. Methods The survey was sent electronically to all employees (clinical and nonclinical staff) at a children’s hospital and an adult hospital. The survey was voluntary and confidential. Questions focused on plans to receive a COVID-19 vaccine when available, reasons why employees would/would not get vaccinated, when employees planned to be vaccinated, vaccine safety and efficacy features that would be acceptable, and past history of receipt of other vaccines by the employee and family. Responses were analyzed using univariate and multiple logistic regression methods. Results A total of 12,034 hospital employees completed the survey (a 34.5% response rate). Overall, 63.7% of employees reported that they planned to receive a COVID-19 vaccine, 26.3% were unsure, and 10.0% did not plan to be vaccinated. Over 80% of those unsure or unwilling to be vaccinated expressed concerns about vaccine side effects and the vaccines’ newness. In multivariable logistic regression, persons planning to take a COVID-19 vaccine were more likely to be older, male, more educated, Asian or White, up-to-date on vaccinations, without direct patient contact, and tested for COVID-19 in the past. No significant difference in intention to be vaccinated was found between those with higher versus lower levels of exposure to COVID-19 patients or the number of previous exposures to patients with COVID-19. Conclusions While the majority of hospital employees are planning to receive a COVID-19 vaccine, many are unsure or not planning to do so. Further education of hospital employees about the safety, efficacy, and value of the currently available COVID-19 vaccines is critical to vaccine acceptance in this population.
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Affiliation(s)
- Barbara J Kuter
- Vaccine Education Center, Children's Hospital of Philadelphia, United States.
| | - Safa Browne
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
| | | | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
| | - Angela K Shen
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
| | | | - Walter Faig
- Children's Hospital of Philadelphia, United States
| | - Paul A Offit
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
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Kowalski-McGraw M, Green-McKenzie J, Pandalai SP, Schulte PA. Characterizing the Interrelationships of Prescription Opioid and Benzodiazepine Drugs With Worker Health and Workplace Hazards. J Occup Environ Med 2018; 59:1114-1126. [PMID: 28930799 DOI: 10.1097/jom.0000000000001154] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Prescription opioid and benzodiazepine drug use, which has risen significantly, can affect worker health. Exploration of the scientific literature assessed (1) interrelationships of such drug use, occupational risk factors, and illness and injury, and (2) occupational and personal risk factor combinations that can affect their use. METHODS The scientific literature from 2000 to 2015 was searched to determine any interrelationships. RESULTS Evidence for eight conceptual models emerged based on the search yield of 133 articles. These models summarize interrelationships among prescription opioid and benzodiazepine use with occupational injury and illness. Factors associated with the use of these drugs included fatigue, impaired cognition, falls, motor vehicle crashes, and the use of multiple providers. CONCLUSION Prescription opioid and benzodiazepine drugs may be both a personal risk factor for work-related injury and a consequence of workplace exposures.
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Affiliation(s)
- Michele Kowalski-McGraw
- The Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Drs Kowalski-McGraw, Green-McKenzie); Geisinger Health, Wilkes Barre, Pennsylvania (Dr Kowalski-McGraw); and The Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio (Drs Pandalai, Schulte)
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Swanson RL, Hampton S, Green-McKenzie J, Diaz-Arrastia R, Grady MS, Verma R, Biester R, Duda D, Wolf RL, Smith DH. Neurological Manifestations Among US Government Personnel Reporting Directional Audible and Sensory Phenomena in Havana, Cuba. JAMA 2018; 319:1125-1133. [PMID: 29450484 PMCID: PMC5885885 DOI: 10.1001/jama.2018.1742] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE From late 2016 through August 2017, US government personnel serving on diplomatic assignment in Havana, Cuba, reported neurological symptoms associated with exposure to auditory and sensory phenomena. OBJECTIVE To describe the neurological manifestations that followed exposure to an unknown energy source associated with auditory and sensory phenomena. DESIGN, SETTING, AND PARTICIPANTS Preliminary results from a retrospective case series of US government personnel in Havana, Cuba. Following reported exposure to auditory and sensory phenomena in their homes or hotel rooms, the individuals reported a similar constellation of neurological symptoms resembling brain injury. These individuals were referred to an academic brain injury center for multidisciplinary evaluation and treatment. EXPOSURES Report of experiencing audible and sensory phenomena emanating from a distinct direction (directional phenomena) associated with an undetermined source, while serving on US government assignments in Havana, Cuba, since 2016. MAIN OUTCOMES AND MEASURES Descriptions of the exposures and symptoms were obtained from medical record review of multidisciplinary clinical interviews and examinations. Additional objective assessments included clinical tests of vestibular (dynamic and static balance, vestibulo-ocular reflex testing, caloric testing), oculomotor (measurement of convergence, saccadic, and smooth pursuit eye movements), cognitive (comprehensive neuropsychological battery), and audiometric (pure tone and speech audiometry) functioning. Neuroimaging was also obtained. RESULTS Of 24 individuals with suspected exposure identified by the US Department of State, 21 completed multidisciplinary evaluation an average of 203 days after exposure. Persistent symptoms (>3 months after exposure) were reported by these individuals including cognitive (n = 17, 81%), balance (n = 15, 71%), visual (n = 18, 86%), and auditory (n = 15, 68%) dysfunction, sleep impairment (n = 18, 86%), and headaches (n = 16, 76%). Objective findings included cognitive (n = 16, 76%), vestibular (n = 17, 81%), and oculomotor (n = 15, 71%) abnormalities. Moderate to severe sensorineural hearing loss was identified in 3 individuals. Pharmacologic intervention was required for persistent sleep dysfunction (n = 15, 71%) and headache (n = 12, 57%). Fourteen individuals (67%) were held from work at the time of multidisciplinary evaluation. Of those, 7 began graduated return to work with restrictions in place, home exercise programs, and higher-level work-focused cognitive rehabilitation. CONCLUSIONS AND RELEVANCE In this preliminary report of a retrospective case series, persistent cognitive, vestibular, and oculomotor dysfunction, as well as sleep impairment and headaches, were observed among US government personnel in Havana, Cuba, associated with reports of directional audible and/or sensory phenomena of unclear origin. These individuals appeared to have sustained injury to widespread brain networks without an associated history of head trauma.
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Affiliation(s)
- Randel L. Swanson
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
| | - Stephen Hampton
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
| | - Judith Green-McKenzie
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Division of Occupational and Environmental Medicine, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ramon Diaz-Arrastia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - M. Sean Grady
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Ragini Verma
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Rosette Biester
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
| | - Diana Duda
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Penn Therapy & Fitness, Good Shepherd Penn Partners, University of Pennsylvania, Philadelphia
| | - Ronald L. Wolf
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Douglas H. Smith
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia
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Green-McKenzie J. Characteristics and Outcomes of an Innovative Train-in-Place Residency Program. J Grad Med Educ 2017; 9:634-639. [PMID: 29075386 PMCID: PMC5646924 DOI: 10.4300/jgme-d-16-00689.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/16/2017] [Accepted: 06/08/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine. OBJECTIVE We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine. METHODS Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field. RESULTS Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field. CONCLUSIONS Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.
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Goncalves MD, Green-McKenzie J, Alavi A, Torigian DA. Regional Variation in Skeletal Muscle and Adipose Tissue FDG Uptake Using PET/CT and Their Relation to BMI. Acad Radiol 2017; 24:1288-1294. [PMID: 28551398 DOI: 10.1016/j.acra.2017.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES Skeletal muscle metabolism is a primary contributor to whole-body energy expenditure. Currently, methods to measure changes in skeletal muscle metabolism in vivo are limited. Our objectives were to characterize the regional variation in skeletal muscle and adipose tissue (AT) FDG uptake as a surrogate for glycolytic metabolism using 18F-2-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in healthy men and to correlate these findings to body mass index (BMI). MATERIALS AND METHODS Eighteen healthy men were enrolled and underwent FDG-PET/CT. The mean standardized uptake value of 14 skeletal muscles and two AT regions was measured and linear regression analysis was performed to identify metabolic predictors of BMI. RESULTS FDG-PET/CT reliably detected changes in skeletal muscle and AT depot metabolic activity based on location. The most metabolically active muscles were those used for posture and breathing, which have the highest percentage of reported type I muscle myofiber content. Visceral AT tended to have a higher FDG uptake than subcutaneous AT. The mean standardized uptake value of VAT, pectoralis major, and gluteus maximus muscles accounted for 64% of the variance in BMI. CONCLUSIONS FDG-PET/CT can be used to quantify the regional variation in glucose metabolism of multiple skeletal muscle groups and AT depots.
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Affiliation(s)
- Marcus D Goncalves
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - Judith Green-McKenzie
- Department of Emergency Medicine, Division of Occupational Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - Drew A Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
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Torigian DA, Green-McKenzie J, Liu X, Shofer FS, Werner T, Smith CE, Strasser AA, Moghbel MC, Parekh AH, Choi G, Goncalves MD, Spaccarelli N, Gholami S, Kumar PS, Tong Y, Udupa JK, Mesaros C, Alavi A. A Study of the Feasibility of FDG-PET/CT to Systematically Detect and Quantify Differential Metabolic Effects of Chronic Tobacco Use in Organs of the Whole Body-A Prospective Pilot Study. Acad Radiol 2017; 24:930-940. [PMID: 27769824 DOI: 10.1016/j.acra.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/10/2016] [Accepted: 09/19/2016] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to assess the feasibility of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) to systematically detect and quantify differential effects of chronic tobacco use in organs of the whole body. MATERIALS AND METHODS Twenty healthy male subjects (10 nonsmokers and 10 chronic heavy smokers) were enrolled. Subjects underwent whole-body FDG-PET/CT, diagnostic unenhanced chest CT, mini-mental state examination, urine testing for oxidative stress, and serum testing. The organs of interest (thyroid, skin, skeletal muscle, aorta, heart, lung, adipose tissue, liver, spleen, brain, lumbar spinal bone marrow, and testis) were analyzed on FDG-PET/CT images to determine their metabolic activities using standardized uptake value (SUV) or metabolic volumetric product (MVP). Measurements were compared between subject groups using two-sample t tests or Wilcoxon rank-sum tests as determined by tests for normality. Correlational analyses were also performed. RESULTS FDG-PET/CT revealed significantly decreased metabolic activity of lumbar spinal bone marrow (MVPmean: 29.8 ± 9.7 cc vs 40.8 ± 11.6 cc, P = 0.03) and liver (SUVmean: 1.8 ± 0.2 vs 2.0 ± 0.2, P = 0.049) and increased metabolic activity of visceral adipose tissue (SUVmean: 0.35 ± 0.10 vs 0.26 ± 0.06, P = 0.02) in chronic smokers compared to nonsmokers. Normalized visceral adipose tissue volume was also significantly decreased (P = 0.04) in chronic smokers. There were no statistically significant differences in the metabolic activity of other assessed organs. CONCLUSIONS Subclinical organ effects of chronic tobacco use are detectable and quantifiable on FDG-PET/CT. FDG-PET/CT may, therefore, play a major role in the study of systemic toxic effects of tobacco use in organs of the whole body for clinical or research purposes.
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Abstract
Use of traditional folkloric remedies not disclosed to the physician may be difficult to identify as a source of lead toxicity. This report illustrates the presentation of a 26-year-old man who, during his 1 month vacation in India, was treated for low back pain with Ayurvedic herbal medicine. On his return to the USA, he presented to the emergency department with epigastric pain, weight loss, dark stools, nausea and vomiting. He was admitted and noted to be anaemic with a blood lead level (BLL) of 94.8 µg/dL. Peripheral blood smear demonstrated basophilic stippling. Chelation therapy with succimer was initiated. The patient became asymptomatic within months. Three years later, he remained asymptomatic with BLL <20 µg/dL. Physicians should be cognisant of potential toxicity from these Ayurvedic medications and have a heightened level of suspicion for lead toxicity in the face of anaemia and abdominal pain without obvious cause.
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Affiliation(s)
- Amelia Breyre
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Green-McKenzie J, McCarthy RB, Shofer FS. Characterisation of occupational blood and body fluid exposures beyond the Needlestick Safety and Prevention Act. J Infect Prev 2016; 17:226-232. [PMID: 28989483 DOI: 10.1177/1757177416645339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/27/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the use of mandated safety engineered sharps devices (SESDs) and personal protective equipment in healthcare workers (HCWs) with occupational body fluid exposures (BFE) since the Needlestick Safety and Prevention Act. METHODS Two questionnaires were administered, over 3 years, to HCWs who reported sharps or splash BFEs. Descriptive statistics and chi-square analysis were used. RESULTS Of the 498 questionnaires completed, nurses completed 262 (53%), house staff 155 (32 %), technicians 63 (13%) and phlebotomists 11 (2%). Four (1%) completers reported 'other' and three (1%) reported unknown. Sharps injuries accounted for 349 (70%) of the BFEs. SESDs were utilised 43% (128/299) of the time with a 54% (70/130) activation rate. Phlebotomists (80%; 8/10) and nurses (59%; 79/267) used SESDs more than doctors (27%; 31/86) and technicians (26%; 10/39) (P <0.0001). Fifty-four percent (185/207) of HCWs reported having had training on SESD use; nurses (64%; 98/154) and phlebotomists (70%; 7/8) significantly more so than house staff (44%; 59/133) and technicians (44%; 21/48) (P <0.05). Most splash BFEs were to the eyes 73% (91/149). Five percent (4/79) of HCWs used protective eyewear. CONCLUSIONS Systematic regular training, appropriate protocols and iteratively providing the safest SESDs based on HCW experience and technological advances will further reduce the physical and emotional toll of BFEs.
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Affiliation(s)
- Judith Green-McKenzie
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Frances S Shofer
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Saberi P, Propert KJ, Powers M, Emmett E, Green-McKenzie J. Field survey of health perception and complaints of Pennsylvania residents in the Marcellus Shale region. Int J Environ Res Public Health 2015; 11:6517-27. [PMID: 25003172 PMCID: PMC4078593 DOI: 10.3390/ijerph110606517] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pennsylvania Marcellus Shale region residents have reported medical symptoms they believe are related to nearby Unconventional Natural Gas Development (UNGD). Associations between medical symptoms and UNGD have been minimally explored. The objective of this descriptive study is to explore whether shale region Pennsylvania residents perceive UNGD as a health concern and whether they attribute health symptoms to UNGD exposures. A questionnaire was administered to adult volunteers with medical complaints in a primary-care medical office in a county where UNGD was present. Participants were asked whether they were concerned about health effects from UNGD, and whether they attributed current symptoms to UNGD or to some other environmental exposure. There were 72 respondents; 22% perceived UNGD as a health concern and 13% attributed medical symptoms to UNGD exposures. Overall, 42% attributed one or more of their medical symptoms to environmental causes, of which UNGD was the most frequent. A medical record review conducted on six participants who attributed their medical symptoms to UNGD revealed that only one of these records documented both the symptoms in question and the attribution to UNGD. The results of this pilot study suggest that there is substantial concern about adverse health effects of UNGD among Pennsylvania Marcellus Shale residents, and that these concerns may not be adequately represented in medical records. Further efforts to determine the relationship between UNGD and health are recommended in order to address community concerns.
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Affiliation(s)
- Pouné Saberi
- Department of Emergency Medicine, Division of Occupational and Environmental Medicine, Center of Excellence in Environmental Toxicology, University of Pennsylvania Health Systems, One Convention Ave, 4 Penn Tower, Philadelphia, PA 19104, USA; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-267-978-3934
| | - Kathleen Joy Propert
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA; E-Mail:
| | - Martha Powers
- Department of Earth and Environmental Science, University of Pennsylvania, Philadelphia, PA, 19104, USA; E-Mail:
| | - Edward Emmett
- Department of Emergency Medicine, Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; E-Mail:
| | - Judith Green-McKenzie
- Department of Emergency Medicine, Division of Occupational and Environmental Medicine, Center of Excellence in Environmental Toxicology, University of Pennsylvania Health Systems, One Convention Ave, 4 Penn Tower, Philadelphia, PA 19104, USA; E-Mail:
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Green-McKenzie J, Shofer FS. Duration of Time on Shift Before Accidental Blood or Body Fluid Exposure for Housestaff, Nurses, and Technicians. Infect Control Hosp Epidemiol 2015; 28:5-9. [PMID: 17230381 DOI: 10.1086/510568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 04/14/2006] [Indexed: 11/04/2022]
Abstract
Background.Shift work has been found to be associated with an increased rate of errors and accidents among healthcare workers (HCWs), but the effect of shift work on accidental blood and body fluid exposure sustained by HCWs has not been well characterized.Objectives.To determine the duration of time on shift before accidental blood and body fluid exposure in housestaff, nurses, and technicians and the proportion of housestaff who sustain a blood and body fluid exposure after 12 hours on duty.Methods.This retrospective, descriptive study was conducted during a 24-month period at a large urban teaching hospital. Participants were HCWs who sustained an accidental blood and body fluid exposure.Results.Housestaff were on duty significantly longer than both nursing staff (P = .02) and technicians (P < .0001) before accidental blood and body fluid exposure. Half of the blood and body fluid exposures sustained by housestaff occurred after being on duty 8 hours or more, and 24% were sustained after being on duty 12 hours or more. Of all HCWs, 3% reported an accidental blood and body fluid exposure, with specific rates of 7.9% among nurses, 9.4% among housestaff, and 3% among phlebotomists.Conclusions.Housestaff were significantly more likely to have longer duration of time on shift before blood and body fluid exposure than were the other groups. Almost one-quarter of accidental blood and body fluid exposures to housestaff were incurred after they had been on duty for 12 hours or more. Housestaff sustained a higher rate of accidental blood and body fluid exposures than did nursing staff and technicians.
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Green-McKenzie J, Watkins M, Shofer FS. Outcomes of a consultation service to emergency medicine clinicians for postexposure management of occupational bloodborne pathogen exposures. Am J Infect Control 2012; 40:774-5. [PMID: 22317859 DOI: 10.1016/j.ajic.2011.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 09/27/2011] [Accepted: 09/27/2011] [Indexed: 11/24/2022]
Abstract
Potential bloodborne pathogen exposures, many of which occur after hours and are evaluated by emergency medicine physicians, are an important occupational hazard. Emergency medicine physicians might not be as conversant with the latest US Public Health Service guidelines as occupational medicine physicians. This research presents an efficient model in which a single expert occupational medicine physician provides guidance to many emergency medicine clinicians. Outcomes evaluation indicates that the service was widely utilized and highly rated.
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Green-McKenzie J, Pak VM, Crawford GH. Thiuram allergy--a potential dermal allergy among health care workers. AAOHN J 2009; 57:139-141. [PMID: 19438079 DOI: 10.3928/08910162-20090401-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Occupational health nurses should be cognizant of the myriad exposures that can result in dermal reactions among health care workers.
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Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Medical Center, USA
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Azar-Cavanagh M, Burdt P, Green-McKenzie J. Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers. Infect Control Hosp Epidemiol 2007; 28:165-70. [PMID: 17265397 DOI: 10.1086/511699] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 07/11/2005] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the effect of introducing an engineered device for preventing injuries from sharp instruments (engineered sharps injury prevention device [ESIPD]) on the percutaneous injury rate in healthcare workers (HCWs). METHODS We undertook a controlled, interventional, before-after study during a period of 3 years (from January 1998 through December 2000) at a major medical center. The study population was HCWs with potential exposure to bloodborne pathogens. HCWs who sustain a needlestick injury are required by hospital policy to report the exposure. A confidential log of these injuries is maintained that includes information on the date and time of the incident, the type and brand of sharp device involved, and whether an ESIPD was used. INTERVENTION Introduction of an intravenous (IV) catheter stylet with a safety-engineered feature (a retractable protection shield), which was placed in clinics and hospital wards in lieu of other IV catheter devices that did not have safety features. No protective devices were present on suture needles during any of the periods. The incidence of percutaneous needlestick injury by IV catheter and suture needles was evaluated for 18 months before and 18 months after the intervention. RESULTS After the intervention, the incidence of percutaneous injuries resulting from IV catheters decreased significantly (P<.01), whereas the incidence of injuries resulting from suture needle injuries increased significantly (P<.008). CONCLUSION ESIPDs lead to a reduction in percutaneous injuries in HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens.
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Green-McKenzie J. HIV update. Prehospital risks and prevention methods. JEMS 2007; 32:62-72; quiz 74. [PMID: 17285734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania School of Medicine, PA, USA.
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Green-McKenzie J, D'Souza DJ. Facing airborne infections. Occup Health Saf 2006; 75:92, 94, 96 passim. [PMID: 16734293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
The Occupational Physicians Scholarship Fund (OPSF) was established 20 years ago with the goal of helping to address the critical shortage of qualified physicians entering occupational and environmental medicine (OEM). We examined descriptive and outcome measures to evaluate its success. Information was obtained from members of the original board of directors, the OPSF office, and the American Board of Preventive Medicine (ABPM). Most of the scholars (88%) are diplomats of the ABPM, certified in OEM. Scholars represent 6% of board-certified OEM physicians, score higher on the certifying examination than other examinees, practice in all regions of the United States, and are represented in diverse practice settings. The OPSF has achieved its objectives, producing well-trained physicians who contribute to the growth and vitality of the specialty improving worker health, business productivity, and the environment.
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Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4283, USA.
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Green-McKenzie J, Caruso G. Health care workers' crucial barriers. Occup Health Saf 2006; 75:57-8, 112. [PMID: 16642676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania School of Medicine, USA
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Abstract
CONTEXT Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice. CASE PRESENTATION A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time. DISCUSSION The patient's presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.
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Affiliation(s)
- Judith Green-McKenzie
- University of Pennsylvania Medical Center, Division of Occupational and Environmental Medicine, Philadelphia, Pennsylvania 19104-4283, USA.
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Green-McKenzie J, Watkins M. Lowering the risk. Occup Health Saf 2005; 74:24, 26, 28. [PMID: 15915690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Abstract
The cost of workers' compensation health care has been a challenge during the past few decades. Various programs have been initiated on the local, state, and national levels to address this issue. The purpose of this article is to examine some of the programs that have initiated cost control measures. Most of those published claim successful outcomes. The initiatives reviewed herein were instituted at medical centers in Maryland and Pennsylvania, at casino hotels in Nevada, at an occupational health clinic in Ohio, at an electrical union in New York State, and at an insurance company. Initiatives in Minnesota and Washington State are also described. Sharing the outcomes of initiatives may allow such research to be translated into action on a broader scale.
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Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Medical Center, 3400 Spruce Street, Ground Silverstein, Philadelphia, PA 19104, USA.
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Green-McKenzie J. Workers' compensation costs: still a challenge. Clin Occup Environ Med 2004; 4:ix, 395-8. [PMID: 15182757 DOI: 10.1016/j.coem.2004.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The workers' compensation system in the United States, comprised of independent state based and national programs for federal workers, covers approximately 127 million workers and has evolved and grown since its inception in 1911. Coverage has significantly broadened in scope to allow for the inclusion of most occupational injuries and illnesses. The cost of workers' compensation care has also increased. Some of the cost drivers have been identified,and various approaches have been taken to address medical cost containment. There is a need to balance cost control with ensuring benefit adequacy and quality of medical care. It is likely that managing workers' compensation costs will continue to be a challenge in the foreseeable future. The cost of workers' compensation care affects all stakeholders including workers, employers,providers, state workers' compensation regulators, legislatures,and insurers. A continued commitment to quality, accessibility to care, and cost containment, and being alert to emerging issues that can affect these elements, will help ensure that workers are afforded accessible, high quality, and cost-effective care.
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Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Medical Center, 3400 Spruce Street, Ground Silverstein, Philadelphia, 19104, USA.
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Green-McKenzie J, Kiselica D. Definitions of terms commonly used in workers' compensation. Clin Occup Environ Med 2004; 4:ix, 399-405. [PMID: 15182758 DOI: 10.1016/j.coem.2004.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This article provides definitions for the various terms commonly used in the area of workers' compensation.
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Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Medical Center, 3400 Spruce Street, Ground Silverstein, Philadelphia, PA 19104, USA.
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Abstract
The workers' compensation system is a no-fault legal and social insurance system established to address compensation issues that involve work-related injuries and illnesses. The system was developed in response to dissatisfaction with common law litigation on the parts of injured workers and employers. The history of the development of workers' compensation is reviewed, and a general description of the system is offered, including discussion of state law and insurance structures, benefits and costs, administrative boards/commissions, and the federal systems for workers' compensation and related programs. The recent history of the workers' compensation system is provided, the recommendations of the National Commission on State Workmen's Compensation Laws in 1972 are reviewed, and the problems and state-initiated changes in worker's compensation that occurred during the 1990s are discussed.
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Affiliation(s)
- Daria Kiselica
- Department of Internal Medicine, Occupational Health Services, University of Virginia, 337 15th Street SW, Charlottesville, VA 22903, USA.
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Green-McKenzie J. Training African-American residents in the 20th century. J Natl Med Assoc 2004; 96:372-5. [PMID: 15040520 PMCID: PMC2594890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Bellevue Hospital, the oldest public hospital in the United States and a lineal descendant of an infirmary for slaves, accepted its first African-American resident, Dr. Ubert Conrad Vincent, in 1918. This occurred at a time when many medical centers were not accepting African-American residents. At the end of WWII, one-third of the accredited medical schools still barred African Americans. However, Bellevue Hospital continued to train African-American residents. Between the 1920s and 1940s four African Americans matriculated at Bellevue Hospital. There were six in the 1950s, four in the 1960s, and 25 in the 1970s. By the 1980s, 40 African Americans matriculated, and between 1990 and 1995, 61 matriculated. Despite its historic first, Bellevue lagged slightly behind the national average. While the number of African-American residents occupying U.S. residency slots increased from 2.8% in 1978 to 6.5% in 1996, African Americans comprised 3.6% of residency slots at Bellevue between 1985-1995. Currently, only 7% of practicing physicians and 5% in faculty positions are latino, African-American, and Native American. Increasing the number of under-represented minority (URM) physicians is important to the United States, as URM physicians are more likely to serve the poor and uninsured, therefore improving the overall healthcare of the underprivileged. A study by the Association of American Medical Colleges indicated that minority medical school graduates were five times more likely to report that they planned to serve minority populations than other graduates. In their position paper, the American College of Physicians expressed the belief that increasing the number of URM physicians will help reduce healthcare disparities that can hurt minority populations and lead to poor health outcomes. The Supreme Court acknowledged the importance of racial diversity by upholding the University of Michigan affirmative action admissions policy in its June 2003 ruling. URM physicians are needed not only to serve minority populations but also to serve as mentors and role models for prospective and current students. The first African-American resident to graduate from the Bellevue Residency Program did indeed treat the underserved, as Dr. Vincent founded the Vincent Sanatorium, dedicated to treating African-American patients, and training African-American nurses and doctors. Over the course of the 20th century, Bellevue Hospital has trained increasing numbers of African-American physicians. It is hoped that, like their predecessor, Dr. Vincent, they will provide care to underserved communities and to the community as a whole, as well as serve as role models for generations to come.
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Affiliation(s)
- Judith Green-McKenzie
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104-4283, USA.
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Green-McKenzie J, Watkins M. Experience with vaccinia vaccine in the post-eradication era. J Occup Environ Med 2003; 45:344-5. [PMID: 12708136 DOI: 10.1097/01.jom.0000063625.37065.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The effect of both a cost control and health care management initiative (HCMI) on Workers' Compensation costs at a self-insured University Hospital was assessed. Seven cohorts of injured workers were studied. Cost control measures started in 1993 included early return to work and injury prevention programs, internal administration of legal cases, and utilization of modified duty assignments. The health care management initiative fully in place in 1997 included aggressive case management and preferred provider panel utilization. Workers' Compensation indemnity costs and lost workdays incurred by each cohort were compared. A 41 to 59% reduction in indemnity payments and 46 to 67% reduction in lost time cases were realized after the health care management initiative was fully in place. During this time, accepted claims were reduced by 10 to 15%. The quality of the provider panel, as measured by academic credentials, experience and board certification, did not change. Cost control measures, without comprehensive case management, did not decrease these parameters significantly. The health care management initiative realized reductions in lost time cases and Workers' Compensation indemnity costs.
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Affiliation(s)
- Judith Green-McKenzie
- Hospital, University of Pennsylvania, 3400 Spruce Street, Occupational Medicine, Philadelphia, PA 19104-4283, USA.
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Green-McKenzie J, Gershon RR, Karkashian C. Infection control practices among correctional healthcare workers: effect of management attitudes and availabiity of protective equipment and engineering controls. Infect Control Hosp Epidemiol 2001; 22:555-9. [PMID: 11732784 DOI: 10.1086/501951] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the relation of the availability of personal protective equipment (PPE) and engineering controls to infection control (IC) practices in a prison healthcare setting, and to explore the effect on IC practices of a perceived organizational commitment to safety. DESIGN Cross-sectional survey. SETTING The study population was drawn from the 28 regional Correctional Health Care Workers Facilities in Maryland. PARTICIPANTS All full-time Maryland correctional healthcare workers (HCWs) were surveyed, and 225 (64%) of the 350 responded. METHOD A confidential, self-administered questionnaire was mailed to all correctional HCWs employed in the 28 Maryland Correctional Health Care Facilities. The questionnaire was analyzed psychometrically and validated through extensive pilot testing. It included items on three major constructs: IC practices, safety climate (defined as the perception of organizational commitment to safety), and availability of IC equipment and supplies. RESULTS A strong correlation was found between the availability of PPE and IC practices. Similarly, a strong correlation was found between IC practices and the presence of engineering controls. In addition, an equally strong association was seen between the adoption of IC practices and employee perception of management commitment to safety. Those employees who perceived a high level of management support for safety were more than twice as likely to adhere to recommended IC practices. IC practices were significantly more likely to be followed if PPE was always readily available. Similarly, IC practices were more likely to be followed if engineering controls were provided. CONCLUSION These findings suggest that ready availability of PPE and the presence of engineering controls are crucial to help ensure their use in this high-risk environment. This is especially important because correctional HCWs are potentially at risk of exposure to bloodborne pathogens such as human immunodeficiency virus and hepatitis B and C viruses. Commitment to safety was found to be highly associated with the adoption of safe work practices. There is an inherent conflict of "custody versus care" in this setting; hence, it is especially important that we understand and appreciate the relation between safety climate and IC practices. Interventions designed to improve safety climate, as well as availability of necessary IC supplies and equipment, will most likely prove effective in improving employee compliance with IC practices in this healthcare setting.
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Affiliation(s)
- J Green-McKenzie
- The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA
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Emmett EA, Green-McKenzie J. External Practicum-Year Residency Training in Occupational and Environmental Medicine: the University of Pennsylvania Medical Center Program. J Occup Environ Med 2001; 43:501-11. [PMID: 11382186 DOI: 10.1097/00043764-200105000-00012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe a competency-based training program that allows physicians employed full-time in occupational and environmental medicine to satisfy the supervised practicum year of training required by the American Board of Preventive Medicine (ABPM). The program is designed for trainees with greater clinical experience than the 1 clinical year required by the ABPM. To date, 25 physicians from clinic-based, academic, corporate, and government employment across most geographic regions of the United States have been admitted into the program. Most completed a master's in public health (MPH) in a distance-learning, on-job, on-campus, or executive program. The practicum-year training has been highly successful, as evidenced by improvements in resident self-assessment of competency, resident satisfaction with the training, faculty evaluation of resident performance, and success rate in the ABPM examination. The program has opened a new pathway for physicians making a mid-career shift to occupational and environmental medicine to obtain high-quality, in-depth education and board certification.
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Affiliation(s)
- E A Emmett
- Hospital of University of Pennsylvania, Department of Occupational Medicine, GR Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Abstract
Health care workers (HCWs) risk occupational exposure to bloodborne pathogens. Effective postexposure treatment and testing depend on compliance with follow-up, but compliance rates are poorly understood. We examined trends in exposure and follow-up at a large teaching hospital after interventions to improve compliance. We reviewed exposures from October 1987 to September 1988 (group 1) and July 1996 to June 1997 (group 2). Data were analyzed for HCW demographics, source patient characteristics, and follow-up outcomes. We found that group 2 source patient serologic data were obtained more often. Group 1 source patients were more likely to be positive for the human immunodeficiency virus (HIV). Group 2 HCWs were more likely to be immune to hepatitis B virus, to agree to HIV testing, and to comply with follow-up. Follow-up rates remained suboptimal, even after high-risk exposures. Non-licensed HCWs were less likely to accept postexposure testing than physicians or nurses in group 2. General and targeted interventions to improve compliance and follow-up are still needed.
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Affiliation(s)
- A J Behrman
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Health System, One Silverstein Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Gershon RR, Karkashian CD, Vlahov D, Kummer L, Kasting C, Green-McKenzie J, Escamilla-Cejudo JA, Kendig N, Swetz A, Martin L. Compliance with universal precautions in correctional health care facilities. J Occup Environ Med 1999; 41:181-9. [PMID: 10091141 DOI: 10.1097/00043764-199903000-00007] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There were three main objectives of this cross-sectional study of Maryland State correctional health care workers. The first was to evaluate compliance with work practices designed to minimize exposure to blood and body fluids; the second, to identify correlates of compliance with universal precautions (UPs); and the third was to determine the relationship, if any, between compliance and exposures. Of 216 responding health care workers, 34% reported overall compliance across all 15 items on a compliance scale. Rates for specific items were particularly low for use of certain types of personal protective equipment, such as protective eyewear (53.5%), face mask (47.2%) and protective clothing (33.9%). Compliance rates were highest for glove use (93.2%) waste disposal (89.8%), and sharps disposal (80.8%). Compliance rates were generally not associated with demographic factors, except for age; younger workers were more likely to be compliant with safe work practices than were older workers (P < 0.05). Compliance was positively associated with several work-related variables, including perceived safety climate (i.e., management's commitment to infection control and the overall safety program) and job satisfaction, and was found to be inversely associated with security-related work constraints, job/task factors, adverse working conditions, workplace discrimination, and perceived work stress. Bloodborne exposures were not uncommon; 13.8% of all respondents had at least one bloodborne exposure within the previous 6 months, and compliance was inversely related to blood and body fluid exposures. This study identified several potentially modifiable correlates of compliance, including factors unique to the correctional setting. Infection-control interventional strategies specifically tailored to these health care workers may therefore be most effective in reducing the risk of bloodborne exposures.
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Affiliation(s)
- R R Gershon
- Department of Environmental Health Sciences, Johns Hopkins University School of Public Health, Baltimore, Md. 21205, USA
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