A systematic review of literature on occupational health and safety interventions for older workers

As the global population ages there is an imperative to enhance labour participation of older workers in ways that support good physical and psychological health. However, there is limited guidance for organisations on how to do this effectively. This systematic review examined literature identified through four databases and a targeted web-search, yielding 39 PRISMA records (32 scholarly, seven grey literature) reporting workplace interventions aimed at improving the injury outcomes of older workers. The review revealed that organisational and composite interventions may be most effective, although an absence of robust research in this area and a scarcity of empirical evidence-based interventions known to improve injury outcomes for older workers was noted. Responding to these shortcomings, this article presents 'A future research agenda for older worker health, safety and well-being interventions.' This systems-based approach has a dual focus on organisational and composite interventions combined with robust research design.Practitioner summary: We conducted a systematic literature review of studies focussed on workplace interventions to improve the physical and psychological safety of older workers. Within the existing literature, evidence for effective interventions and guidance for organisations is weak. We present a future research agenda with a systems approach to address these gaps.

Older Worker-Orientated Human Resource Practices, Wellbeing and Leave Intentions: A Conservation of Resources Approach for Ageing Workforces

At a time where there are ageing populations, global shortages of skilled labour, and migration pathways impacted by the COVID-19 pandemic, retaining older workers presents as a vital strategic initiative for organizations globally. This study examines the role of Human Resource Practices (HRPs), which are oriented towards accommodating the needs of an ageing workforce in mitigating psychological distress and turnover intentions. The study collected self-reported survey data from 300 Australian employees over the age of 45, over two time points. Using structural equation modelling, the study analyzed the extent to which Older Worker-oriented Human Resources Practices (OW-HRPs) translate into employee psychological health and retention within organizations, through the mediation of ageism and work-life conflict. The results support our hypothesis that OW-HRPs are associated with lower ageism, better work-life balance; and in combination these reduce psychological distress and help retain older workers in the workforce. We conclude that OW-HRPs can foster work environments conducive to older worker wellbeing, supporting the retention of talent and maintaining effectiveness, in the face of substantial labour supply challenges brought on by the COVID-19 pandemic and an ageing population.

Ethnicity and paediatric healthcare utilisation: Improving the quality of quantitative research

Background

The COVID-19 pandemic highlighted the stark health inequities affecting minority ethnic populations in Europe. However, research on ethnic inequities and healthcare utilisation in children has seldom entered the policy discourse. A scoping review was conducted in the UK, summarising and appraising the quantitative evidence on ethnic differences (unequal) and inequities (unequal and unfair or disproportionate to healthcare needs) in paediatric healthcare utilisation.

Methods

Embase, Medline and grey literature sources were searched for studies published 2001-2021. Studies that found differences and inequities were mapped by ethnic group and healthcare utilisation outcome. They were appraised using the National Institute for Health and Care Excellence appraisal checklists. The distribution of studies was described across various methodological parameters.

Results

Of the 61 included studies, most found evidence of ethnic variations in healthcare utilisation (n = 54, 89%). Less than half attempted to distinguish between ethnic differences and inequities (n = 27, 44%). Studies were concentrated on primary and preventive care and hospitalisation, with minimal evidence on emergency and outpatient care. The quality of studies was often limited by a lack of theory underpinning analytical decisions, resulting in conflation of difference and inequity, and heterogeneity in ethnic classification. The majority of studies examined children's ethnicity but overlooked parent/caregiver ethnicity, and also didn't investigate patterns across age, year or location.

Conclusions

To improve the validity, generalisability and comparability of research on ethnicity and paediatric healthcare utilisation, findings from this scoping review were used to develop recommendations for future research. These lessons could be applied more broadly across the European context to improve evidence generation and evidence-based policy-making to reduce inequities in healthcare.

Key messages

• Quantitative studies of ethnicity and paediatric healthcare utilisation in the UK lack the use of sound theoretical frameworks, and often do not distinguish between ethnic differences and inequities.

• The quality of future studies can be improved with greater attention to how ethnicity is classified and analysed, alongside specific considerations for examining healthcare utilisation in children.

1266 Digital Rectal Examination: Do You Still Put Your Foot in It If You Don’t Put Your Finger in It?

Introduction

Most surgical trainees are familiar with the aphorism ‘if you don’t put your finger in it, you put your foot in it’, with regards to digital rectal examination (DRE). This commonly taught maxim, attributed to Bailey and Love in their Short Practice of Surgery, was coined to highlight the folly of neglecting DRE in patients with histories suggestive of malignant anorectal pathology. However, data are lacking on the diagnostic yield of DRE for detecting anorectal cancer in patients with lower gastrointestinal bleeding (LGIB), whilst advances in biomarker and imaging technology beg the question: is there still a role for DRE in the assessment of patients with LGIB?

Method

We designed a clinical coding search strategy to identify all adult patients with acute LGIB referred to general surgery at a UK university hospital from January to July 2020. Electronic patient records were interrogated to identify history and examination findings, diagnoses and clinical outcomes.

Results

169 patients (median age 63 (16-94) years, 54.4% male) were identified, 74.6% (126/169) with bright red bleeding, 23.7% (40/169) with altered blood and 1.8% (3/169) with melaena. DRE was performed in 91.1% (154/169) of patients, identifying blood in 42.9% (66/154) of cases and suspicious lesions, which were subsequently confirmed as anorectal malignancy, in 1.3% (2/154).

Conclusions

DRE represents a possibly stigmatising and uncomfortable examination for patients and clinicians alike. These data support the utility of DRE in patients with LGIB and may inform the discussion at the bedside to facilitate the timely diagnosis of anorectal malignancy.

State of science: the future of work - ergonomics and human factors contributions to the field

This article is concerned with scholarly ergonomics and human factors (E/HF) contributions to date to the field of research inquiry known as the 'future of work'. The review considers E/HF perspectives on how the nature of work is changing and what this means for the practice of E/HF and for human performance and wellbeing at work. This field of research has attracted much attention from scholars from various disciplines as flexible working arrangements and casualised employment, in particular, have come under the microscope during the COVID-19 pandemic. The article begins by setting out the future of work field, focussing on the mega trends and future of work forces that are most relevant to the discipline. Next, E/HF contributions to this field are identified and discussed. Surprisingly, given the E/HF tradition as a system discipline fundamentally concerned with the study of human work, and as a contributor to transdisciplinary research related to the design of work systems, a search of the scholarly literature found few contributions outside of the automation systems field that addressed the future of work and E/HF directly. A research agenda is presented to address gaps in current knowledge in a number of key future of work domains. Practitioner's Summary: We reflect on E/HF contributions to the 'future of work' field and how the practice of E/HF needs to consider the changing nature of work. We outline future of work concerns and suggest research areas for further E/HF attention towards the design of decent and sustainable work for all. Abbreviations: E/HF: ergonomics and human factors; ILO: International Labour Organisation; COVID-19.

Predictors of Workplace Bullying and Cyber-Bullying in New Zealand

Background: The negative effects of in-person workplace bullying (WB) are well established. Less is known about cyber-bullying (CB), in which negative behaviours are mediated by technology. Drawing on the conservation of resources theory, the current research examined how individual and organisational factors were related to WB and CB at two time points three months apart. Methods: Data were collected by means of an online self-report survey. Eight hundred and twenty-six respondents (58% female, 42% male) provided data at both time points. Results: One hundred and twenty-three (15%) of participants had been bullied and 23 (2.8%) of participants had been cyber-bullied within the last six months. Women reported more WB, but not more CB, than men. Worse physical health, higher strain, more destructive leadership, more team conflict and less effective organisational strategies were associated with more WB. Managerial employees experienced more CB than non-managerial employees. Poor physical health, less organisational support and less effective organisational strategies were associated with more CB. Conclusion: Rates of CB were lower than those of WB, and very few participants reported experiencing CB without also experiencing WB. Both forms of bullying were associated with poorer work environments, indicating that, where bullying is occurring, the focus should be on organisational systems and processes.

Descriptive data on cardiovascular and metabolic risk factors in ambulatory and non-ambulatory adults with cerebral palsy

Forty-two participants with cerebral palsy were recruited for a study examining traditional and novel indicators of cardiovascular risk (McPhee et al., 2015 [1]). Data pertaining to the prevalence of obesity, smoking, hypertension, and metabolic risk are provided. These data are presented along with the scoring methods used in evaluation of the study participants. Percentages are included for comparative purposes with the existing literature.

Effect of the 12-gene colon cancer assay results on adjuvant treatment recommendations in patients with stage II colon cancer

INTRODUCTION

The 12-gene colon cancer Recurrence Score assay is a clinically validated predictor of recurrence risk in stage II colon cancer patients. A survey was performed characterizing the assay's impact on treatment recommendations for these patients.

METHODS

US medical oncologists (n = 346) who ordered the assay for ≥3 stage II colon cancer patients were asked to complete a web-based survey regarding their most recent such patient. Physicians surveyed represented users of the assay within the first 2 years of commercial availability which may include 'early adopters'.

RESULTS

Most of 116 eligible physicians were in community practice (86%), with median 14.5 years' experience (range = 2-40). Mean patient age was 61 years (range = 32-85); 81% had T3 disease, and 38% had comorbidities. Of 76 patients tested for mismatch-repair/microsatellite-instability (MMR/MSI), 13 (17%) were MMR-deficient/MSI-high; 46 (61%) MMR-proficient/MSI-low; and 17 (22%) unknown. Most patients (84%) had ≥12 nodes examined. Median Recurrence Score result was 20 (range = 1-77). Before assay, treatment recommendations were specified for 92 (79%) patients, with no recommendation for 24 (21%). Of the 92 with pre-assay recommendations, chemotherapy was planned for 52 (57%) and observation for 40 (43%); the assay changed recommendations for 27 (29%). Treatment intensity decreased for 18 (67%) and increased for nine (33%) patients; it was more likely to decrease for lower Recurrence Score values and increase for higher values (p < 0.001).

CONCLUSION

For stage II colon cancer patients receiving Recurrence Score testing, 29% of treatment recommendations were changed. Use of the assay may lead to reductions in treatment intensity. Study limitations include retrospective design, data gathering during the first 2 years of assay availability only, and potential non-representativeness of respondents.

Incorporating organisational safety culture within ergonomics practice

This paper conceptualises organisational safety culture and considers its relevance to ergonomics practice. Issues discussed in the paper include the modest contribution that ergonomists and ergonomics as a discipline have made to this burgeoning field of study and the significance of safety culture to a systems approach. The relevance of safety culture to ergonomics work with regard to the analysis, design, implementation and evaluation process, and implications for participatory ergonomics approaches, are also discussed. A potential user-friendly, qualitative approach to assessing safety culture as part of ergonomics work is presented, based on a recently published conceptual framework that recognises the dynamic and multi-dimensional nature of safety culture. The paper concludes by considering the use of such an approach, where an understanding of different aspects of safety culture within an organisation is seen as important to the success of ergonomics projects. STATEMENT OF RELEVANCE: The relevance of safety culture to ergonomics practice is a key focus of this paper, including its relationship with the systems approach, participatory ergonomics and the ergonomics analysis, design, implementation and evaluation process. An approach to assessing safety culture as part of ergonomics work is presented.

The role of latent and active failures in workplace slips, trips and falls: an information processing approach

The vast majority of the published workplace slips, trips and falls (STF) literature is exceedingly narrow in its focus and often ignores wider systems issues in workplace STF aetiology. There is little recognition within the published literature of the importance of latent failures or the upstream organisational and cultural contexts within which workplace STF occur. This is unfortunate, as a systems approach to workplace STF analysis, that is inclusive of latent design and work organisation factors that often shape worker behaviour patterns related to STF risk (e.g. rushing, risk taking), is fundamental to the development of effective prevention measures. The aims of this paper are to provide an understanding of workplace STF causation that is cognisant of the potential role of both active and latent failures in STF causation. The paper presents an ergonomics model for workplace STF analysis that highlights information processing in STF aetiology, the STF incident process and the interaction between latent and active failures in STF causation. The paper draws upon ergonomics research conducted in a range of occupational contexts to illustrate the key features of the model as it applies to workplace STF. Implications of the model for analysis and prevention of STF are discussed.

Characterization of a resistance locus (Pfs-1) to the spinach downy mildew pathogen (Peronospora farinosa f. sp. spinaciae) and development of a molecular marker linked to Pfs-1

Downy mildew is a destructive disease of spinach worldwide. There have been 10 races described since 1824, six of which have been identified in the past 10 years. Race identification is based on qualitative disease reactions on a set of diverse host differentials which include open-pollinated cultivars, contemporary hybrid cultivars, and older hybrid cultivars that are no longer produced. The development of a set of near-isogenic open-pollinated spinach lines (NILs), having different resistance loci in a susceptible and otherwise common genetic background, would facilitate identification of races of the downy mildew pathogen, provide a tool to better understand the genetics of resistance, and expedite the development of molecular markers linked to these disease resistance loci. To achieve this objective, the spinach cv. Viroflay, susceptible to race 6 of Peronospora farinosa f. sp. spinaciae, was used as the recurrent susceptible parent in crosses with the hybrid spinach cv. Lion, resistant to race 6. Resistant F(1) progeny were subsequently backcrossed to Viroflay four times with selection for race 6 resistance each time. Analysis of the segregation data showed that resistance was controlled by a single dominant gene, and the resistance locus was designated Pfs-1. By bulk segregant analysis, an amplified fragment length polymorphism (AFLP) marker (E-ACT/M-CTG) linked to Pfs-1 was identified and used to develop a co-dominant Sequence characterized amplified region (SCAR) marker. This SCAR marker, designated Dm-1, was closely linked ( approximately 1.7 cM) to the Pfs-1 locus and could discriminate among spinach genotypes that were homozygous resistant (Pfs-1Pfs-1), heterozygous resistant (Pfs-1pfs-1), or homozygous susceptible (pfs-1pfs-1) to race 6 within the original mapping population. Evaluation of a wide range of commercial spinach lines outside of the mapping population indicated that Dm-1 could effectively identify Pfs-1 resistant genotypes; the Dm-1 marker correctly predicted the disease resistance phenotype in 120 out of 123 lines tested. In addition, the NIL containing the Pfs-1 locus (Pfs-1Pfs-1) was resistant to multiple races of the downy mildew pathogen indicating Pfs-1 locus may contain a cluster of resistance genes.

Injuries to New Zealanders participating in adventure tourism and adventure sports: an analysis of Accident Compensation Corporation (ACC) claims

AIMS

The aim of this study was to examine the involvement of adventure tourism and adventure sports activity in injury claims made to the Accident Compensation Corporation (ACC).

METHODS

Epidemiological analysis of ACC claims for the period, July 2004 to June 2005, where adventure activities were involved in the injury.

RESULTS

18,697 adventure tourism and adventure sports injury claims were identified from the data, representing 28 activity sectors. Injuries were most common during the summer months, and were most frequently located in the major population centres. The majority of injuries were incurred by claimants in the 20-50 years age groups, although claimants over 50 years of age had highest claims costs. Males incurred 60% of all claims. Four activities (horse riding, mountain biking, tramping/hiking, and surfing) were responsible for approximately 60% of all adventure tourism and adventure sports-related injuries. Slips, trips, and falls were the most common injury initiating events, and injuries were most often to the back/spine, shoulder, and knee.

CONCLUSIONS

These findings suggest the need to investigate whether regulatory intervention in the form of codes of practice for high injury count activities such as horse riding and mountain biking may be necessary. Health promotion messages and education programs should focus on these and other high-injury risk areas. Improved risk management practices are required for commercial adventure tourism and adventure sports operators in New Zealand if safety is to be improved across this sector.

Investigating slips, trips and falls in the New Zealand dairy farming sector

The paper presents findings from 39 detailed follow-up investigations of slips, trips and falls (STF) incurred by individuals working in New Zealand's dairy farming industry. The study sought to identify the key contributory risk factors for STF in this sector to provide evidence to support intervention design, and to determine the effectiveness of the investigative methodology used to achieve these objectives. Findings from the follow-up investigations included an analysis of factors related to the underfoot surface, underfoot hazard and footwear. Of note here was the propensity for STF-involved workers to not see or identify an underfoot hazard due to concurrent visual task distractions, and for workers to use footwear that both lacked effective tread and was unsuitable for the task and underfoot surface. Key latent risk factors and their interactions identified included problems associated with time pressure and related time-saving behaviours and the presence of design errors that, for example, required workers to climb onto equipment to view aspects of the task they were working on. The paper concludes that the potential resource and logistical problems associated with conducting detailed STF investigations are outweighed by the opportunity to collect rich data on key risk factors and their interactions in STF research.

Evaluation in industry of a draft code of practice for manual handling

This paper reports findings from a study which evaluated the draft New Zealand Code of Practice for Manual Handling. The evaluation assessed the ease of use, applicability and validity of the Code and in particular the associated manual handling hazard assessment tools, within New Zealand industry. The Code was studied in a sample of eight companies from four sectors of industry. Subjective feedback and objective findings indicated that the Code was useful, applicable and informative. The manual handling hazard assessment tools incorporated in the Code could be adequately applied by most users, with risk assessment outcomes largely consistent with the findings of researchers using more specific ergonomics methodologies. However, some changes were recommended to the risk assessment tools to improve usability and validity. The evaluation concluded that both the Code and the tools within it would benefit from simplification, improved typography and layout, and industry-specific information on manual handling hazards.

How safe is adventure tourism in New Zealand? An exploratory analysis

The paper reports findings from a multidisciplinary programme of research, the major aims of which were to determine the nature and extent of the New Zealand adventure tourism injury problem. Analysis of hospital discharge and mortality data for a 15-year period identified adventure tourism-related activities as contributing to approximately 20% of overseas visitor injuries, and 22% of fatalities. Activities that commonly involve independent-unguided adventure tourism, notably mountaineering, skiing and tramping, contributed most to injury and fatality incidence. Horse riding and cycling activities were identified from hospital discharge data and adventure tourism operators' reported client injury-incidence, as the commercial adventure tourism activities most frequently involved in client injuries. Falls were the most common injury events, and a range of client, equipment, environmental and organisational risk factors were identified. Possible interventions to reduce injury risk among overseas and domestic adventure tourists are discussed.

Mapping between SNOMED RT and Clinical terms version 3: a key component of the SNOMED CT development process

SNOMED RT and Clinical Terms Version 3 are two large, controlled medical terminologies that are being merged to form a new work titled SNOMED Clinical Terms (SNOMED CT). One of the first steps in this process was to create maps between semantically equivalent and proximate concepts in the two terminologies. Same-as and is-a relationships were used to map the descriptions from one terminology to concepts in the other terminology. The objectives were to identify semantically equivalent concepts in the two terminologies, to find the most semantically proximate is-a relationships for non-equivalent concepts, and to evaluate the synonymy in the source terminologies. The results suggest that the rate of semantic overlap between descriptions in SNOMED RT and CTV3 is approximately 28%. This article discusses the methodology, issues, and findings of the description mapping process.

The sleep of older people in hospital and nursing homes

Disturbed sleep can affect personal wellbeing and impede the rehabilitation and recovery of older people from illness. This paper reports the findings of a pilot study which included examination of sleep quality and sleep patterns of older people in community hospital and nursing home settings. A marked proportion of older people reported sleeping well in nursing care settings, and those in nursing homes slept better than those in the community hospital. The main causes of sleep disturbance in both settings were: needing to go to the toilet, noise, pain, and discomfort; a similar pattern was seen across the different settings. No discernible difference was found in quality of sleep and whether patients felt rested or not between those patients on hypnotic medication and those who were not. The implications of the findings for practice and future research are discussed.

The geniculohypothalamic pathway in a congenitally anophthalmic mouse

In a previous study we described abnormalities in cytoarchitecture and vasoactive intestinal polypeptide distribution in the suprachiasmatic nucleus (SCN) of anophthalmic mice. However, the effect of anophthalmia on the geniculohypothalamic pathway, an important pathway for relay of photic information to the SCN, is not known. The present study examined the geniculohypothalamic pathway in congenitally anophthalmic and sighted control mice. The data demonstrate that the development of an intergeniculate leaflet (IGL), the expression of neuropeptide Y (NPY) by IGL neurons and the formation of NPY terminal fields in the SCN proceed in the absence of retinal input. Although the cytoarchitectural organization of the anophthalmic IGL differs from that of the control mouse, the distribution of NPY plexuses in the suprachiasmatic nucleus is remarkably similar.

Control of IgG/Fc glycosylation: a comparison of oligosaccharides from chimeric human/mouse and mouse subclass immunoglobulin Gs

Oligosaccharide profiles were obtained for chimeric mouse-human antibodies corresponding to each of the human IgG subclasses 1-4, and mouse IgG2b antibodies each expressed in the mouse J558L cell line. These antibodies have specificity for the NIP hapten and form a matched set of IgGs. An IgG4 chimeric antibody (B72.3) produced in the chinese hamster ovary (CHO-K1) cell line was also analysed for carbohydrate. Additionally aglycosylated mutants of this IgG4 (B72.3) and anti-NIP mouse IgG2b were analysed. The total lack of carbohydrate found in the aglycosylated site-directed mutants human chimeric IgG4 B72.3 (Asn 297-->Gln) and mouse IgG2b (Asn 297-->Ala) demonstrates that there are no N-glycosylation sites other than Asn 297. Therefore glycosylation profiles for all the IgGs analysed reflect carbohydrate attached to this site. Factors such as cell type (A), template direction by the IgG heavy chains (B) and culture conditions (C) are shown to influence IgG glycosylation profiles. (A) The anti-NIP IgG antibodies expressed by the J558L cell line may have one or two Gal (alpha 1-->3) Gal residues per oligosaccharide unit, indicative of the presence of (alpha 1-->3) galactosyl transferase in the J558L mouse cell line. (B) The galactosylation profiles obtained for the IgG heavy chains, in particular the preference for galactosylation of the Man (alpha 1-->6) arm rather than the Man (alpha 1-->3) arm, contrary to the beta-galactosyltransferase specificity, suggest that the polypeptide chain may act as a template to influence the extent of galactosylation and hence the proportions of each oligosaccharide incorporated. The IgG2 antibody does not display this galactosylation preference. (C) The extent of galactosylation appears to be influenced by the growth conditions, with the highest levels of galactosylation being found for IgG produced by cells grown in still cultures, rather than cells grown as ascites or in hollow fibre bioreactors. It is concluded that though the profile of glycosylation is controlled predominantly by the glycosylation activity of the cell in which the IgG is expressed, differences between the IgG heavy chain templates of the various subclasses and culture conditions can also influence glycosylation.

Multiple binding sites on the CH2 domain of IgG for mouse Fc gamma R11

Important mammalian defensive functions such as phagocytosis are triggered in leukocytes by the interaction of the Fc region of IgG with cell surface receptors (Fc gamma R). The CH2 domain of IgG has been implicated previously as the site of interaction with human and mouse Fc gamma R. This domain was mapped for interaction with mouse Fc gamma R11 expressed by the macrophage-like cell line P388D1, using two panels of a total of 32 site-directed mutants of mouse IgG2b and chimeric human IgG3 monoclonal antibodies. Two potential binding sites have been identified: one in or within the vicinity of the lower hinge site on IgG for human Fc gamma R1, and one within the binding site on IgG for Clq. The three mutant IgGs (Gly 237----Ala, Asn 297----Ala, and Glu 318----Ala) which do not interact in complexed form also fail to bind as monomers. A 1H NMR study of the three non-binding monomeric mutants suggests that the mutations are largely site-specific, indicating that IgG interacts with mouse Fc gamma R11 at two regions within the CH2 domain. This interaction dictates phagocytosis mediated by Fc gamma R11 of the P388D1 cell line.