Using machine learning algorithm to predict the risk of post-traumatic stress disorder among firefighters in Changsha / 中南大学学报(医学版)

OBJECTIVES@#Firefighters are prone to suffer from psychological trauma and post-traumatic stress disorder (PTSD) in the workplace, and have a poor prognosis after PTSD. Reliable models for predicting PTSD allow for effective identification and intervention for patients with early PTSD. By collecting the psychological traits, psychological states and work situations of firefighters, this study aims to develop a machine learning algorithm with the aim of effectively and accurately identifying the onset of PTSD in firefighters, as well as detecting some important predictors of PTSD onset.@*METHODS@#This study conducted a cross-sectional survey through convenient sampling of firefighters from 20 fire brigades in Changsha, which were evenly distributed across 6 districts and Changsha County, with a total of 628 firefighters. We used the synthetic minority oversampling technique (SMOTE) to process data sets and used grid search to finish the parameter tuning. The predictive capability of several commonly used machine learning models was compared by 5-fold cross-validation and using the area under the receiver operating characteristic curve (ROC-AUC), accuracy, precision, recall, and F1 score.@*RESULTS@#The random forest model achieved good performance in predicting PTSD with an average AUC score at 0.790. The mean accuracy of the model was 90.1%, with an F1 score of 0.945. The three most important predictors were perseverance, forced thinking, and reflective deep thinking, with weights of 0.165, 0.158, and 0.152, respectively. The next most important predictors were employment time, psychological power, and optimism.@*CONCLUSIONS@#PTSD onset prediction model for Changsha firefighters constructed by random forest has strong predictive ability, and both psychological characteristics and work situation can be used as predictors of PTSD onset risk for firefighters. In the next step of the study, validation using other large datasets is needed to ensure that the predictive models can be used in clinical setting.

Análise de dados sobre postagens e documentos veiculados em Serviços de Redes Sociais On-line para informação sobre a covid-19 / Data analysis of posts and documents about covid-19 in Online Social Network Services / Análisis de datos en postes y documentos publicados en Servicios de Red Social en Línea para información sobre covid-19

O objetivo foi analisar as postagens relacionadas à covid-19 em Serviços de Redes Sociais On-line por parte do Corpo de Bombeiros Militares, especialmente o caráter informativo desta instituição, com o propósito de identificar a relação entre postagens e documentos oficiais. Como procedimentos metodológicos foram delimitadas as seguintes ações: coletar os dados das postagens; analisar os dados, incluindo o cálculo de representatividade de postagens com suporte de documentos, os serviços mais utilizados e os períodos das postagens; verificar os termos de classificação; e realizar a análise dos documentos oficiais. A amostra foi delimitada ao Corpo de Bombeiros Militar dos estados do Pará, do Ceará, de São Paulo, de Santa Catarina e de Goiás ­ no Facebook, no Instagram e no Twitter. Os resultados apontam tempestividade na publicação de conteúdos nesses serviços nos primeiros dias. As publicações foram marcadas com termos da temática e do georreferenciamento. Identificou-se um baixo percentual de publicações ligadas a documentos oficiais: 5,05% do total analisado. Destacam-se o Instagram, com maior veiculação, e a atuação nos estados de Goiás, Santa Catarina e Pará.

The objective was to analyze the posts on Online Social Network Services by the Military Firefighters Corps related to covid-19, especially the informative character of the institution, to identify the relationship between posts and official documents. As methodological procedures, the following actions were defined: collect data from the posts; analyze the data including the calculation of representativeness of posts supported by documents, most used services and post periods; check classification terms; and perform the analysis of official documents. The sample was limited to the Military Fire Brigades of the states of Pará, Ceará, São Paulo, Santa Catarina and Goiás on Facebook, Instagram and Twitter. The results show timeliness in the publication of content in these services in the early days. The publications were marked with terms of the theme and georeferencing. It was identified a low percentage of publications linked to official documents, 5.05% of the publications. Instagram stands out, with the greatest coverage, and the actions taken by the states of Goiás, Santa Catarina, and Pará.

El objetivo fue analizar las publicaciones en los los Servicios de Redes Sociales en Línea de los Cuerpos de Bomberos Militares relacionadas con el covid-19, especialmente el carácter informativo de esta entidad, con el fin de identificar la relación entre las publicaciones y los documentos oficiales. Como procedimientos metodológicos se definieron las siguientes acciones: recolección de datos de las publicaciones; análisis de los datos, incluido el cálculo de la representatividad de las publicaciones respaldados por documentos, servicios y periodos de publicación más utilizados; consulta a los términos de clasificación; y la análisis de documentos oficiales. La muestra se limitó a los Bomberos Militares de los estados de Pará, Ceará, São Paulo, Santa Catarina y Goiás en Facebook, Instagram y Twitter. Los resultados muestran la puntualidad en la publicación de contenidos en estos servicios en los primeros días. Las publicaciones fueron marcadas con términos de la temática y georreferenciación. Se identificó un bajo porcentaje de publicaciones vinculadas a documentos oficiales: 5,05% del total analizado. Se destacan Instagram, con la mayor cobertura, y la actuación de los estados de Goiás, Santa Catarina y Pará.

Validity assessment of self-reported smoking status in firefighters using the urine cotinine test

Descriptive analysis of prevalence and medical expenses of cancer, cardio-cerebrovascular disease, psychiatric disease, and musculoskeletal disease in Korean firefighters

Does Emotional Labor Increase the Risk of Suicidal Ideation among Firefighters?

Intermediary role of experiential avoidance in neurosis and posttraumatic stress response in firefighters / 中国职业医学

OBJECTIVE: To explore the mediating effect of experiential avoidance on neurosis and posttraumatic stress response in firefighters. METHODS: A cluster random sampling method was used to select 275 male firefighters from 26 Fire Alarm squadrons in a province of China.The Neuroticism subscale of Eysenck Personality Questionnaire Short Scale, the Acceptance and Action Questionnaire-Second Edition, and the Impact of Event Scale were used to investigate the relationship of neurosis, experiential avoidance and posttraumatic stress response. RESULTS: The median score of neurosis, experiential avoidance and posttraumatic stress response was 5, 21 and 15, respectively. Both neurosis and experiential avoidance were positively correlated with posttraumatic stress syndromes(Spearman correlation coefficient were 0.45 and 0.45, P<0.01). The total effect of neurosis on posttraumatic stress response in firefighters was 0.57. The intermediary role of experiential avoidance on neurosis and posttraumatic stress response was 0.19, accounting for 33.33% of the total effect. CONCLUSION: Experiential avoidance plays a partial positive mediating role between neurosis and posttraumatic stress response in firefighters.

An overview of compensated work-related injuries among Korean firefighters from 2010 to 2015

BACKGROUND: Although one in two firefighters in South Korea have experienced work-related injuries, there are few studies which show the overview description on work-related injuries and its analysis regarding such causes. Therefore, we aimed to show the overview of compensated work-related injuries in order to serve fundamental data for establishing prevention policies on work-related injuries for Korean firefighters. METHODS: We requested the all claimed work-related injury data of Korean firefighters from 2010 to 2015 to the Korean National Fire Agency (NFA). The data from NFA including 2457 claimed cases was analyzed and we confirmed, 2154 approved work-related injuries for the kinds of job activities, cause of accident and type of injuries. Among 2154 approved cases, we analyzed more variables for the sex, age, and job duration of 1344 compensated cases through served text file on summary of accident. RESULTS: The Government Employees Pension Service (GEPS) recognized 2154 (87.7%) approved work-related injuries among 2457 claimed cases. The incidence of work-related injuries per 1000 firefighters was 9.8 persons. By region, the incidence of work-related injuries per 1000 firefighters ranged from a maximum of 14.5 to a minimum of 4.0. The most common job activity caused the accident was fire suppression (18.0%), followed by Emergency medical services (EMS) (17.5%) and training (10.7%). The most common cause of these accident was movement imbalance (30.3%), followed by falls (18.9%) and traffic accident (13.4%). In these work-related injuries, sprains and bruises were the most common type of injury (27.2%), and the most commonly injured body site was the upper and lower back (25.3%). Data from identified 1344 firefighters showed that 1264 (94.0%) were male and 80 (6.0%) were female. Age group was the highest in the 40s with 623 cases (46.4%), and job duration was the highest with 650 cases in 5–10 years (48.4%). CONCLUSION: In this study, we could obtain the preliminary data necessary to establish preventive measures, including the cause of accident and region with high accident rates. However, the number of applications for compensated injuries was very small compared to the frequency of injuries found in previous studies. The lack of appropriate treatment suggested that many firefighter injuries can become chronic. In this study, we suggest that it is necessary to introduce an injury monitoring system and improve the accessibility of compensated injuries. TRIAL REGISTRATION: CR318031. Registered 20 June 2018.

Firefighters and Posttraumatic Stress Disorder

Occupational hazards of firefighting and rescue works include frequent exposure to emergencies and life-threatening situations. These stressful work conditions of being constantly under pressure and exposed to potentially traumatic events put them at higher risk of developing posttraumatic stress disorder (PTSD), compared to the general population. PTSD is a potentially debilitating mental disorder, due to persistent intrusive thoughts, negative alterations of mood and cognition, hypervigilance, avoidance of similar situations and reminders, and re-experiences of the traumatic event. Previous studies have shown a relatively high prevalence of PTSD among firefighters, indicating the need for a systematic approach of early detection and prevention. Therefore, a critical review of the current literature on PTSD in firefighters would provide valuable insights into developing effective prevention and intervention programs. Literature indicated that there are risk factors of PTSD in firefighters, such as pre-existing depression, anxiety, sleep disorders, occupational stress, physical symptoms, and binge drinking, whereas social support and adequate rewards are protective factors. Although there are differences in the prevalence of PTSD across studies, partly due to various assessment tools utilized, different sample sizes, and sample characteristics, over one tenth of the firefighters were estimated to have PTSD. The current review warrants further investigations to precisely assess PTSD and co-morbid mental disorders, functional outcomes, and associated factors, and to develop evidence-based preventive and interventional programs to help firefighters with PTSD.

Parkinson's Disease among Firefighters : A Focused Review on the Potential Effects of Exposure to Toxic Chemicals at the Fire Scene

Previous studies have found that firefighters have a tenfold higher prevalence of Parkinson's disease (PD) compare to the general population. Firefighters are constantly exposed to various occupational hazards including toxic chemicals of fire residue and the toxic chemicals can effects development and progression of PD. Nevertheless, there were no studies about the association between exposure to chemical byproducts of combustion and the development of PD among firefighters. Thus the aim of this study is to look into existing researches regarding the effect of chemical byproducts of combustion on the development of PD. An extensive literature search was conducted to identify harmful chemical components of smoke and fire residue, using the PubMed database during November of 2016. We searched for relevant articles by combining several keywords that contained “Parkinson's disease” and each of the different toxic chemicals, yielding a total of 1401 articles. After applying the selection criteria, 12 articles were chosen. Chemical substances reported to have a harmful effect on PD, in at least one article, were carbon monoxide, toluene, manganese and lead. Carbon monoxide and metal substances including manganese and lead were found to be associated with an increased PD risk in more than two articles. There was a heightened risk of PD in firefighters due to exposure of chemical byproducts of combustion including carbon monoxide, toluene, man-ganese and lead. However, to the best of our knowledge, to support this result we need more systematic epidemiological studies about these risk factors of PD among firefighters. In addition, further studies for the effects of prolonged exposure to toxic fire residue on the development and progression of PD in firefighters are needed.

Effect of Post-traumatic Stress and Ways of Stress Coping on Problem Drinking in Firefighters / 한국직업건강간호학회지

PURPOSE: The study aimed to determine the impact of post-traumatic stress and ways of stress coping on problem drinking in firefighters. METHODS: Data were collected from May 11 to June 11, 2015, in fire brigades across South Korea. Participants were 183 male firefighters who used self-report questionnaires containing questions from the Impact of Event Scale-Revised (IES-R), Ways of Coping Checklist (WCC), and Alcohol Use Disorders Identification Test (AUDIT). Data were analyzed using χ2 test, t-test, and logistic regression with the SPSS/WIN 21.0 program. RESULTS: The prevalence of PTSD among firefighters was 36.7% and that of problem drinking was 39.3%. Firefighters with single (OR=0.23, 95% CI=0.038~1.321) and married status (OR=0.46, 95% CI=0.069~3.040) were less likely to have problem drinking than those who were divorced or bereavement. Those with invasion symptoms (OR=1.17, 95% CI=1.031~1.327) and hyperarousal symptoms (OR=0.85, 95% CI=0.722~0.989) were more likely to have problem drinking than those with avoidance symptoms. CONCLUSION: Post-traumatic stress symptom was a major risk factor that increased problem drinking, and married status reduced problem drinking. There is a need to develop post-traumatic stress symptom management program and early education content for symptom management.

Impact of Health-related Quality of Life in Firefighters: Focused on Posttraumatic Stress, Health-related Work Limitations, and Family Support / 한국직업건강간호학회지

PURPOSE: The purpose of this descriptive, cross-sectional study was to identify the factors affecting health-related quality of life by examining the relationships among posttraumatic stress, health-related work limitations, and family support in firefighters. METHODS: The data were collected from 390 firefighters working in four fire stations located in the G district using self-report questionnaires. The collected data were analyzed using descriptive statistics, t-test, one-way ANOVA along with the Scheffé test, and multiple regression. RESULTS: As per the results of multiple regression analysis, the factors affecting health-related quality of life in firefighters were posttraumatic stress, health-related work limitations, and family support. This model explained 31% of the variance in health-related quality of life (F=30.03, p<.001). CONCLUSION: Considering the findings of this study, there is a need to reduce posttraumatic stress and health-related work limitations and develop family support toward firefighters.

Cardiorespiratory Fitness Is Associated with Gait Changes among Firefighters after a Live Burn Training Evolution

BACKGROUND: Recommendations have been proposed for minimum aerobic fitness among firefighters but it is unclear if those criteria relate to performance on the fireground. Less fit individuals fatigue more quickly than fit individuals when working at comparable intensity and may have gait changes, increasing risk of falls. We evaluated the effect of fatigue during a live burn evolution on gait parameters and functional balance comparing them to aerobic fitness levels. METHODS: A total of 24 firefighters had gait and balance tested before and after a live burn evolution. Data were stratified by aerobic fitness of greater/less than 14 metabolic equivalents (METs). RESULTS: Analysis of gait cycles measurements before and after the live burn evolution revealed that single leg stance, cycle, and swing time decreased (p < 0.05) but there were no differences in the other measures. There were no differences in time to complete the functional balance test, or errors committed before or after a live burn evolution. When firefighters were sorted by fitness level of 14 METs, there were no differences for errors or time before or after the live burn evolution. Balance data were analyzed using a linear regression. Individuals with lower fitness levels required more time to complete the test. CONCLUSION: A 14-MET criterion failed to distinguish gait or balance characteristics in this group. However, less fit firefighters did require more time to complete the balance test (p = 0.003). Aerobic fitness alone does not predict gait changes among firefighters following a live burn evolution but does appear to influence functional balance.

Characteristics of Workplace Injuries among Nineteen Thousand Korean Firefighters

To determine the actual firefighter injury statistics in Korea, we conducted a survey on the nature of on-duty injuries among all male firefighters in Korea. We distributed questionnaires to all Korean male firefighters via email, and data from the 19,119 workers that responded were used for data analysis. The job types were categorized into fire suppression, emergency medical service (EMS) and officers. As estimated of age standardized injury prevalence per one thousand workers, 354 fire extinguishing personnel, 533 EMS workers, and 228 officers experienced one or more injuries during the previous 12 months. The odds ratio (95% confidence interval) of injuries was 1.86 (1.61-2.15) for fire suppression and 2.93 (2.51-3.42) for EMS personnel compared to officers after adjusting for age, marital status, smoking habit and career period. Age standardized absence days from work due to injuries per one thousand workers were 1,120, 1,337, and 676 for fire suppression, EMS and officers, respectively. Car accident (24.5%) was the most common cause and wound (42.3%) was the most common type of injuries. Our nationwide representative study showed that fire suppression and EMS workers are at greater risk of on-duty injuries compared to officers. We observed different injury characteristics compared to those reported in other countries.

The effect of organisational system on self-rated depression in a panel of male municipal firefighters

OBJECTIVES: The present study evaluated the effects of job stress, including organisational system to self-rated depression through a panel study of male municipal firefighters in the Republic of Korea. METHODS: A panel of 186 municipal firefighters reported self-rated depressive symptoms according to the Beck Depression Inventory (BDI). The effects of job stress were evaluated using the Korea Occupational Stress Scale, taken one year earlier and classified by the median value. Panel members were classified into Depression or Control groups according to BDI scores, with a cut-off level of \'over mild depression' in a follow-up survey. RESULTS: The Depression group included 17 (9.1%) workers. Firefighters who scored high on occupational system had an 8.3 times greater risk of being assigned to the Depression group than those who had not (adjusted odds ratio [OR] = 8.03, 95% confidence interval (CI) = [1.73-37.22]). In contrast, job stress from a \'difficult physical environment' revealed negative risks related to being classified in the Depression group (AOR = 0.20, 95% CI = [0.04-0.92]). CONCLUSIONS: Although the healthy worker effect may be involved, job stress based on perceptions of organisational system was a strong risk factor for depression. A comprehensive approach should be considered that encompasses social issues when assessing or mental health in high-risk groups, as well as the practical issue of physiochemical hazards.

High-intensity Fitness Training Among a National Sample of Male Career Firefighters

Obesity and fitness have been identified as key health concerns among USA firefighters yet little is known about the current habits related to exercise and diet. In particular, high-intensity training (HIT) has gained increasing popularity among this population but limited quantitative data are available about how often it is used and the relationship between HIT and other outcomes. Using survey methodology, the current study evaluated self-reported HIT and diet practice among 625 male firefighters. Almost one-third (32.3%) of participants reported engaging in HIT. Body composition, as measured by waist circumference and percentage body fat, was significantly related to HIT training, with HIT participants being approximately half as likely to be classified as obese using body fat [odds ratio (OR) = 0.52, 95% confidence interval (CI) = 0.34-0.78] or waist circumference (OR = 0.61, 95% CI = 0.37-0.98). Those who engaged in HIT were more than twice as likely as those who did not (OR = 2.24, 95% CI = 1.42-3.55) to meet fitness recommendations. Findings highlight directions for future prevention and intervention efforts.

The Relationship between Chronotype and Sleep Quality in Korean Firefighters

OBJECTIVE: We examined the relationship between chronotype and sleep disturbance, and assessed various factors that might be associated with sleep disturbance in Korean firefighters. METHODS: Self-administered questionnaires assessing chronotype, depression, alcohol use, posttraumatic stress disorder (PTSD), stress response and sleep quality were examined in 515 firefighters. RESULTS: Evening type firefighters more reported depression, alcohol use, PTSD, stress response and sleep disturbance. Also evening chronotype was the most significant risk factor for poor sleep quality (odds ratio [OR], 4.812; 95% confidence interval [CI], 2.448-9.459), even after controlling for all other variables (OR, 3.996; 95% CI, 1.806-8.841). CONCLUSION: Chronotype was the factor most strongly associated with sleep disturbance, and therefore should be considered an important variable in sleep quality, particularly in occupations involving stressful activities, such as firefighting.

Job Stress, Coping Type, and Job Satisfaction in Firefighters / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate job stress, coping type, and job satisfaction in firefighters. METHODS: It was a descriptive study, and 114 subjects were recruited during July to August, 2014. The data were analyzed by t-test, ANOVA (Sheffe's test), and Pearson's correlation coefficient using SPSS/WIN 22.0. RESULTS: The job stress level of subjects was 47.45, coping type was 2.38 and the level of subjects' job satisfaction was 2.97. The job satisfaction was very closely negatively correlated with the job stress (r=-.66, p<.001). CONCLUSION: These results may contribute to better understanding of stress degree, coping type, and job satisfaction in firefighters. Further follow-up study on firefighters is necessary to relieve their job stress and increase active coping type.

Effects of Low-Dose Aspirin Therapy on Thermoregulation in Firefighters

BACKGROUND: Heart attack is the most common cause of line-of-duty death in the fire service. Daily aspirin therapy is a preventative measure used to reduce the morbidity of heart attacks but may decrease the ability to dissipate heat by reducing skin blood flow. METHODS: In this double-blind, placebo-controlled, crossover study, firefighters were randomized to receive 14 days of therapy (81-mg aspirin or placebo) before performing treadmill exercise in thermal-protective clothing in a hot room [38.8 +/- 2.1degrees C, 24.9 +/- 9.1% relative humidity (RH)]. Three weeks without therapy was provided before crossing to the other arm. Firefighters completed a baseline skin blood-flow assessment via laser Doppler flowmetry; skin was heated to 44degrees C to achieve maximal cutaneous vasodilation. Skin blood flow was measured before and after exercise in a hot room, and at 0 minutes, 10 minutes, 20 minutes, and 30 minutes of recovery under temperature conditions (25.3 +/- 1.2degrees C, 40.3 +/- 13.7% RH). Platelet clotting time was assessed before drug administration, and before and after exercise. RESULTS: Fifteen firefighters completed the study. Aspirin increased clotting time before and after exercise compared with placebo (p = 0.003). There were no differences in absolute skin blood flow between groups (p = 0.35). Following exercise, cutaneous vascular conductance (CVC) was 85 +/- 42% of maximum in the aspirin and 76 +/- 37% in the placebo groups. The percentage of maximal CVC did not differ by treatment before or after recovery. Neither maximal core body temperature nor heart rate responses to exercise differed between trials. CONCLUSION: There were no differences in skin blood flow during uncompensable heat stress following exercise after aspirin or placebo therapy.

Minnesota multiphasic personality inventory as related factor for post traumatic stress disorder symptoms according to job stress level in experienced firefighters: 5-year study

OBJECTIVES: As first responders to an increasing number of natural and manmade disasters, active-duty firefighters are at increased risk for physical and psychiatric impairment as reflected by high rates of posttraumatic stress disorder (PTSD). Because little is known about related factor with PTSD according to job stress level among firefighters, we assessed utility of the Minnesota Multiphasic Personality Inventory (MMPI) using 5-year medical surveillance. METHODS: Data were analyzed from 185 male firefighters without psychiatric disease history and who at assessments in 2006 and 2011 completed all questionnaires on personal behaviors (including exercise, drinking and smoking habits) and job history (including job duration and department). MMPI, Events Scale-Revised-Korean version (IES-R-K) and Korean Occupational Stress Scale-Short Form (KOSS-SF) were used to screen for personality trait, PTSD symptom presence and job stress level, respectively. IES-R-K subgroups were compared using two-sample t- and chi2 tests, and factors influencing IES-R-K according to KOSS-SF were determined using uni- and multivariate logistic regression. RESULTS: Mean age and job duration were higher in PTSD-positive than negative groups. In multivariate analysis, increased PTSD risk was associated with: job duration (Odds ratio (OR) = 1.064, 95 % CI 1.012-1.118) for firefighters overall; masculinity-femininity (OR = 5.304, 95 % CI 1.191-23.624) and job duration (OR = 1.126, 95 % CI 1.003-1.265) for lower job stress level; and social introversion (OR = 3.727, 95 % CI 1.096-12.673) for higher job stress level. CONCLUSIONS: MMPI relates with PTSD according to job stress level among experienced firefighters. Masculinity-femininity and social introversion were the strongest related factor for PTSD symptom development in low and high job stress levels, respectively.

Effects of a Stress Management Program Providing Cognitive Behavior Therapy on Problem-focused Coping, Job Stress, and Depression in Firefighters / 정신간호학회지

PURPOSE: This study was done to investigate the effects of a Stress Management Program providing Cognitive Behavior Therapy on problem-focused coping, job stress, and depression. METHODS: The research design was a quasi-experimental research with a nonequivalent control group pre-posttest. Participants were recruited from two fire safety centers in D city, and the research was carried out from March 11 to April 2, 2011. To test the effects of the Stress Management Program participants were divided into two groups, an experimental group (21) and a control group (20). The research tools included problem-focused coping, job stress, and depression scales. The Stress Management Program was provided to the experiment group for 60 minutes/session twice a week, for 4 weeks. Data were analyzed using Fisher's exact probability test, chi2-test, t-test with the SPSS/WIN 14.0 program. RESULTS: After attending the Stress Management Program, significant differences were found in problem-focused coping scores and depression scores between the experimental group and the control group (t=4.70, p<.001; t=-3.16, p=.003). But there were no significant differences in job stress scores between the two groups. CONCLUSION: The results indicate that the Stress Management Program providing Cognitive Behavior Therapy is an effective nursing intervention for improving problem-focused coping and decreasing depression in firefighters.