The Geriatric Emergency Care Applied Research (GEAR) network approach: a protocol to advance stakeholder consensus and research priorities in geriatrics and dementia care in the emergency department.

INTRODUCTION: Increasingly, older adults are turning to emergency departments (EDs) to address healthcare needs. To achieve these research demands, infrastructure is needed to both generate evidence of intervention impact and advance the development of implementation science, pragmatic trials evaluation and dissemination of findings from studies addressing the emergency care needs of older adults. The Geriatric Emergency Care Applied Research Network (https://gearnetwork.org) has been created in response to these scientific needs-to build a transdisciplinary infrastructure to support the research that will optimise emergency care for older adults and persons living with dementia. METHODS AND ANALYSIS: In this paper, we describe our approach to developing the GEAR Network infrastructure, the scoping reviews to identify research and clinical gaps and its use of consensus-driven research priorities with a transdisciplinary taskforce of stakeholders that includes patients and care partners. We describe how priority topic areas are ascertained, the process of conducting scoping reviews with integrated academic librarians performing standardised searches and providing quality control on reviews, input and support from the taskforce and conducting a large-scale consensus workshop to prioritise future research topics. The GEAR Network approach provides a framework and systematic approach to develop a research agenda and support research in geriatric emergency care. ETHICS AND DISSEMINATION: This is a systematic review of previously conducted research; accordingly, it does not constitute human subjects research needing ethics review. These reviews will be prepared as manuscripts and submitted for publication to peer-reviewed journals, and the results will be presented at conferences.Open Science Framework registered DOI: 10.17605/OSF.IO/6QRYX, 10.17605/OSF.IO/AKVZ8, 10.17605/OSF.IO/EPVR5, 10.17605/OSF.IO/VXPRS.

Process evaluation of two participatory approaches: Implementing total worker health® interventions in a correctional workforce.

BACKGROUND: Correctional Officers (COs) have among the highest injury rates and poorest health of all the public safety occupations. The HITEC-2 (Health Improvement Through Employee Control-2) study uses Participatory Action Research (PAR) to design and implement interventions to improve health and safety of COs. METHOD: HITEC-2 compared two different types of participatory program, a CO-only "Design Team" (DT) and "Kaizen Event Teams" (KET) of COs and supervisors, to determine differences in implementation process and outcomes. The Program Evaluation Rating Sheet (PERS) was developed to document and evaluate program implementation. RESULTS: Both programs yielded successful and unsuccessful interventions, dependent upon team-, facility-, organizational, state-, facilitator-, and intervention-level factors. CONCLUSIONS: PAR in corrections, and possibly other sectors, depends upon factors including participation, leadership, continuity and timing, resilience, and financial circumstances. The new PERS instrument may be useful in other sectors to assist in assessing intervention success. Am. J. Ind. Med. 59:897-918, 2016. © 2016 Wiley Periodicals, Inc.

Participatory action research in corrections: The HITEC 2 program.

BACKGROUND: HITEC 2 (Health Improvement through Employee Control 2) is the follow-up to HITEC, a participatory action research (PAR) program that integrates health and work conditions interventions designed by the workforce. HITEC 2 compares intervention programs between two correctional sites, one using a pure workforce level design team and the other using a more structured and time delineated labor-management kaizen effectiveness team. METHODS: HITEC 2 utilizes a seven step participatory Intervention Design and Analysis Scorecard (IDEAS) for planning interventions. Consistent with PAR, process and intervention efficacy measures are developed and administered through workforce representation. RESULTS: Participation levels, robustness of participatory structures and sophistication of interventions have increased at each measured interval. Health comparisons between 2008 and 2013 showed increased hypertension, static weight maintenance, and increased 'readiness to change'. CONCLUSIONS: The PAR approaches are robust and sustained. Their long-term effectiveness in this population is not yet clear.

Musculoskeletal disorder symptoms in correction officers: why do they increase rapidly with job tenure?

OBJECTIVE: In this study, we sought to explain the rapid musculoskeletal symptomatology increase in correction officers (COs). BACKGROUND: COs are exposed to levels of biomechanical and psychosocial stressors that have strong associations with musculoskeletal disorders (MSDs) in other occupations, possibly contributing to their rapid health deterioration. METHOD: Baseline survey data from a longitudinal study of COs and manufacturing line workers were used to model musculoskeletal symptom prevalence and intensity in the upper (UE) and lower (LE) extremity. Outcomes were regressed on demographics and biomechanical and psychosocial exposures. RESULTS: COs reported significantly higher prevalence and intensity of LE symptoms compared to the industrial workers. In regression models, job tenure was a primary driver of CO musculoskeletal outcomes. In CO models, a single biomechanical exposure, head and arms in awkward positions, explained variance in both UE and LE prevalence (ß of 0.338 and 0.357, respectively), and low decision latitude was associated with increased LE prevalence and intensity (ß of 0.229 and 0.233, respectively). Manufacturing models were less explanatory. Examining demographic associations with exposure intensity, we found none to be significant in manufacturing, but in CO models, important psychosocial exposure levels increased with job tenure. CONCLUSION: Symptom prevalence and intensity increased more rapidly with job tenure in corrections, compared to manufacturing, and were related to both biomechanical and psychosocial exposures. Tenure-related increases in psychosocial exposure levels may help explain the CO symptom increase. APPLICATION: Although exposure assessment improvements are proposed, findings suggest focusing on improving the psychosocial work environment to reduce MSD prevalence and intensity in corrections.

Workplace cohort studies in times of economic instability.

BACKGROUND: A prospective study directed to musculoskeletal health in the manufacturing workforce. METHODS: A 36-month longitudinal study using mixed method; surveys with work and non-work psychosocial variables, physiologic measurements physical performance, interviews and focus groups, and direct observation of work activity. RESULTS: Changing economic conditions introduced barriers requiring recruiting a larger number of study sites. Study adherence was unexpectedly high. Coincident with their economic concerns, participants perceived an increase in workplace stress, but not physical demand. New instruments were added to assess economic effects on retirement planning and the physical and emotional costs of caregiving responsibilities. CONCLUSIONS: The economic conditions required adaptive alterations in design due to workforce volatility but presented opportunities for studying the link between working conditions and health. Nevertheless, study size expectations were met through an adaptive approach that suggests a potential effect of the economy on health and well-being.

Reference values for physical performance measures in the aging working population.

OBJECTIVE: The aim of this study was to determine reference physical performance values in older aging workers. BACKGROUND: Cross-sectional physical performance measures were collected for 736 manufacturing workers to assess effects of work and nonwork factors on age-related changes in musculoskeletal function and health. METHOD: Participants underwent surveys and physical testing that included bioelectrical impedance analysis, range-of-motion measures, exercise testing, and dynamic assessment. RESULTS: Physical characteristics, such as blood pressure and body fat percentage, were comparable to published values. Dynamic and range-of-motion measurements differed from published normative results. Women had age-related decreases in cervical extension and lateral rotation. Older men had better spinal flexion than expected. Predicted age-related decline in lower-extremity strength and shoulder strength in women was not seen. Men declined in handgrip, lower-extremity strength, and knee extension strength, but not trunk strength, across age groups. There was no appreciable decline in muscle fatigue at the trunk, shoulder, and knee with aging for either gender, except for the youngest age group of women. CONCLUSION: Normative values may underestimate physical performance in "healthy" older workers, thereby underappreciating declines in less healthy older workers. Work may be preservative of function for a large group of selected individuals. A "healthy worker effect" may be greater for musculoskeletal disease and function than for heart disease and mortality. APPLICATION: Clinicians and researchers studying musculoskeletal function in older workers can use a more specific set of reference values.

Talking about health: correction employees' assessments of obstacles to healthy living.

OBJECTIVE: Describe health risks/obstacles to health among correctional employees. METHODS: Mixed-methods approach combined results from four focus groups, 10 interviews, 335 surveys, and 197 physical assessments. RESULTS: Obesity levels were higher than national averages (40.7% overweight and 43.3% obese), with higher levels associated with job tenure, male gender, and working off-shift. Despite widespread concern about the lack of fitness, leisure exercise was higher than national norms. Respondents had higher levels of hypertension than national norms, with 31% of men and 25.8% of women hypertensive compared with 17.1% and 15.1% for national norms. Stress levels were elevated. Officers related their stress to concerns about security, administrative requirements, and work/family imbalance. High stress levels are reflected in elevated levels of hypertension. CONCLUSIONS: Correctional employees are at high risk for chronic disease, and environmental changes are needed to reduce risk factors.

Musculoskeletal disorders of the neck and shoulder in the dental professions.

The prevalence of and risk factors for neck and shoulder disorders among dental practitioners (dentists, dental hygienists, and dental assistants) is reviewed. Dentists report 26-73% period prevalence of neck symptoms over the previous year, and 20-65% with shoulder symptoms. Dental hygienists report even higher rates, from 54-83% for neck and 35-76% for shoulder, and dental assistants in between (38-62% and 27-62% respectively). Symptoms begin to appear early in the career, with significant increases upon starting clinical practice. Significant social and economic consequences have been reported, including leaving the profession or reducing hours. While ergonomic improvements appear to have some positive impact, these have not been well studied, and some changes (such as the historic shift from standing to seated posture) may have moved risk from the lower back to the upper extremities. Static awkward posture, particularly those with isometric contractions of the trapezius, has been identified as a risk factor particular to these occupations. Ergonomic improvements, health promotion, and organizational interventions have been suggested as needs for reducing risk.

The effect of different warming methods on sensory nerve conduction velocity in shipyard workers occupationally exposed to hand-arm vibration.

OBJECTIVES: Segmental sensory nerve conduction velocity (SNCV) was measured from the wrists to the hands and digits in a population of 134 (126 men and 8 women) vibration-exposed shipyard workers following systemic warming using a bicycle ergometer. Results were compared to earlier nerve conduction tests, identical in execution, except that the warming process was segmental and cutaneous. The study was designed to investigate whether SNCVs, which were selectively slow in the fingers after segmental cutaneous (skin surface) warming, would be affected differently by systemic warming. METHODS: Wrist-palm, palm-proximal digit, and digital sensory nerve segments were assessed antidromically by stimulating at the wrist with recording electrodes placed distally. The same subjects were cutaneously warmed in 2001 to >or=31 degrees C and were systemically warmed 28 months later in 2004 by ramped sustained exercise to 100 W for 12 min. Skin temperatures were measured by traditional thermistry and by infrared thermal images taken over the hand and wrist surfaces. RESULTS: When systemic warming was compared to segmental cutaneous warming, SNCVs were increased by 15.1% in the third digit and 20.4% in the fifth digit of the dominant hand. Respective increases in the non-dominant hand were 11.0% and 19.4%. A strong association between increased surface skin temperature and faster SNCV, which had been observed after segmental cutaneous warming, was largely eliminated for both digit and palmar anatomic segments after systemic warming. Significant differences in SNCV between vibration-exposed and non-exposed workers, which had been observed after segmental cutaneous warming, were eliminated after systemic warming. Systemic warming had only a small effect on the wrist-palm (transcarpal) segmental SNCVs. CONCLUSIONS: Reduced SNCV in the digits was observed in vibration-exposed and non-exposed workers. Substituting exercise-induced systemic warming for segmental cutaneous warming significantly increased SNCV in the digits and appeared to reduce differences in SNCV between vibration-exposed and non-exposed workers. These findings persisted despite a substantial time interval between tests, during which the subjects continued to work. There may be more general implications for diagnosing clinical conditions in industrial workers, such as the carpal tunnel syndrome and the hand-arm vibration syndrome.

Syndromes from segmental vibration and nerve entrapment: observations on case definitions for carpal tunnel syndrome.

OBJECTIVES: The purpose of this paper is to assess the overlap and stability of two different case definitions of carpal tunnel syndrome CTS. The analysis considers the association between different case definitions and objective tests (sensory nerve conduction velocities, SNCVs and vibrotactile perception thresholds, TTS), and the natural history of CTS, in the context of two vibration-exposed cohorts. METHODS: Clinical CTS cases were defined in two ways: (1) by the study physician using fixed criteria, and; (2) by questionnaire and hand diagram. SNCV in median and ulnar nerves was measured for digital, transpalmar, and transcarpal segments, and conventionally as from wrist-digit. Skin temperature was assessed as a point measurement by thermistor and regionally by thermal imaging. VTTs were determined at the bilateral fingertips of the third and fifth digits using a tactometer meeting the requirements of ISO 13091-1 (ISO 2001). The subjects were cohorts of shipyard workers in 2001 and 2004, and dental hygienists in 2002 and 2004. RESULTS: Results are reported for 214 shipyard workers in 2001 and 135 in 2004, and for 94 dental hygienists in 2002 and 66 in 2004. In 2001, 50% of shipyard workers were diagnosed as CTS cases by at least one of the diagnostic schemes, but only 20% were positive by both criteria. Among study physician diagnosed cases, 64% were CTS negative in 2001, 76% were negative in 2004, 13% were positive in both years, 22% became negative after being positive, and 11% became positive after being negative. For only study physician diagnosed CTS did VTTs differ between cases differ and non-cases in digit 3; there was no such distinction in digit 5. The dental hygienists had little CTS. CONCLUSION: Clinical case definitions of CTS based on diagrams and self-assessment, and clinical evaluation have limited overlap. Combining clinical criteria to create a more narrow or specific case definition of CTS does not appear to predict SNCV. The natural history of CTS suggests a protean disorder with considerable flux in case status over time.