Feasibility of Implementing a Total Worker Health® Intervention During the COVID-19 Pandemic in Small and Medium Businesses : Results From the Carolina PROSPER Study.

OBJECTIVE: In response to the COVID-19 pandemic's disruptive effect on employers and workers, an interdisciplinary team launched the Carolina Promoting Safe Practices for Employees' Return study to assess the feasibility of providing tailored technical assistance to small and medium North Carolina businesses using a Total Worker Health (TWH) ® approach. METHODS: Feasibility of the approach was assessed via surveys and interviews of business representatives from four participating businesses ranging in size from 3 to 110 employees. RESULTS: The TWH approach is feasible, that is, in demand, practical, and acceptable to protect and promote worker safety, health, and well-being. Potential challenges include implementation cost, difficulty engaging all employees, and difficulty accessing tailored health and safety materials in a timely manner. CONCLUSIONS: Additional refinement and testing of the TWH approach postpandemic with more worksites is warranted.

The Potential for Total Worker Health® Approaches in State and Territorial Health Departments : A National Mixed-Methods Study.

OBJECTIVE: To document the extent to which state and territorial health departments (SHDs) integrate their occupational safety and health (OSH) and workplace health promotion (WHP) activities consistent with a Total Worker Health (TWH) approach. METHODS: Nationally representative survey of OSH and WHP practitioners at 56 SHDs followed by in-depth interviews. RESULTS: Despite reporting limited awareness of the TWH initiative and TWH resources, most respondents (57% OSH, 64% WHP) reported collaboration between OSH and WHP staff in their departments. Collaborations were described in-depth. Barriers to OSH-WHP collaborations included resource insufficiencies, organizational structure in the SHD, and conflicting practices. Facilitators included knowledge of TWH approaches, proximity to TWH Centers of Excellence, proximity between OSH/WHP programs, and leadership initiative. Motivations for collaboration were enumerated. CONCLUSIONS: Strategies for building TWH capacity and activity among SHDs are discussed.

Education and Training to Build Capacity in Total Worker Health®: Proposed Competencies for an Emerging Field.

OBJECTIVE: Establishment of core competencies for education and training of professionals entering the emerging field of Total Worker Health®. METHODS: Compilation and distillation of information obtained over a 5-year period from Total Worker Health symposia, workshops, and academic offerings, plus contributions from key stakeholders regarding education and training needs. RESULTS: A proposed set of Total Worker Health competencies aligns under six broad domains: Subject Matter Expertize; Advocacy and Engagement; Program Planning, Implementation and Evaluation; Communications and Dissemination; Leadership and Management; and Partnership Building and Coordination. CONCLUSIONS: Proposed set of core competencies will help standardize education and training for professionals being trained in Total Worker Health. It serves as an invitation for further input from stakeholders in academia, business, labor, and government.

Nursing Assistants' Use of Personal Protective Equipment Regarding Contact With Excreta Contaminated With Antineoplastic Drugs.

PURPOSE: To examine the feasibility of observing and interviewing nursing assistants about handling of antineoplastic drugs contaminated with excreta, acceptability of a measure of personal protective equipment (PPE) use with nursing assistants, and predictors of PPE use. PARTICIPANTS & SETTING: 27 nursing assistants in an inpatient hematology-oncology unit at an academic medical center in the southeastern United States. METHODOLOGIC APPROACH: This was an exploratory, multimethod study using observation, verbally administered questionnaires, and interviews. Research variables included recruitment rates, acceptability of observation, and understandability of a safe-handling instrument. FINDINGS: Observed use of double gloves, chemotherapy gowns, and face shields was low; use of plastic-backed pads when flushing excreta was high. IMPLICATIONS FOR NURSING: Nursing assistants are willing to participate in research. Standardized training and education about PPE use are needed.

Results of the Workplace Health in America Survey.

PURPOSE: To provide a nationally representative snapshot of workplace health promotion (WHP) and protection practices among United States worksites. DESIGN: Cross-sectional, self-report Workplace Health in America (WHA) Survey between November 2016 and September 2017. SETTING: National. PARTICIPANTS: Random sample of US worksites with ≥10 employees, stratified by region, size, and North American Industrial Classification System sector. MEASURES: Workplace health promotion programs, program administration, evidence-based strategies, health screenings, disease management, incentives, work-life policies, implementation barriers, and occupational safety and health (OSH). ANALYSIS: Descriptive statistics, t tests, and logistic regression. RESULTS: Among eligible worksites, 10.1% (n = 3109) responded, 2843 retained in final sample, and 46.1% offered some type of WHP program. The proportion of comparable worksites with comprehensive programs (as defined in Healthy People 2010) rose from 6.9% in 2004 to 17.1% in 2017 ( P < .001). Occupational safety and health programs were more prevalent than WHP programs, and 83.5% of all worksites had an individual responsible for employee safety, while only 72.2% of those with a WHP program had an individual responsible for it. Smaller worksites were less likely than larger to offer most programs. CONCLUSION: The prevalence of WHP programs has increased but remains low across most health programs; few worksites have comprehensive programs. Smaller worksites have persistent deficits and require targeted approaches; integrated OSH and WHP efforts may help. Ongoing monitoring using the WHA Survey benchmarks OSH and WHP in US worksites, updates estimates from previous surveys, and identifies gaps in research and practice.

Workplace health promotion and safety in state and territorial health departments in the United States: a national mixed-methods study of activity, capacity, and growth opportunities.

BACKGROUND: State and Territorial Health Departments (SHDs) have a unique role in protecting and promoting workers' health. This mixed-methods study presents the first systematic investigation of SHDs' activities and capacity in both Occupational Safety and Health (OSH) and Workplace Health Promotion (WHP) in the United States (US). METHODS: National survey of OSH and WHP practitioners from each of 56 SHDs, followed by in-depth interviews with a subset of survey respondents. We calculated descriptive statistics for survey variables and conducted conventional content analysis of interviews. RESULTS: Seventy percent (n = 39) of OSH and 71% (n = 40) of WHP contacts responded to the survey. Twenty-seven (n = 14 OSH, n = 13 WHP) participated in follow-up interviews. Despite limited funding, staffing, or organizational support, SHDs reported a wide array of activities. We assessed OSH and WHP surveillance activities, support that SHDs provided to employers to implement OSH and WHP interventions (implementation support), OSH and WHP services provided directly to workers, OSH follow-back investigations, and OSH standard and policy development. Each of the categories we asked about (excluding OSH standard and policy development) were performed by more than half of responding SHDs. Surveillance was the area of greatest OSH activity, while implementation support was the area of greatest WHP activity. Respondents characterized their overall capacity as low. Thirty percent (n = 9) of WHP and 19% (n = 6) of OSH respondents reported no funds at all for OSH/WHP work, and both groups reported a median 1.0 FTEs working on OSH/WHP at the SHD. Organizational support for OSH and WHP was characterized as "low" to "moderate". To increase SHDs' capacity for OSH and WHP, interview respondents recommended that OSH and WHP approaches be better integrated into other public health initiatives (e.g., infectious disease prevention), and that federal funding for OSH and WHP increase. They also discussed specific recommendations for improving the accessibility and utility of existing funding mechanisms, and the educational resources they desired from the CDC. CONCLUSIONS: Results revealed current activities and specific strategies for increasing capacity of SHDs to promote the safety and health of workers and workplaces - an important public health setting for reducing acute injury and chronic disease.

Latvian family physicians' experience diagnosing depression in somatically presenting depression patients: A qualitative study.

BACKGROUND: Depression continues to be under-diagnosed in primary care settings. One factor that influences physicians' likelihood of diagnosing depression is patients' presentation style. Patients who initially present with somatic symptoms are diagnosed at a lower rate and with greater delay than patients who present with psychosocial complaints. OBJECTIVES: To identify the barriers preventing depression diagnosis in somatically presenting patients in an Eastern European primary care setting. METHODS: Thematic analysis of semi-structured interviews with 16 family physicians (FPs) in Latvia. FPs were sampled using a maximum variation strategy, varying on patient load, urban/rural setting, FP gender, presence/absence of on-site mental health specialists, and FP years of practice. RESULTS: FPs observed that a large subgroup of depression patients presented with solely somatic complaints. FPs often did not recognize depression in somatically presenting patients until several consultations had passed without resolution of the somatic complaint. When FPs had psychosocial information about the somatically presenting patient, they recognized depression more quickly. Use of depression screening questionnaires was rare. Barriers to diagnosis continued beyond recognition. Faced with equivocal symptoms that undermined clinical certainty, FPs postponed investigating their clinical suspicion that the patient had depression and pursued physical examinations that delayed depression diagnosis. FPs also used negative physical examination results to convince reluctant patients of a depression diagnosis. CONCLUSION: Delayed recognition, the need to rule out physical illness, and the use of negative physical examination results to discuss depression with patients all slowed the path to depression diagnosis for somatically presenting patients in Latvian primary care.

PdeB, a cyclic Di-GMP-specific phosphodiesterase that regulates Shewanella oneidensis MR-1 motility and biofilm formation.

Shewanella oneidensis MR-1, a gammaproteobacterium with respiratory versatility, forms biofilms on mineral surfaces through a process controlled by the cyclic dinucleotide messenger c-di-GMP. Cellular concentrations of c-di-GMP are maintained by proteins containing GGDEF and EAL domains, which encode diguanylate cyclases for c-di-GMP synthesis and phosphodiesterases for c-di-GMP hydrolysis, respectively. The S. oneidensis MR-1 genome encodes several GGDEF and EAL domain proteins (50 and 31, respectively), with a significant fraction (∼10) predicted to be multidomain (e.g., GGDEF-EAL) enzymes containing an additional Per-Arnt-Sim (PAS) sensor domain. However, the biochemical activities and physiological functions of these multidomain enzymes remain largely unknown. Here, we present genetic and biochemical analyses of a predicted PAS-GGDEF-EAL domain-containing protein, SO0437, here named PdeB. A pdeB deletion mutant exhibited decreased swimming motility and increased biofilm formation under rich growth medium conditions, which was consistent with an increase in intracellular c-di-GMP. A mutation inactivating the EAL domain also produced similar swimming and biofilm phenotypes, indicating that the increase in c-di-GMP was likely due to a loss in phosphodiesterase activity. Therefore, we also examined the enzymatic activity of purified PdeB and found that the protein exhibited phosphodiesterase activity via the EAL domain. No diguanylate cyclase activity was observed. In addition to the motility and biofilm phenotypes, transcriptional profiling by DNA microarray analysis of biofilms of pdeB (in-frame deletion and EAL) mutant cells revealed that expression of genes involved in sulfate uptake and assimilation were repressed. Addition of sulfate to the growth medium resulted in significantly less motile pdeB mutants. Together, these results indicate a link between c-di-GMP metabolism, S. oneidensis MR-1 biofilm development, and sulfate uptake/assimilation.

Indirect modulation of the intracellular c-Di-GMP level in Shewanella oneidensis MR-1 by MxdA.

The GGDEF domain protein MxdA, which is important for biofilm formation in Shewanella oneidensis MR-1, was hypothesized to possess diguanylate cyclase activity. Here, we demonstrate that while MxdA controls the cellular level of c-di-GMP in S. oneidensis, it modulates the c-di-GMP pool indirectly.