Comprehension of Safety Pictograms Affixed to Agricultural Machinery among Pakistani Migrant Farmworkers in Italy.

Objectives: Safety pictograms are important graphic elements that are useful for rapidly conveying messages in workplaces. The purpose of this study was to investigate the comprehension of safety pictograms affixed to agricultural machinery among a group of Pakistani migrant farmworkers employed in Italy. Methods: Interviews about the meanings attributed to four standardized safety pictograms affixed to agricultural machinery depicting the most frequent causes of farm accidents were administered to 29 Pakistani migrant farmworkers employed on Italian farms. Results: There was high variability in pictogram comprehension. None of the participants interpreted all the pictograms in accordance with the definitions provided by the international standards. Higher comprehension rates were reported for pictograms related to the risks of tractor rollover and foot injury, while pictograms referring to the need to consult a technical manual and the risk of entanglement yielded lower comprehension scores. Previous farming experience in the country of origin and the number of years of education were significantly associated with comprehension scores. Conclusion: A discussion of pictogram features that may be critical for comprehension is provided, and (re)design suggestions are given to improve the cross-cultural comprehension of these safety signs.

Halo and spillover effect illustrations for selected beneficial medical devices and drugs.

BACKGROUND: Negative news media reports regarding potential health hazards of implanted medical devices and pharmaceuticals can lead to a 'negative halo effect,' a phenomenon whereby judgments about a product or product type can be unconsciously altered even though the scientific support is tenuous. To determine how a 'negative halo effect' may impact the rates of use and/or explantation of medical products, we analyzed the occurrence of such an effect on three implanted medical devices and one drug: 1) intrauterine contraceptive devices (IUDs); 2) silicone gel-filled breast implants (SGBI); 3) metal-on-metal hip implants (MoM); and 4) the drug Tysabri. METHODS: Data on IUD use from 1965 to 2008 were gathered from the Department of Health and Human Services Vital and Health Statistics and peer-reviewed publications. Data regarding SGBI implant and explantation rates from 1989 to 2012 were obtained from the Institute of Medicine and the American Society of Plastic Surgeons. MoM implant and explantation data were extracted from the England and Wales National Joint Registry and peer-reviewed publications. Tysabri patient data were reported by Elan Corporation or Biogen Idec Inc. Data trends for all products were compared with historical recall or withdrawal events and discussed in the context of public perceptions following such events. RESULTS: We found that common factors altered public risk perceptions and patterns of continued use. First, a negative halo effect may be driven by continuing patient anxiety despite positive clinical outcomes. Second, negative reports about one product can spill over to affect the use of dissimilar products in the same category. Third, a negative halo effect on an entire category of medical devices can be sustained regardless of the scientific findings pertaining to safety. Fourth, recovery of a product's safety reputation and prevalent use may take decades in the U.S., even while these products may exhibit widespread use and good safety records in other countries. CONCLUSIONS: We conclude that the 'negative halo effect' associated with a stigma, rather than an objective risk-benefit assessment of medical products can increase negative health outcomes for patients due to reduced or inappropriate product usage.

The Helmet Fit Index--An intelligent tool for fit assessment and design customisation.

Helmet safety benefits are reduced if the headgear is poorly fitted on the wearer's head. At present, there are no industry standards available to assess objectively how a specific protective helmet fits a particular person. A proper fit is typically defined as a small and uniform distance between the helmet liner and the wearer's head shape, with a broad coverage of the head area. This paper presents a novel method to investigate and compare fitting accuracy of helmets based on 3D anthropometry, reverse engineering techniques and computational analysis. The Helmet Fit Index (HFI) that provides a fit score on a scale from 0 (excessively poor fit) to 100 (perfect fit) was compared with subjective fit assessments of surveyed cyclists. Results in this study showed that quantitative (HFI) and qualitative (participants' feelings) data were related when comparing three commercially available bicycle helmets. Findings also demonstrated that females and Asian people have lower fit scores than males and Caucasians, respectively. The HFI could provide detailed understanding of helmet efficiency regarding fit and could be used during helmet design and development phases.

CARE OF A PATIENT'S VASCULAR ACCESS FOR HAEMODIALYSIS: A NARRATIVE LITERATURE REVIEW.

BACKGROUND: Patients requiring haemodialysis have diverse clinical needs impacting on the longevity of their vascular access and their quality of life. A clinical practice scenario is presented that raises the potential of unsafe cannulation of a patient's vascular access as a result of minimal patient empowerment. Vascular access care is the responsibility of everyone, including the patient and carer. AIM: The aim of this narrative literature review (1997-2014) is to explore the current understanding of what factors influence the care of vascular access for haemodialysis. METHOD: A narrative literature review allows the synthesis of the known literature pertinent to the research question into a succinct model or unique order to enable new understandings to emerge. The bio-ecological model was used to guide the thematic analysis of the literature. RESULTS: The narrative literature review revealed five themes related to care of vascular access: patient experience; relationships-empowerment and shared decision making; environment of healthcare; time; and quality of life as the outcome of care. CONCLUSION: The management of vascular access is complicated. Current available literature predominantly concentrates on bio-medical aspects of vascular access care. Contextualised vascular access care in the complex ecology of the patient and carer's lives has the potential to enhance nursing practice and patient outcomes.

Implementing evidence-based policy in a network setting: road safety policy in the Netherlands.

In the early 1990s, in order to improve road safety in The Netherlands, the Institute for Road Safety Research (SWOV) developed an evidence-based "Sustainable Safety" concept. Based on this concept, Dutch road safety policy, was seen as successful and as a best practice in Europe. In The Netherlands, the policy context has now changed from a sectoral policy setting towards a fragmented network in which safety is a facet of other transport-related policies. In this contribution, it is argued that the implementation strategy underlying Sustainable Safety should be aligned with the changed context. In order to explore the adjustments needed, two perspectives of policy implementation are discussed: (1) national evidence-based policies with sectoral implementation; and (2) decentralized negotiation on transport policy in which road safety is but one aspect. We argue that the latter approach matches the characteristics of the newly evolved policy context best, and conclude with recommendations for reformulating the implementation strategy.

Securing the safety of our most precious cargo: SAFE KIDS.

There are staggering and tragic statistics involving children, car seats, and motor vehicle accidents. According to the Centers for Disease Control and Prevention, motor vehicle injuries are the leading cause of death among children from 0 to 15 years of age, and in the United States during 2005, 1,335 children ages 14 years and younger died as occupants in motor vehicle accidents; approximately 184,000 were injured. That is an average of 4 deaths and 504 injuries each day. National Highway Traffic Safety Administration (NHTSA) statistics show that nearly one-half of deaths and injuries in children occurred because they were not properly restrained. Child safety seats and safety belts, when installed and used properly, can prevent injuries and save lives. Among children under age 5, an estimated 425 lives were saved in 2006 by child restraint use. Research on the effectiveness of child safety seats has found them to reduce fatal injury by 71% for infants, and by 54% for toddlers in passenger cars. This article discusses the need for increased education of parents and healthcare professionals about selection and installation of car safety restraints, and the importance of developing a child safety restraint program.

Traffic safety behaviour among young people in different residential settings: the use of seat belts, bicycle helmets, and reflectors by young people in Sweden.

This study examines if, and how, the size of the community in which people live may contribute to explaining differences in traffic safety behaviour (self-reported behaviour regarding the use of seat belts, bicycle helmets and reflectors) among young people in Sweden. The study is based on a Swedish nationwide traffic safety survey with a net sample of 2854 respondents aged 16-25. Ordered logit regressions were performed, and place of residence is shown to have an impact on traffic safety behaviour. The results are presented and discussed in relation to risk exposure and traffic safety facilities in different settings. The implications of the study are considered, and the importance of investigating the way in which young people see traffic safety behaviour is emphasised.

Patient evaluation of ICD recall communication strategies: a vignette study.

INTRODUCTION: Communication about the unprecedented number of implantable cardioverter defibrillator (ICD) recalls has proved challenging. While initial studies have explored the psychological impact of recalls on patients, the optimal way to communicate recalls is not currently known. This study investigated the way communication of a recall can affect patients' responses. METHODS: Sixty-six ICD patients read one of six vignettes that detailed a hypothetical device recall. Vignette variables included the source of recall dissemination (physician vs. media vs. device manufacturer) and the personal relevance (own brand is recalled vs. different brand is recalled). Subsequently, patients rated their agreement to 12 statements concerning their response to the recall on a scale from 1 (Strongly Disagree) to 5 (Strongly Agree). RESULTS: Patients were significantly more confident in the accuracy of recall information from both their physician and their manufacturer compared with the media, F (2, 63) = 36.10, P < 0.01, eta(2)= 0.53. Interestingly, patients were concerned about the recall regardless of whether their brand of ICD was recalled. Survey results indicated that 78.6% of patients reported learning about recalls from the media. In stark contrast, 77.0% of patients asserted preferring to learn about recalls from their physician. CONCLUSIONS: ICD patients report increased confidence in the accuracy of the recall information from physicians and manufacturers compared with the media in reporting recalls. Because it seems that most ICD patients learn about recalls from the media, these results demonstrate a disconnect between the initial source of recall information and the patients' desired sources.

Institutional decision-making to select patient care devices: identifying venues to promote patient safety.

Many medical errors that involve drug infusion devices are related to classic interface problems. Although manufacturers are becoming increasingly aware of human factors design considerations, many devices that are currently on the market are still sub-optimal for human use. This places significant responsibility for device selection on institutional purchasing groups. Theories of naturalistic decision-making point to many potential strengths and pitfalls of group decision-making processes that may affect the final outcome. This paper describes a retrospective analysis of decision-making process for infusion pump selection in a large hospital and focuses on factors related to patient safety. Through a series of detailed interviews and a study of relevant documentation we characterized the nature of the decision-making, patterns of communication, and the roles of different participants. Findings show that although the process involves a number of different professional groups and committees, the information flow among them is restricted. This results in inadequate representation of critical device usability considerations in the decision-making process. While all participants view device safety as an important consideration in the selection process, administrators (who are the final decision-makers) tend to equate safety with technical accuracy and reliability, paying less attention to the role of human factors in safe device use. Findings suggest that collaborative communication technology and automated evidence-based guidelines could provide support to institutional decision-making, ensuring that the process is efficient, effective, and ultimately safe for the patients.

Effects of training and experience on perception of hazard and risk.

This study was designed to show how those proficient at a machining task, where proficiency was gained through both training and past experience, influence the perceived hazard and risk when observing Computer Numerical Control (CNC) machining. The study was also designed to determine whether the impact of the visual and auditory cues can be isolated during diagnosis of the hazard. In a study that included 40 participants, results show that trained observers can perceive more correctly a hazardous condition which is different from what one would predict based on psychophysics. The results also show that trained participants relied strongly on the auditory cues to diagnose the potential hazard and risk correctly whereas the untrained participants who had access to both auditory and visual senses perceived the potential hazard more incorrectly than those trained and more similarly to a traditional Stevens' psychophysical curve. Untrained subjects who had only auditory input had the most difficulty in distinguishing differences in the perception of hazard. This is important considering recent dialogue about whether there is a need to train for tasks that will be automated. The idea of training, especially for automated tasks, is important in allowing better recognition of hazard and risk in unusual circumstances. Additional research may help to improve the diagnosis of hazard and risk and may enable generalization of the results to other training scenarios in the manufacturing and services industries.

Left ventricular assist devices and the slippery slope of ageism.

The use of left ventricular assist devices is growing each year, as is the size of the United Network for Organ Sharing cardiac waiting pool. Notably, the geriatric waiting pool (age 65 and older), although small, is growing each year and this growth is predicted to increase as geriatric population projection curves soar. While left ventricular assist devices have clinically proven benefit, their use in geriatric patients raises ethical issues. Where these devices are currently not approved as destination therapy, their use must be reflected upon in conjunction with allograft transplantation. Age-based organ allocation policies could facilitate left ventricular assist devices as a bridge to nowhere for some geriatric patients. Specifically, the extended use of a left ventricular assist device by older patients could, in theory, put them in a position of not being able to get an allograft due to the fact that they have aged while on the waiting list. Unless these devices are approved as destination therapy, or age-based organ allocation policies contain exception clauses, an older person's cardiac dilemma could be confounded as an assist device recipient. Without these measures one might argue the devices themselves should be subject to age-based allocation procedures. Is this the slippery slope of ageism?