Drivers of international variation in prevalence of disabling low back pain: Findings from the Cultural and Psychosocial Influences on Disability study.

BACKGROUND: Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally. METHODS: Baseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline ('pain propensity index'). After a mean interval of 14 months, 9055 participants (77.3%) provided follow-up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow-up were assessed by random intercept Poisson regression. RESULTS: After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95% CI: 2.2-3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within-country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58). CONCLUSIONS: Within our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine. SIGNIFICANCE: Our findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working age.

An initial radiation safety needs assessment of Costa Rica: the South Texas Chapter of the Health Physics Society's strategic planning appraisal for participation in the "Radiation Safety Without Borders" initiative.

In response to the Health Physics Society's recent 'radiation safety without borders" initiative, the South Texas Chapter of the Health Physics Society selected Costa Rica as its partner country of choice. To develop an understanding of the radiation safety needs of this country, the fall 2001 University of Texas Health Science Center at Houston School of Public Health Environmental Radiation and Radioactivity class was tasked with the assignment of assessing the possible radiation safety needs and concerns for this country. The assignment culminated in a class presentation to the membership of the South Texas Chapter during its annual fall meeting. Using library and web based resources, tile students reviewed a number of public health and radiation-related topics. Life expectancies were found to be equivalent to the United States, even though significant differences in per capita health expenditures were noted. Costa Rica exhibited lower population mortality rates from major causes such as cardiovascular diseases, neoplasms, and external sources. Maternal and infant mortality rates were found to be much higher in Costa Rica than in the United States. Naturally occurring radiation sources such as uranium deposits were not identified as apparent major radiation issues of concern, although ultraviolet radiation exposures are consistently high. Several recent events in the country and the region involving patient overexposures suggest that concerns are likely focused on ensuring the proper use and maintenance of healing arts radiation equipment. The lack of available information on radioactive waste disposal suggests that waste handling also may be an issue warranting attention. The exercise proved to be very educational for the students, and the information gathered will serve to focus the Chapter's efforts when technical exchanges are initiated. The importance of linking this initiative to other existing programs within the country is also discussed.

Safety climate and its association with injuries and safety practices in public hospitals in Costa Rica.

In response to growing concern for occupational health and safety in the public hospital system in Costa Rica, a cross-sectional survey of 1,000 hospital-based health care workers was conducted in 1997 to collect baseline data that are being used to develop worker training programs in occupational health in Costa Rica. The objectives of this survey were to: 1) describe the safety climate within the national hospital system, 2) identify factors associated with safety, and 3) evaluate the relationship between safety climate and workplace injuries and safety practices of employees. The safety climate was found to be very poor. The two most significant predictors of safety climate were training and administrative support for safety. Safety climate was a statistically significant predictor of workplace injuries and safety practices, respectively, and there was an underreporting rate of 71% of workplace injuries. These findings underscore the need for improvement of the safety climate in the public hospital system in Costa Rica.

The role of information dissemination in sustainability of international partnerships.

The Fogarty-supported International Training Program of the Southwest Center for Occupational and Environmental Health (SWCOEH) at the University of Texas School of Public Health was initiated in 1995, with its activities focused primarily on Latin America. As this program has matured, its participants have been concerned about including elements that increase the likelihood that its trainees and projects will have a sustainable impact on occupational and environmental health in collaborating countries. The Center recently reviewed the experiences of various international organizations and national development agencies with established track records involving donor-supported projects. The authors summarize factors associated with project sustainability and describe how some of them are being incorporated into the SWCOEH program. Particular mention is made of the importance of supporting an infrastructure for broad information dissemination in the language of the intended audience. An example of a project to support a peer-reviewed Spanish-language journal devoted to occupational and environmental health, Salud de los Trabajadores, is presented.

The effectiveness of a needleless intravenous connection system: an assessment by injury rate and user satisfaction.

OBJECTIVE: To assess the impact of a needleless intravenous (i.v.) connection system on the rate of reported intravenous-connection-related (IVCR) percutaneous injuries, and to assess user satisfaction, frequency of use, and barriers to use. DESIGN: A pre-post intervention design, with injury incidence rates being compared 3 years before and 1 year after hospital wide device implementation; and a cross-sectional descriptive user satisfaction survey. SETTING: Two tertiary-care teaching hospitals, one general and one pediatric, located in a large metropolitan medical center. OUTCOME VARIABLE: All IVCR percutaneous injuries reported to the employee health services at both hospitals during the years from 1989 to 1991 and 1993. STUDY POPULATION: Survey participants were selected randomly from licensed nursing employees at both hospitals. INTERVENTION: i.v. connection system consisting of blunt plastic cannulas and compressed latex injection sites. RESULTS: After device implementation, the IVCR injury rate was reduced 62.4% (rate ratio [RR], 0.38; 95% confidence interval [CI95], 0.27-0.53) at the general hospital and 70.2% (RR, 0.30; CI95, 0.17-0.53) at the pediatric hospital. After adjusting for the reduction in injury rate due to factors other than device implementation, the IVCR injury rate was reduced 54.5% (adjusted RR, 0.46; CI95, 0.32-0.65) at the general hospital and 57.2% (adjusted RR, 0.43; CI95, 0.24-0.78) at the pediatric hospital. Approximately 94% of survey respondents (n = 478, response rate = 51%) were satisfied with the device and recommended continued use. However, needles still were being used for activities that could have been performed with the needleless system because of compatibility, accessibility, and other technical problems related to the device. CONCLUSIONS: The device was effective in reducing the rate of reported IVCR percutaneous injuries and users were satisfied with the device, but barriers to universal use were identified.

Compliance with universal precautions among physicians.

This study characterized and assessed self-reported levels of compliance with universal precautions (UP) among hospital-based physicians, and determined significant factors associated with both compliance and noncompliance. The physicians (n = 322) were a subgroup of a larger study population of hospital-based health care workers recruited from three geographically distinct locations (n = 1746), and were surveyed using a detailed confidential questionnaire that assessed personal, work-related, and organizational factors. Compliance with UP was measured through 11 items that examined how often physicians followed specific recommended work practices. Compliance was found to vary among the 11 items: they were high for certain activities (eg, glove use, 94%; disposal of sharps, 92%) and low for others (eg, wearing protective clothing, 55%; not recapping needles, 56%). Compliance with all items was low (31% to 38%). Stepwise logistic regression revealed that noncompliant physicians were likely to be age 37 or older, to report high work stress, and to perceive a conflict of interest between providing patient care and protecting themselves. Compliant physicians were more likely to be knowledgeable and to have been trained in universal precautions, to perceive protective measures as being effective, and to perceive an organizational commitment to safety.

Compliance with universal precautions among health care workers at three regional hospitals.

OBJECTIVE: To assess and characterize self-reported levels of compliance with universal precautions among hospital-based health care workers and to determine correlates of compliance. DESIGN: Confidential questionnaire survey of 1716 hospital-based health care workers. PARTICIPANTS: Participants were recruited from three geographically distinct hospitals. A stratified convenience sample of physicians, nurses, technicians, and phlebotomists working in emergency, surgery, critical care, and laboratory departments was selected from employment lists to receive the survey instrument. All participants had direct contact with either patients or patient specimens. RESULTS: For this study, overall compliance was defined as "always" or "often" adhering to the desired protective behavior. Eleven different items composed the overall compliance scale. Compliance rates varied among the 11 items, from extremely high for certain activities (e.g., glove use, 97%; disposal of sharps, 95%) to low for others (e.g., wearing protective outer clothing, 62%; wearing eye protection, 63%). Compliance was strongly correlated with several key factors: (1) perceived organizational commitment to safety, (2) perceived conflict of interest between workers' need to protect themselves and their need to provide medical care to patients; (3) risk-taking personality; (4) perception of risk; (5) knowledge regarding routes of HIV transmission; and (6) training in universal precautions. Compliance rates were associated with some demographic characteristics: female workers had higher overall compliance scores than did male workers (25% of female and 19% of male respondents circled "always" or "often" on each of the 11 items, p < 0.05); and overall compliance scores were highest for nurses, intermediate for technicians, and lowest for physicians. Overall compliance scores were higher for the mid-Atlantic respondents (28%) than for those from the Southwest (20%) or Midwest (20%, p = 0.001). CONCLUSIONS: This study supports earlier findings regarding several compliance correlates (perception of risk, knowledge of universal precautions), but it also identifies important new variables, such as the organizational safety climate and perceived conflict of interest. Several modifiable variables were identified, and intervention programs that address as many of these factors as possible will probably succeed in facilitating employee compliance.