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Applying risk perception theory to public health workforce preparedness training.

Since 9/11, public health has seen a progressive culture change toward a 24/7 emergency response organizational model. This transition entails new expectations for public health workers, including (1) a readiness and willingness to report to duty in emergencies and (2) an ability to effectively communicate risk to an anxious public about terrorism or naturally occurring disasters. To date, however, research on readiness education for health department workers has focused little attention upon the risk perceptions that may influence their willingness to report to duty during disasters, as well as their ability to provide effective emergency risk communication to the public. Here, we apply risk perception factors to explore the potential barriers and remedies to effective public health workforce emergency response.

Attitude of Health Personnel↗

Assessment of public health workforce bioterrorism and emergency preparedness readiness among tribes in Washington State: a collaborative approach among the Northwest Center for Public Health Practice, the Northwest Portland Area Indian Health Board, and the Washington State Department of Health.

This article examines the collaboration, methodology, results, and lessons learned stemming from the experience of a unique university, state, and tribal collaborative model for public health emergency preparedness assessment activities. This collaborative model may be applicable to other public health preparedness efforts, as well as the broader range of general public health or workforce development partnerships between state, local, and tribal health departments and academic institutions.

Adult↗

Principles of workforce stability.

The low unemployment rate and the shortage of skilled health care personnel stoke the trend for workers to change jobs and employers. To build workforce stability, employers and managers must make special efforts to counter this trend. Workplace stability is achieved by fielding teams of carefully selected workers and taking measures to prevent them from jumping ship. This article relates how employers and managers can accomplish this.

Humans↗

Strengthening organizational commitment. Understanding the concept as a basis for creating effective workforce retention strategies.

One of the most significant challenges facing any health care leader today is that of building commitment among followers. The last decade, with its tumultuous changes in our organizations, left many employees emotionally detached from their workplace. Mistrust, increasing cynicism, escalating financial pressures, and continuing challenges adversely impact our workforce's organizational commitment. The author explores the concept of commitment, which can serve as a basis for developing practical effective retention strategies.

Attitude of Health Personnel↗

Nursing workforce: a perspective for now and the future.

The vital links between nursing workforce research and policy are clear. Documented findings on current and projected continued shortages of nurses have lead to new legislation and policies targeted to increase the numbers of qualified nurses and to improve the image of nurses. These initiatives will be effective only if there is concurrent leadership in the practice arena. Research and policy must be linked to practice through initiatives to strengthen leadership, develop new practice models that improve utilization of nurses and patient satisfaction, and strengthen nursing's participation in decision making in healthcare delivery.

Forecasting↗

The productivity of Washington State's obstetrician-gynecologist workforce: does gender make a difference?

OBJECTIVE: To compare the practice productivity of female and male obstetrician-gynecologists in Washington State. METHODS: The primary data collection tool was a practice survey that accompanied each licensed practitioner's license renewal in 1998-1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births. RESULTS: Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P < or =.01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P < or =.05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P <.01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30-39 through the 50-59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40-49 age group. CONCLUSION: Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States. LEVEL OF EVIDENCE: II-3

Adult↗

Trends in the prevalence of hearing loss among young adults entering an industrial workforce 1985 to 2004.

OBJECTIVES: Studies have suggested that hearing loss due to recreational noise exposure may be on the rise among adolescents and young adults. This study examines whether the hearing status of young US adults entering an industrial workforce has worsened over the past 20 yr. DESIGN: The baseline audiograms of 2526 individuals ages 17 to 25 beginning employment at a multisite US corporation between 1985 and 2004 were analyzed to determine the yearly prevalence of hearing loss. RESULTS: Approximately 16% of the young adults in the sample had high frequency hearing loss (defined as hearing thresholds greater than 15 dB in either ear at 3,4, or 6 kHz). In a linear regression model, this prevalence decreased over the 20-yr period (odds ratio (OR) = 0.96, 95% confidence interval (CI): 0.94, 0.99). Almost 20% of subjects had audiometric "notches" consistent with noise exposure; this rate remained constant over the 20 yr, as did the prevalence (5%) of low frequency hearing loss. CONCLUSIONS: These results indicate that despite concern about widespread recreational noise exposures, the prevalence of hearing loss among a group of young US adults has not significantly increased over the past two decades.

Adolescent↗

Risk factors for tuberculin skin test positivity in an industrial workforce results of a contact investigation.

OBJECTIVE: The objective of this study was to determine the prevalence of and risk factors for tuberculin skin test (TST) positivity among an industrial workforce employing many foreign-born workers after one employee was hospitalized for active tuberculosis (TB). METHODS: A contact investigation was performed. We used crude odds ratios and a multivariate model to assess risk factors for TST positivity. RESULTS: The rate of TST positivity was 37.1% (N=97). Twenty-nine of 36 (80.6%) workers from higher TB prevalence countries versus seven of 61 (11.5%) workers born in low-prevalence countries were positive. Workplace risk factors included using the lunchroom, carpooling with the case, or working on the same or subsequent shift. A total of 66.7% of immigrant workers denied previous screening. CONCLUSION: TB contact investigations should probe into workplace transmission. Workplaces with workers from higher TB prevalence countries should consider pre-placement TB screening.

Adult↗

Fatigue in the U.S. workforce: prevalence and implications for lost productive work time.

OBJECTIVE: The objective of this study was to estimate fatigue prevalence and associated health-related lost productive time (LPT) in U.S. workers. METHODS: Fatigue prevalence, LPT due to fatigue, and LPT for any health-related reason (in hours and dollars) were measured in a national cross-sectional telephone survey of U.S. workers. RESULTS: The 2-week period prevalence of fatigue was 37.9%. Of workers with fatigue, 65.7% reported health-related LPT compared with 26.4% of those without fatigue. Workers with fatigue cost employers 136.4 billion dollars annually in health-related LPT, an excess of 101.0 billion dollars compared with workers without fatigue. Fatigue frequently co-occurs with other conditions and, when present, is associated with a threefold increase, on average, in the proportion of workers with condition-specific LPT. CONCLUSIONS: Fatigue is prevalent in the U.S. workforce. When occurring with other health conditions, it is associated with significantly more condition-specific LPT.

Adolescent↗

Integrated workforce planning. The acid test for the education commissioning consortia?

The education commissioning system established in the NHS in England in the mid-1990s is facing a series of reviews. A major challenge which it faces is how integrated workforce planning is addressed. Newly-emerging approaches to planning are reviewed and the nature of "integration" examined. Sensitive management of the change process will be needed to "learn our way into the future".

Decision Making, Organizational↗

Microcomputer-based workforce scheduling for hospital porters.

This paper focuses on labour scheduling for hospital porters who are the major workforce providing routine cleansing of wards, transportation and messenger services. Generating an equitable monthly roster for porters while meeting the daily minimum demand is a tedious task scheduled manually by a supervisor. In considering a variety of constraints and goals, a manual schedule was usually produced in seven to ten days. To be in line with the strategic goal of scientific management of an acute care regional hospital in Hong Kong, a microcomputer-based algorithm was developed to schedule the monthly roster. The algorithm, coded in Digital Visual Fortran 5.0 Professional, could generate a monthly roster in seconds. Implementation has been carried out since September 1998 and the results proved to be useful to hospital administrators and porters. This paper discusses both the technical and human issues involved during the computerization process.

Algorithms↗

Building a research conscious workforce.

With the aim of building a research conscious workforce, the former Northern and Yorkshire Research and Development office explored the nature and purpose of research and development (R&D) support for NHS staff. Part of the study used a questionnaire to seek healthcare professionals' R&D education and training needs. Some findings were unexpected, such as the significant differences between professional groups' needs and preferences. Recommendations, therefore, include local, flexible R&D education and training programmes.

Attitude of Health Personnel↗

Transforming the obstetric nursing workforce in NE Brazil through international collaboration.

AIMS: This paper seeks to analyse the content, people and process of transformational change to introduce new ways of working for specialized obstetric nurses in northeast Brazil, and identify the lessons learned. BACKGROUND: Countries across the globe are beginning to focus on improving the nursing workforce through new ways of working. High numbers of caesarean sections coupled with high indices of maternal mortality in northeast Brazil prompted the introduction of a British Council Higher Education Links scheme to work collaboratively to transform the role of the specialist obstetric nurse and introduce the principles of Safe Motherhood. The concept of a normal birth had not been widely accepted, with the birth process viewed as a medical condition requiring pharmaco-therapeutic interventions rather than as a natural process. METHOD: Between 2000 and 2003, a more woman-centred approach to childbirth was introduced through the local delivery of two in-house education programmes and the qualification of 38 nurse-midwives. DISCUSSION: In spite of its slow progress, the success of the Higher Education collaboration has been recognized nationally, a new philosophy is guiding practice and new ways of working have been established. CONCLUSION: Lessons learned include the need to set achievable goals (content), respond to the emotional needs of those involved in the change (people) and make best use of reciprocal visits to rally the teams and sustain the focus for change (process). Although the Higher Education link is complete, funds are being sought for formal evaluation and dissemination. Overall, the process and outcomes of this collaboration suggest that to embrace such an opportunity to learn from each other can lead to real improvements in service and the lives of women.

Attitude of Health Personnel↗

Retaining the mental health nursing workforce: early indicators of retention and attrition.

In the UK, strategies to improve retention of the mental health workforce feature prominently in health policy. This paper reports on a longitudinal national study into the careers of mental health nurses in the UK. The findings reveal little attrition during the first 6 months after qualification. Investigation of career experiences showed that the main sources of job satisfaction were caregiving opportunities and supportive working relationships. The main sources of dissatisfaction were pay in relation to responsibility, paperwork, continuing education opportunities, and career guidance. Participants were asked whether they predicted being in nursing in the future. Gender and ethnicity were related to likelihood to remain in nursing in 5 years time. Age, having children, educational background, ethnic background, and time in first job were associated with likelihood of remaining in nursing at 10 years. Associations between elements of job satisfaction (quality of clinical supervision, ratio of qualified to unqualified staff, support from immediate line manager, and paperwork) and anticipated retention are complex and there are likely to be interaction effects because of the complexity of the issues. Sustaining positive experiences, remedying sources of dissatisfaction, and supporting diplomats from all backgrounds should be central to the development of retention strategies.

Adult↗

Understanding rural and remote divisions under a workforce framework.

In Australia, divisions of general practice are the organisational structures for local networks of general practitioners. They facilitate communication across the profession and with other parts of the health system and are established in urban, rural and remote areas. Funding is provided contractually to divisions through the Federal Government's Divisions and Projects Grants Program. The under-supply of doctors and other health professionals in rural and remote areas of Australia is a serious problem that has far-reaching effects. The present paper argues that if the Divisions and Projects Grants Program is to be effective in achieving its aims and objectives, then the Program's policies must be responsive to the different needs, roles, constraints, expectations and capabilities of divisions and their members as well as the structural impediments imposed by the medical workforce.

Australia↗

Small-area estimates of general practice workforce shortage in rural and remote Western Australia.

OBJECTIVE: To trial a measure of rural and remote GP access for small areas. DESIGN: A cross-sectional study using geographical information systems software to calculate GP to population rates with a floating catchment of 100 km radius around census collection districts (CCDs). SETTING: Non-metropolitan Western Australia. PARTICIPANTS: The locations and full-time equivalents of GPs and other primary-care doctors were identified through a GP workforce survey. MAIN OUTCOME MEASURES: GP to population ratios for each CCD were classified as being above or below a benchmark of adequate GP access. CCDs with no GP sessions reported within 100 km were identified separately. These categories were investigated by divisions of general practice and by indigenous status, age and employment characteristics of the population. RESULTS: Small-area estimates detected greater variation in access than depicted by conventional methods. Sixty-four per cent of the non-metropolitan population live in CCDs with adequate GP access. Forty-five per cent of indigenous people and 52% of people working in rural industries live in CCDs with access below the benchmark. CONCLUSIONS: The floating catchment method is a powerful tool to identify small areas of inadequate service. It can be applied to measure access to other professionals, medical equipment or facilities.

Catchment Area, Health↗

Serum 25-hydroxyvitamin D3 is related to physical activity and ethnicity but not obesity in a multicultural workforce.

BACKGROUND: Recent research suggests that body vitamin D levels are decreased in coronary heart disease and diabetes, but it is unclear which cardiovascular risk factors are related to vitamin D status. AIMS: To examine the relation between vitamin D status and major cardiovascular risk factors. METHODS: Serum 25-hydroxyvitamin D3, a marker of recent sun exposure and vitamin D status, was measured in 390 New Zealand residents (95 Pacific Islanders, 74 Maori and 221 others mostly of European descent), who were part of a larger cross-sectional survey of a workforce (n = 5677) aged 40-64 years. RESULTS: Serum 25-hydroxyvitamin D3 levels were significantly lower in Pacific Islanders (mean (SE) = 56 (3) nmol/L; p = 0.0001) and Maoris (68 (3) nmol/L; p = 0.036) compared with Europeans (75 (2) nmol/L) after adjusting for age, sex and time of year. Also adjusting for ethnic group, 25-hydroxyvitamin D3 was higher in people doing vigorous (aerobic) leisure physical activities (71 (2) nmol/L; p = 0.0066) and moderate (non-aerobic) activities (68 (3) nmol/L; p = 0.12) compared with those who were inactive (63 (2) nmol/L). However, 25-hydroxyvitamin D3 was unrelated to body mass index, serum lipids, blood pressure or cigarette smoking. CONCLUSIONS: People with increased skin pigmentation, such as Polynesians, and people who are inactive, have decreased body levels of vitamin D; this might partly explain their increased risk of cardiovascular disease.

Adult↗

Diabetes mellitus and employment: survey of a New Zealand workforce.

A cross-sectional survey of a 5670 multiracial New Zealand workforce aged > 40 years was used to determine the health status of people with diabetes mellitus in employment. One hundred and two workers (73 men, 29 women) had known diabetes mellitus (prevalence of 1.8%) of whom 91 individuals (89.2%) had Type 2 diabetes. Mean age of diabetic workers was 51.1 +/- 5.6 (SD) years and median duration of disease was 5.0 (range 0-51) years. Most subjects were asymptomatic, although only 31.4% of diabetic workers had fasting glucose concentrations and 35.5% had fructosamine concentrations within the mean +/- 2SD range of a matched control group. Moreover, 22.5% of diabetic participants had fasting hypertriglyceridaemia and 21.6% had microalbuminuria. Ethnicity (non-European vs European) and lack of insulin therapy were the most important predictors of poor glycaemic control. We advocate more aggressive therapy with insulin and with culturally sensitive education programmes to avert long-term macrovascular complications.

Adult↗