Abstract Risk factors associated with the incidence of recipient injuries, bedsores and contractures, and health care use (i.e., emergency department and hospital use) among aged and non-aged adult personal care recipients are investigated. Data are from a statewide survey of aged and non-aged adult personal assistance service (PAS) recipients (n = 913) in California's In-Home Supportive Services (IHSS) program. This is a consumer-directed PAS program. Outcomes among recipients using relatives (other than spouses or parents) as paid providers are compared with those of recipients having non-relatives as providers. No differences were found by provider-recipient relationships. Non-aged recipients, those in poorer health, those with more than three activities of daily living (ADL) limitations, and those changing providers during the year were all at greater risk for adverse health outcomes. African American, Hispanic, and Asian recipients were at lower risk for injuries and hospital stays than were White recipients. Keywords: consumer-directedhome and community-based servicespersonal care Acknowledgments The research reported was performed with the permission of the California Department of Social Services (CDSS) under funding from the National Institute for Occupational Safety and Health (NIOSH; R01 OH008759-01A1) and the National Institute for Disability and Rehabilitation Research (NIDRR; #H133B031102). The authors acknowledge CDSS as the source of the Case Management, Information and Payrolling System (CMIPS) data used in these analyses. The opinions and conclusions expressed herein are solely those of the authors and should not be considered as representing the policy of any agency of the California State Government, the National Institute for Occupational Safety and Health, or the National Institute for Disability and Rehabilitation Research. Notes 1. The research protocol was approved by the state Committee for the Protection of Human Subjects (#06-02-03), University of California–San Francisco Committee for Human Research (#H945-28245), and San Francisco State University's Committee for the Protection of Human Subjects (H8-012R1). 2. CMIPS has three cognitive limitations questions. These, respectively, evaluate memory, orientation, and judgment; each scored to indicate whether human assistance is required relative to these functions. A report released by the Office of the Assistant Secretary for Planning and Evaluation (CitationNewcomer & Kang, 2008) showed that 2.9% of the aged IHSS recipients had one or more cognitive functions needing at least human assistance. This prevalence estimate appears to undercount the prevalence of cognitive limitations in the IHSS population, as it is substantially below prevalence estimates for dementia in the aged population more generally. Alzheimer's disease and related dementia (ADRD) affect 3–11% of the elderly with prevalence increasing dramatically with age such that more than 47% of persons 85 or more are estimated to have ADRD (CitationU.S. General Accounting Office, 1998).
Advancing the science of symptom management Abstract. Since the publication of the original Symptom Management Model ( Larson et al . 1994 ), faculty and students at the University of California, San Francisco (UCSF) School of Nursing Centre for System Management have tested this model in research studies and expanded the model through collegial discussions and seminars. Aim. In this paper, we describe the evidence‐based revised conceptual model, the three dimensions of the model, and the areas where further research is needed. Background/Rationale. The experience of symptoms, minor to severe, prompts millions of patients to visit their healthcare providers each year. Symptoms not only create distress, but also disrupt social functioning. The management of symptoms and their resulting outcomes often become the responsibility of the patient and his or her family members. Healthcare providers have difficulty developing symptom management strategies that can be applied across acute and home‐care settings because few models of symptom management have been tested empirically. To date, the majority of research on symptoms was directed toward studying a single symptom, such as pain or fatigue, or toward evaluating associated symptoms, such as depression and sleep disturbance. While this approach has advanced our understanding of some symptoms, we offer a generic symptom management model to provide direction for selecting clinical interventions, informing research, and bridging an array of symptoms associated with a variety of diseases and conditions. Finally, a broadly‐based symptom management model allows the integration of science from other fields.
Increasing interest has been focused on understanding the role working conditions play in terms of the serious issues facing hospitals today, including quality of patient care, nurse shortages, and financial challenges. One particular working condition that has been the subject of recent research, is the impact of organizational climate on nurses' well-being, including occupational health outcomes. To examine evidence-based research on the association between organizational climate and occupational health outcomes among acute-care registered nurses, a systematic review of published studies was conducted. Studies assessing the association between organizational climate variables and three common health outcomes in nurses (blood/body fluid exposures, musculoskeletal disorders, and burnout) were reviewed. Fourteen studies met the inclusion criteria. Although most were cross-sectional in design and variability was noted across studies with respect to operational definitions and assessment measures, all noted significant associations between specific negative aspects of hospital organizational climate and adverse health impacts in registered nurses. While evidence for an association between organizational climate constructs and nurses' health was found, data were limited and some of the relationships were weak. Additional studies are warranted to clarify the nature of these complex relationships.
Hand-harvest work in wine grape vineyards is physically demanding and exposes workers to a variety of ergonomics risk factors. Analysis of these exposures together with data on reported work-related injuries points to the risk of back injury as a prevention priority, in particular the lifting and carrying of tubs of cut grapes (weighing up to 80 pounds) during harvest. Our study evaluated the effectiveness of an intervention — the use of a smaller picking tub — on the incidence of musculoskeletal symptoms among workers during two harvest seasons. Reducing the weight of the picking tub by about one-fifth to below 50 pounds resulted in a five-fold reduction in workers' postseason musculoskeletal symptom scores, without significant reductions in productivity.
The Thai Version of Effort‐Reward Imbalance Questionnaire (Thai ERIQ): A Study of Psychometric Properties in Garment Workers: Aporntip B uapetch , et al . Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand —This study aimed to test the psychometric properties of the Thai version of the Effort‐Reward Imbalance Questionnaire (T‐ERIQ). The English version of the 23‐item ERIQ was translated and back‐translated. Content validity was examined by five experts and face validity was examined by twelve key informants before being tested for construct validity with 828 workers from six garment factories. Predictive validity was assessed through the relationship between the ERI constructs and psychological health outcomes including psychosomatic symptoms, state of anxiety, depression, and job satisfaction. The internal consistency of the Thai ERIQ was tested using the first survey (n=828), and test‐retest stability was examined 2 to 4 wk later with a subsample (n=408). The results show that 2% of workers reported effort‐reward imbalance (ERI ratio≥1). The Thai ERIQ has good content validity with a Content Validity Index of 0.95. Cronbach's alpha coefficients for the effort, reward, and overcommitment scales were 0.77, 0.81, and 0.66, respectively. The 2–4 wk stability of these three constructs was moderate (r=0.496–0.576, p <0.001). Overall, the factorial validity was demonstrated as the best model fit, with high values of the goodness‐of‐fit indices, using confirmatory factor analysis, indicating accordance with the theoretical constructs of the ERI model. Logistic regression analyses supported significant associations of reward with all psychological health outcomes ( p <0.05). The findings suggest that the Thai ERIQ has adequate reliability and validity to investigate the psychosocial work environment. The Thai ERIQ can be applied to the Thai working population, particularly industrial manufacturing workers.
