Texte remanié de : Habilitationsschrift : Philosophische Fakultät : Friedrich-Schiller-Universität Jena : 2004. / Bibliogr. p. 422-443. Notes bibliogr. Index.

Dissertation--Philosophische Fakultät--Freiburg i. Br., 1970. / Contient des textes de saint Augustin. Bibliogr. p. 144-146.

This thesis presents a new conceptual model of occupational outcome based on the results of input from 5 key stakeholder groups in the field of occupational health including patients, healthcare providers, employers, unions, and insurers. Data from 77 participants who took part in one of either 18 individual interviews or 11 focus groups were qualitatively content analyzed. The goals were to: 1) compare the range of meanings given to the concepts of health, occupational health, and occupational outcome, 2) understand the range of opinions among stakeholders and identify areas of agreement or disagreement and, 3) to develop a framework of occupational outcome incorporating the views of all key stakeholders. Health, occupational health, and occupational outcome were found to have different and complex meanings that extended beyond those in existing research, and that related to the role a variable is hypothesized to have in a larger framework. Stakeholders differed in the depth, breadth, and qualitative nature of the themes discussed. Natural alignments among some stakeholder groups emerged which varied depending on the context, however a specific focus could be identified for each group. No single stakeholder group alone expressed all the themes and the complexity of the relationships among them; the whole could only be understood in terms of the sum of the stakeholder parts. A new model emerges in which occupational outcome is encompassed by the interactions of 3 key factors: Function and Ability, Individual Behaviours, and Environmental Factors. These are embedded within larger models of both occupational health that includes both individual health and workplace health, and of quality which is comprised of the interactions between structure variables, system participant factors, and outcome. The new model and the process undertaken to develop it meet two important needs for occupational health; enhancing understanding and conceptualization of occupational outcome, and enhancing understanding of the perspectives of stakeholders in the occupational healthcare system. The findings have implications for research, and delivery of quality care to patients with occupational disease or injuries. Some next steps include model validation and testing, measurement scale development, clarifying new variables through ongoing stakeholder discussion, and model application.

Background - Communicable respiratory illness is a serious occupational threat to healthcare workers. A key reason for occupational transmission is failure to implement appropriate barrier precautions. Facial protective equipment, including surgical masks, respirators and eye/face protection, is the least adhered to type of personal protective equipment used by healthcare workers, yet it is an important barrier precaution against communicable respiratory illness. Objectives - To describe nurses’ adherence to recommended use of facial protective equipment and to identify the factors that influence adherence. Methods - A two-phased study was conducted. Phase 1 was a cross-sectional survey of nurses in selected units of six acute care hospitals in Toronto, Canada. Phase 2 was a direct observational study of critical care nurses. Results – Of the 1074 nurses who completed surveys (82% response rate), 44% reported adherence to recommended use of facial protective equipment. Multivariable analysis revealed four organizational predictors of adherence: ready availability of equipment, regular training and fit testing, organizational support for health and safety, and good communication. Following the survey, 112 observations in 14 intensive care units were conducted that showed a 44% competence rate with proper use of N95 respirators. Common gaps included failure to verify the seal and touching the face piece. Multivariable analysis revealed knowledge of recommended use of facial protective equipment as a significant predictor of competence. Discussion – Despite the SARS experience and the resulting investment in our public health system, nurses’ adherence to recommended use of facial protective equipment and competence in effective use of N95 respirators remains suboptimal. To improve adherence, organizational leaders should focus on equipment availability, training and fit testing, organizational support for health and safety, and positive communication. To improve competence in effective use of N95 respirators, strategies to increase knowledge should be implemented. These efforts should assist to reduce occupational transmission of communicable respiratory illness and foster a healthier and safer working environment for nurses.

Abstract Purpose: To determine the prevalence and factors associated with injury in professional ballet and modern dancers, to explore dancers’ attitudes and perceptions of injury, and to assess if dancers are reporting their injuries and reasons for not reporting injuries. Methods: A cross-sectional survey was undertaken in professional ballet and modern dance companies in Canada, Denmark, Israel, and Sweden. Results: The point prevalence of injury in dancers is high (55% ballet; 46% modern) and most have chronic pain. Years dancing professionally and rank were associated with injury in ballet dancers. Attitudes towards injury vary and some dancers are continuing to dance when injured. Greater than 15% of all injured dancers have not reported their injury. Conclusions: Injury is common in dancers and there is an urgent need to investigate interventions to help control injury and understand the long-term implications of these conditions in this population.

Abstract Purpose: To determine the prevalence and factors associated with injury in professional ballet and modern dancers, to explore dancers’ attitudes and perceptions of injury, and to assess if dancers are reporting their injuries and reasons for not reporting injuries. Methods: A cross-sectional survey was undertaken in professional ballet and modern dance companies in Canada, Denmark, Israel, and Sweden. Results: The point prevalence of injury in dancers is high (55% ballet; 46% modern) and most have chronic pain. Years dancing professionally and rank were associated with injury in ballet dancers. Attitudes towards injury vary and some dancers are continuing to dance when injured. Greater than 15% of all injured dancers have not reported their injury. Conclusions: Injury is common in dancers and there is an urgent need to investigate interventions to help control injury and understand the long-term implications of these conditions in this population.

Background - Communicable respiratory illness is a serious occupational threat to healthcare workers. A key reason for occupational transmission is failure to implement appropriate barrier precautions. Facial protective equipment, including surgical masks, respirators and eye/face protection, is the least adhered to type of personal protective equipment used by healthcare workers, yet it is an important barrier precaution against communicable respiratory illness. Objectives - To describe nurses’ adherence to recommended use of facial protective equipment and to identify the factors that influence adherence. Methods - A two-phased study was conducted. Phase 1 was a cross-sectional survey of nurses in selected units of six acute care hospitals in Toronto, Canada. Phase 2 was a direct observational study of critical care nurses. Results – Of the 1074 nurses who completed surveys (82% response rate), 44% reported adherence to recommended use of facial protective equipment. Multivariable analysis revealed four organizational predictors of adherence: ready availability of equipment, regular training and fit testing, organizational support for health and safety, and good communication. Following the survey, 112 observations in 14 intensive care units were conducted that showed a 44% competence rate with proper use of N95 respirators. Common gaps included failure to verify the seal and touching the face piece. Multivariable analysis revealed knowledge of recommended use of facial protective equipment as a significant predictor of competence. Discussion – Despite the SARS experience and the resulting investment in our public health system, nurses’ adherence to recommended use of facial protective equipment and competence in effective use of N95 respirators remains suboptimal. To improve adherence, organizational leaders should focus on equipment availability, training and fit testing, organizational support for health and safety, and positive communication. To improve competence in effective use of N95 respirators, strategies to increase knowledge should be implemented. These efforts should assist to reduce occupational transmission of communicable respiratory illness and foster a healthier and safer working environment for nurses.

Version abrégée d'une thèse soutenue à l'université Grégorienne, sous la dir. du Père K. J. Becker. / Bibliogr. p. [491]-531. Index.

This thesis presents a new conceptual model of occupational outcome based on the results of input from 5 key stakeholder groups in the field of occupational health including patients, healthcare providers, employers, unions, and insurers. Data from 77 participants who took part in one of either 18 individual interviews or 11 focus groups were qualitatively content analyzed. The goals were to: 1) compare the range of meanings given to the concepts of health, occupational health, and occupational outcome, 2) understand the range of opinions among stakeholders and identify areas of agreement or disagreement and, 3) to develop a framework of occupational outcome incorporating the views of all key stakeholders. Health, occupational health, and occupational outcome were found to have different and complex meanings that extended beyond those in existing research, and that related to the role a variable is hypothesized to have in a larger framework. Stakeholders differed in the depth, breadth, and qualitative nature of the themes discussed. Natural alignments among some stakeholder groups emerged which varied depending on the context, however a specific focus could be identified for each group. No single stakeholder group alone expressed all the themes and the complexity of the relationships among them; the whole could only be understood in terms of the sum of the stakeholder parts. A new model emerges in which occupational outcome is encompassed by the interactions of 3 key factors: Function and Ability, Individual Behaviours, and Environmental Factors. These are embedded within larger models of both occupational health that includes both individual health and workplace health, and of quality which is comprised of the interactions between structure variables, system participant factors, and outcome. The new model and the process undertaken to develop it meet two important needs for occupational health; enhancing understanding and conceptualization of occupational outcome, and enhancing understanding of the perspectives of stakeholders in the occupational healthcare system. The findings have implications for research, and delivery of quality care to patients with occupational disease or injuries. Some next steps include model validation and testing, measurement scale development, clarifying new variables through ongoing stakeholder discussion, and model application.

Occupational skin and respiratory symptoms, and disease, are common problems. Workers can develop new disease or aggravate existing disease as a result of exposures at work. Many workers are exposed to chemicals that can cause both respiratory and skin responses and there is evidence that some workers experience symptoms in both systems. There is also evidence that skin exposure may lead to sensitization and the development of respiratory disease. There is very little research that has examined both airborne and skin exposures together with lung and skin outcomes. The purpose of this thesis was to further investigate the relationships between occupational exposures, skin symptoms and disease, and respiratory symptoms and disease. Four studies were undertaken to improve our understanding of these complex relationships. Results from a study of clinical patch test data determined that seven of the ten most common occupational contact allergens are also capable of causing occupational asthma and that these common occupational exposures may not be recognized as sensitizers in common reference materials. Exposure-response relationships for skin symptoms were modeled in bakery workers and auto body shop workers using historical data; significant exposure-response relationships were found for auto body workers. In two separate studies of concurrent skin and respiratory symptoms, workers did report concurrent skin and respiratory symptoms. In predictive models, subjects reporting a history of eczema were more likely to report concurrent skin and respiratory symptoms. Overall, the results from this thesis provide more evidence that the skin and respiratory systems are associated. This body of work suggests that: (1) several common occupational exposures can cause disease in both the skin and respiratory system; (2) a portion of workers report both skin and respiratory symptoms; and (3) exposure-response relationships do exist for skin symptoms, both work-related and non-work-related. Future studies need to gather detailed information about exposure and response in both systems in order to better determine the role of exposure(s) in the development of skin and respiratory symptoms. Improved understanding of these relationships will allow for more targeted and effective exposure prevention strategies and will ultimately reduce the burden of occupational disease.