Purpose To evaluate costs associated with hospitalization due to Firearm-Related Violence and Injuries (FREVI) in the United States over the last decade, 2001-2009. We explored the following research questions: 1. Is there an increase in the prevalence of firearm injuries over the last decade (2001-2009)? 2. What are the demographic patterns that characterize FREVIs in the U.S (i.e., age, sex, racial and ethnic variations, urban/rural locations)? 3. What are the costs associated with firearm-related hospitalizations in the US? Methods This is a descriptive cross-sectional study. A stratified sample of 54,875 hospital discharges were extracted from the National Inpatient Sample Database (NIS-HCUP) using E-Codes (ICD-9) for FREVI. We performed trend analyses to determine the cost and prevalence of the firearm related injuries. Results An estimated 268,639 firearm-related hospital discharges were observed from 2001-2009. Homicidal intent was the leading cause of FREVI, followed by accidents. Hispanic and blacks were more likely to become injured by firearms as compared to whites. Young adults aged 18-34 were more prone to firearm injuries than children and the elderly. Male sex, urban residence and being black or Hispanic were the main risk factors for firearm-related hospitalizations. The average cost of firearm-related hospitalization to the United States is $60,000 every hour, $17,700 per firearm injury related admission, and total of $5.28 billion for the last decade. The prevalence of FREVI and cost trends remained constant over the last decade. Conclusion Firearm Related Violence and Injuries (FREVI), and associated costs remain a major source of hospital-related expenditures in the United States. The constant trend in number of firearm injuries per year over the last decade suggests the absence of effective policy measures to curtail firearm injuries

The present study explores the process through which the regulation of emotions at work, also known as emotional labor, depletes self-regulatory resources, specifically energy, and distally impacts health behaviors in the form of less physical activity and more unhealthy eating. Differences in relationships between two forms of emotional labor, surface acting and deep acting, as well as differences between psychological and physical energy depletion, are explored. Additionally, the roles of trait mindfulness and future temporal focus are examined as between-individual differences moderating the proposed relationships. Multi-level analysis of daily diary data collected from participants (N = 108 participants) over ten work days (N = 1,273 total days) demonstrates that surface acting at work, but not deep acting, is negatively related to after work energy levels, such that participants reported less energy on days when they engaged in more surface acting. No significant differences in strength of relationships for physical versus psychological energy depletion were found. After work energy depletion related to less time and intensity spent on physical activity, but no support for an overall mediated effect was found. No significant effects were found for unhealthy eating, or future temporal focus, while trait mindfulness did positively relate to energy levels in several models. Theoretical and practical implications, as well as future research directions, and methodological recommendations for researchers wishing to conduct similar studies are presented. As one of the first attempts to examine the mechanisms linking emotional labor and health behaviors, this study highlights the intricate nature of the relationships examined and the resultant need for both broader and more targeted multi-faceted research at multiple-levels of analyses to further explain the complex story of work and health.

This study examined the effects of the presence of fungal growth on the phthalate ester content of plasticized polyvinyl chloride (pPVC) used as the vapor barrier component of metal building insulation and the impact the fungal growth may have on the resulting exposure potential to the workers in the building. Individual pieces of the pPVC material exhibiting fungal growth and individual pieces of the pPVC material exhibiting no fungal growth were collected from the building being investigated. Twenty-five pieces each of the pPVC material exhibiting fungal growth and of the pPVC material exhibiting no fungal growth were weighed, reduced to small pieces, and extracted with dichloromethane. The extracts were analyzed using a gas chromatograph coupled with a mass spectrometer. The phthalate content of four phthalate esters identified in the pPVC: diethyl phthalate (DEP), dibutyl phthalate (DBP), butyl benzyl phthalate (BBP), and di-(2-ethylhexyl) phthalate (DEHP), was quantified and the results extrapolated to concentration based on weight ([um]g/Kg) and area ([um]g/m2). A paired samples t test and independent samples t test was used to identify where significant differences occurred (α = 0.05) in the phthalate content between pieces. Using the mean concentration for each phthalate ester, a worst-case-scenario exposure was modeled. There was a statistically significant difference in the phthalate ester content between the pPVC exhibiting fungal growth and pPVC exhibiting no fungal growth for all four phthalate esters investigated. The mean phthalate ester concentration ranged from 13.74 [um]g/m2-34.94 [um]g/m2 in the pPVC exhibiting no fungal growth and 12.00 [um]g/m2-30.63 [um]g/m2 in the pPVC exhibiting fungal growth. The modeled exposure concentration in the building ranged from 0.39 [um]g/m3-0.98 [um]g/m3 and was generally lower than published exposure concentrations in similar settings.

In order to describe the trend, characteristics, and cost of occupational injuries that occurred in industrial settings across the United States between 1998 and 2009, a cross sectional analysis based on hospital discharge data was conducted. The National Inpatient Sample (NIS) data from the Healthcare and Cost Utilization Project (HCUP)(1) was used. Identification of relevant injuries from the sample was performed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code E849.3 (industrial place and premises)(8). A total of 307,586 (weighted) patients with industrial related injuries were discharged from hospitals in the United States during the period 1998-2009. They were largely male (81.8% vs. 16.6% female) and made up of 48.6% Non-Hispanic Whites, 18.2% Hispanic, and 6.2% Non-Hispanic Black. Two-thirds of patients were within the [25-54] years age group, broken down as 20.4%, 24.8% and 22.1% in the 25-34, 35-44, and 45-54 years age group respectively. Persons in the ≥65 age group also represented a sizable proportion at 7.3%. The patients were mostly admitted from an Emergency Department (61.2%), followed by routine/standard admissions (22.2%). While they were for the most part discharged home (81.7%), 7.2% were released to a home care facility, 7.9% to another type of facility, and 0.7% died during their stay in the hospital. As for the geographical distribution, 38.9% were admitted in the West, 24.6% in the South, 19.5% in the Midwest, and 17% in the Northeast United States. Furthermore, 88.6% were admitted in a hospital in urban settings vs. 11.2% in rural settings. The common injury sites were lower and upper extremities (52.6%), multiple locations (14.2%), trunk (9.3%), and head (8.9%). Of all admissions, 48.4% involved fractures, followed by open wounds (25.7%), internal crush injuries (19.4%), and superficial contusions (10.1%). "Foreign Body Entering through Orifice" (0.5%) and poisoning (2.3%) scored the lowest, while burns (5.8%), dislocations (3.9%), and crushing (5%) were noted as well. The mean length of stay was 4.09 days (95% CI 3.92 - 4.22), while the 95th percentile was ≤13 days. When analyzed by injury site, persons with multiple injuries stayed the longest, averaging 6.21 days (95% CI 5.85 - 6.57) while those with injuries at extremities stayed the shortest, 3.53 days (95% CI 3.42 - 3.65). Patients admitted for burns stayed 7.21 days on average (95% CI 6.52 - 7.9) while those with sprain/strain injuries (2.87 days, 95% CI 2.71 - 3.02) and poisoning (2.92 days, 95% CI 2.69 - 3.16) stayed the shortest. Overall, the mean cost of care (crude 2001-2009) was $10,153 per admission. Viewed from the injury site angle, the "multiple" category was the most costly at $17,518 and "extremity" the lowest ($8,269). Diagnostics of "Foreign Body Entering through Orifice" were the most expensive, costing on average ($17,036), closely followed by "burns" ($16,495), while "poisoning" was the least costly, with a mean cost of $6,077. Using Joinpoint regression modeling, we found an overall annual percentage rate change (APC) decrease (-1.73%) over the course of the study. While this improvement was noted in most study sub-segments, it was reversed for women (1.53%), government insurance (Medicare/Medicaid) recipients (7.72%), and older workers (9.16%). The results also revealed a high annual percentage rate (APC) decrease for Hispanics (-9.65%) for the period 1998-2004, jumping to (-18.65%) from 2007 to 2009. A similar pattern with two models was noted for the younger [18-24] age group where the annual percentage rate decreased constantly by (-2.08%) during the period 1998-2007 and drastically jumped to (-18.34%) from 2007 to 2009. In conclusion, a comprehensive trend analysis of industry-related occupational injuries recorded nationwide within the United States as presented in this study is useful to policy makers in formulating targeted strategies and allocation of resources as needed to address disparities found at various levels. Disparities found in trends observed from a gender angle calls for action to reverse the positive rate recorded for females (1.53%) when compared to males (-2.74%). Similarly, there is a call for action to address the age demographic disparity for older worker, the "≥65" age group exhibiting an alarming rate of occupational injuries (9.16%), bucking an across-the-board general negative trend.

The study was a comparative retrospective analysis to determine the effectiveness of MORT (Management Oversight and Risk Tree), a system safety method, in reducing the incidence and cost of occupational injuries occurring at the Tennessee Wheel and Rubber Company. Implementation of MORT on April 1, 1974 at the plant facility allowed for statistical comparison of accidents between the time periods April 1, 1972 through March 31, 1974 and April 1, 1974 through March 31, 1976. Data on injury incidence were gathered by researching the company's worker compensation reports. Cost figures for injuries were drawn from computer printouts provided by the company's insurance carrier. reliable figure for the mean incidence of injuries occurring over the twenty-four month control period and twenty-four month experimental period was determined by calculating monthly injuries per one thousand man hours using the occupational injury rate formula: Total Number of Occupational Injuries Per Month Total Number of Man Hours Worked Per Month X 1000. A figure for mean occupational injury cost rate was determined by calculating annual cost of injuries per one thousand man hours worked for the control and experimental periods using the formula: Total Cost of Occupational Injuries (Year) Total Number of Man Hours Worked (Year) A 1000. Statistical analyses using a t-test at the .05 level of significance was applied to determine if MORT implementation was effective in reducing the mean incidence rate and mean cost of occupational injuries. Results showed a statistically significant reduction in the occupational injury incidence rate at the Tennessee Wheel and Rubber Company following introduction of MORT system safety. MORT implementation did not, however, result in a significant reduction in the cost of occupational injuries between the control and experimental periods. The resultant discrepancy in findings (rejection of Ho1 and acceptance of Ho2) might be explained by: 1) the fact that no medical cost inflation factor was used when comparing injury costs between the two time periods under study, and 2) types of injuries were not differentiated in terms of severity of injuries. The findings brought forth from this research indicate a degree of uncertainty as to the application of MORT to general industry.

Firefighting is a strenuous occupation that increases the risk of cardiovascular events. Greater levels of physical fitness and training improve firefighters’ occupational performance, but little is known whether they are related to lower physiological stress and recovery from fire ground tasks. Heart rate, heart rate recovery and heart rate variability have been used to evaluate physical stress in association with exercise and fire ground tasks. However, there is a paucity of research evaluating the effects of physical fitness and training on heart rate dynamics during a simulated fire ground test (SFGT). Therefore, the primary purposes of this study were to evaluate the relationships between heart rate dynamics during a SFGT and to determine the effects of physical characteristics, fitness and physical training on these measures. The secondary purpose was to assess the relationship between maximal pace SFGT time and heart rate responses from a standardized pace SFGT. This information will help to understand the relationship between occupational performance and level of physical stress associated with work on the fire ground. Twenty-one firefighter academy recruits (Age = 28.4 ± 4.0 yr; Height = 177.1 ± 6.9 cm; Body mass = 88.3 ± 15.4 kg) participated in this cross-sectional and longitudinal study. The subjects completed a battery of physical fitness tests, including a 1.5-mile run, maximal pull-ups, push-ups, sit-ups, and isometric plank hold. In addition, the subjects completed a standardized pace SFGT that consisted of typical fire ground tasks performed in succession, without recovery (i.e., high-rise pack carry, hose drag, equipment carry, ladder raise, forcible entry, search, and victim rescue tasks). Heart rate variability was measured pre- and post-SFGT, and heart rate and 60 s heart rate recovery were measured during and post-SFGT, respectively. After a 10 wk physical training intervention, composed of approximately four physical training sessions per week, the measurements were repeated. A subsample of the original cohort (n = 11) also completed a maximal pace SFGT where their completion time was used as a measure of work capacity. Independent variables for this study included the physical and fitness test measures, physical training and maximal pace SFGT completion time. Dependent variables for this study were mean heart rate reserve during the SFGT (HRRes), difference between resting and mean heart rate during SFGT (HRSFGT-Rest), 60-second heart rate recovery (HRR60), and the difference between resting and post-SFGT root mean square of standard deviation between consecutive heart beats in logarithmic scale (LnRMSSDPost-Rest) measured with standardized pace SFGT. Independent and dependent variables were obtained at baseline and after physical training. Pearson r correlation coefficient was used to evaluate associations between outcome measures. Dependent samples t-test was used to compare differences in outcome measures at baseline and following physical training. Linear regression was used to evaluate the association between independent and dependent variables with standardized pace SFGT at baseline. Linear regression was used to assess the relationship between maximal pace SFGT time and outcome measures during the standardized pace SFGT. The level of significance was set as p ≤ 0.05 for all statistical analyses. In the standardized pace SFGT there was a positive correlation between HRSFGT-Rest and HRRes (R = .79, p < .01). LnRMSSDPre-Post was positively correlated with HRRes (R = .47; p < .05) HRSFGT-Rest (R = .70; p = .01) and HRPost-Rest (R = .84; p < .01). There was also a significant inverse correlation between HRPost-Rest and HRR60 (R = -.46; p < .05). Greater height and fat-free mass were favorably associated with HRSFGT-Res (R2 = .57; p = .02), HRRes (R2 = .55; p = .003) and HRPost-Rest (R2 = .59; p = .02). Height was also associated with attenuated depression of LnRMSSDRest-Post. After accounting for the effect of other independent variables in the multiple linear regression models, height was the only significant predictor for HRSFGT-Rest (β = -.90), HRRes (β = -.64), HRPost-Rest (β = -.76) and LnRMSSDRest-Post (β = -.06). A significant decrease in HRRes (80.1 ± 6.7% vs. 76.0 ± 6.7%; p < 0.001) and increase in HRR60 (29.4 ± 8.3 b∙min-1 vs. 37.8 ± 9.0 b∙min-1; p < .001) were observed after the physical training intervention. There was a significant correlation between maximal pace SFGT time and the standardized pace SFGT HRR60 (R = -0.70; p = 0.02), but not with other dependent variables. In summary, these findings indicate that greater cardiovascular demand during fire ground tasks is related to greater physical stress and lower parasympathetic activity during recovery. Greater height and fat-free mass as well as physical training are associated with lower physiological stress and accelerated recovery from fire ground tasks. Support for relationships between work capacity and heart rate dynamics during a standardized submaximal pace SFGT is limited, indicating that independent SFGT conditions may be necessary to provide work capacity and health information, respectively.

Despite regulatory efforts of the Occupational Safety and Health Administration (OSHA), 104 cases of nonfatal occupational illnesses and injuries (OIIs) per 10,000 full-time workers required time away from work in 2015. Although OII rates in private and public sectors are high, the rates among state and local government agencies were over 50% higher than private sector rates in 2015, especially in the healthcare industry. OIIs can lead to reduced organizational productivity and performance. Guided by the leader member exchange theory (LMXT) and risk homeostasis theory (RHT), the purpose of this single case study was to explore effective strategies that supervisors in a government agency in the mid-Atlantic region of the United States use to reduce OIIs. Data were collected from face-to-face semistructured interviews with 8 purposefully selected supervisors who had reduced OIIs and the review of company documents. Data were analyzed using inductive coding of phrases, word frequency searches, and theme identification. Four themes emerged: managing employee risk-taking behaviors reduced OIIs, communicating the importance of safety with employees decreased OIIs, having high-quality relationships with employees reduced and mitigated OIIs, and continuous education and training reduced OIIs. Both the LMXT and RHT were essential in exploring the role that education and training played in reducing OIIs. Findings may provide government agencies with valuable information that may lead to a healthier and safer work environment, increased productivity and profitability, and healthier lifestyles inside and outside of the workplace.

Este estudo abordou a questão do trabalho e do adoecimento em trabalhadores que atuam na área de saúde, notadamente hospitalar. O objetivo foi relacionar as características sociodemográficas, laborais e de saúde dos membros da equipe multiprofissional da Unidade de Terapia Intensiva, com a presença de Transtornos Mentais Comuns e a ocorrência de absenteísmo e presenteísmo. O estudo foi aprovado por Comitê de Ética em Pesquisa (CAAE 54868316700005393). Trata-se de pesquisa epidemiológica, correlacional, analítica, transversal, com abordagem quantitativa, desenvolvida com 54 trabalhadores da equipe multiprofissional de saúde de uma UTI Adulto de um hospital universitário público do interior do Estado de São Paulo. Foram utilizados os instrumentos: Stanford Presenteeism Scale SPS6 para investigação do presenteísmo; Self-Reporting Questionnaire (SRQ-20) para a mensuração do nível de suspeição de Transtornos Mentais Comuns e questionário para caracterização dos dados sociodemográficos, laborais e de alterações de saúde dos participantes. As informações sobre o absenteísmo foram obtidas nos bancos de dados do setor de Recursos Humanos da instituição. Os dados foram coletados em 2016. Entre os trabalhadores estudados houve predomínio de mulheres (75,9%), com média de idade de 39,8 anos e em união estável (56%). Em relação às variáveis ocupacionais, 66,7% eram contratados pela Consolidação das Leis do Trabalho; o maior número de participantes era da enfermagem (66,7%) e a maior parte (31,6%) atua no hospital de 6 a 10 anos. No que diz respeito à ocorrência de sintomatologia dos Transtornos Mentais Comuns, entre as mulheres foram encontrados os valores médios de 4,37 e entre os homens 3,85. A alteração de saúde mais comum foi a cefaleia (63,0%). A avaliação do presenteísmo mostrou que 48,7% apresentaram comprometimento no trabalho e 31,8% tiveram a realização e finalização das tarefas alteradas por este fenômeno. Quanto ao absenteísmo, em relação a meta pactuada de 8,50% ao mês, durante todos os meses os valores foram excedentes. Os resultados mais preocupantes referem-se ao presenteísmo e ao absenteísmo, fenômenos que podem ser resultantes de adoecimentos entre os trabalhadores. Diante deste cenário identifica-se que a saúde destes trabalhadores requer atenção, visto que muitos podem estar comparecendo a seus postos de trabalho mesmo doentes, o que pode levá-los a um maior comprometimento físico e mental / This study approached the issue of work and illness in health personnel, which works with healthcare highlights in the hospital. The study\'s goal has been to relate in socio-demographic characteristics, working conditions and also health members of the multidisciplinary team were working at Adult intensive care units (ICU), with the presence of Common Mental Disorders and the occurrence the in Absenteeism and Presenteeism. The research was approved by the Research Ethics Committee (CAAE 54868316700005393). It is a epidemiological research, correlacional, analytical, cross with quantitative approach. Developed with 54 workers of the multidisciplinary healthcare team a adult ICU carried out in a university hospital public of the interior of São Paulo State. Which used the following the instruments for data collection: Stanford Presenteeism Scale SPS-6 for research in the Presenteeism Self-Reporting Questionnaire (SRQ-20) for the measurement of the level of suspicion of Mental Disorders and a instruments was a semi-structured form aiming to know the reality socio-demographic characteristics, working conditions and also health of those subjects. Information begin Absenteeism data was collected for 12 months were obtained in the databases of the Department of Human Resources of the institution. The data collection in year 2016. Among the study\'s participants, it was observed a female predominance with (75,9%) and an average age of 39,8 years old and steady union (56,0%). Regarding working conditions 66,7% were hired by the Consolidation of Labor Laws; the most reported labor class were the in nurse and most party 31,6 were working at hospital in 6 the in 10 years. With respect to, likelihood of Common Mental Disorders between women average 4,37 and among men was 3,85. The most reported change in the state health was headache (63,0%). Concerning in the Presenteeism 48,7% presented compromised at work and 31,8 % had completion of assigned. In relation to Absenteeism it was observed every months superior tares in the 8,50% as well as. The more important Results was in relation to Absenteeism and Presenteeism phenomena that may result from sicken workers. In face of has been proven that workers health need attention, as well as may be to appearing their working place illness. Witch can do them to major physical and mental impairment

Cette thèse explore l’émergence d’un régime de gouvernement des conditions de travail par les normes transnationales, les normes ISO. Celles-ci sont des instruments de gestion, qui proposent des principes visant l’optimisation du fonctionnement des organisations, en même temps que des instruments de régulation des marchés, que les organisations doivent respecter pour accéder à certains marchés. Si la normalisation s’est longtemps cantonnée aux domaines techniques, notamment en raison des résistances d’organisations intergouvernementales et gouvernementales qui sont défavorables à son investissement du champ social, plusieurs normes internationales relatives aux conditions de travail sont en cours d’élaboration. Cette thèse explore les enjeux de l’élaboration de ces normes. Elle est fondée sur une enquête ethnographique, menée par observations et entretiens, auprès des entreprises utilisatrices de référentiels de gestion sur les conditions de travail, auprès d’auditeurs certifiant les entreprises sur ce sujet, et auprès d’organismes nationaux et internationaux de normalisation. L’étude de ce « dispositif de gestion » souligne l’intégration des problématiques relatives à la prévention des atteintes à la santé et à la sécurité des travailleurs dans des matrices de management et de gestion des risques. L’émergence de ces formes de gestion renvoie à la nécessaire auditabilité des organisations : celles-ci doivent s’organiser pour maitriser les risques de tous ordres et être en mesure de rendre des comptes sur cette maitrise. L’audit joue ainsi un rôle clé dans l’émergence de cette nouvelle forme de gouvernement des organisations fondées sur le marché. / This dissertation aims at understanding how transnational social standards – ISO standards - give rise to a new form of government of working conditions. ISO standards are management tools, as they advise organisations on performance improvement. They also play a part in performing a global market economy, as certifications on ISO standards may be required to access markets. Historically, standardization focused on technical specifications on products. Although for a long time intergovernmental and governmental organisations refused social standardization, claiming ISO was not the relevant organization for that purpose, several international social standards are currently under development. This dissertation studies the issues at stake in social standardization. Our ethnographic inquiry is based on observations, interviews and surveys, conducted with companies using social standards, with certifying bodies and with standardization bodies. It analyzes the genesis of audit society on occupational safety and health, and underlines how standardization merges occupational safety and health in risk management systems. It contributes to make organizations accountable : they are turned “upside down”, with internal control systems devoted to external control. Audit plays a central part in the institutionnalization of a market based regulation of organizations on occupational safety and health.

This work characterized burn-off emissions from automobiles. After an exhaustive literature review, engine temperatures were determined to reach a maximum temperature of approximately 110oC, while exhaust system components reached a maximum temperature around 600oC. Metal-drawing fluids were used to bend the exhaust system components during manufacturing. Because these components were not rinsed prior to incorporation into a vehicle, residues could be left on the surfaces. An experimental test chamber was constructed to conduct controlled testing of three metalworking fluids of various types to mimic real-world conditions. Real-time particle number measurements were made using a condensation particle counter and an optical particle counter. The temperature at which burn-off begins to occur was found to be around 120 to 150oC. This burn-off was found to be an evaporation-condensation phenomenon when metalworking fluid residues vaporize and condense forming fine (0.1µm to 2.5µm) and ultrafine (<0.1µm) aerosols. The temperature dependency of this phenomenon was observed to follow the Clausius-Clapeyron equation that states as temperature increases, vapor pressure increases. Most aerosol particles were observed to be in the range of less than 0.01µm to approximately 2.0µm.