Workplace violence in Alberta and British Columbia hospitals

Workplace violence is a significant and widespread public health concern among health care workers, including nurses. With growing awareness of how practice environments influence patient outcomes and the retention of health professionals, it is timely to consider the impact of workplace violence in hospitals. Registered nurses in Alberta and British Columbia, Canada were surveyed on their experiences of violence in the workplace over the last five shifts. Our results suggest that nurses are experiencing many incidences of violence in a given work week, particularly in the emergency, psychiatric, and medical-surgical settings. Most violent acts are perpetrated by patients, but there is also a significant portion of violence and abuse committed by hospital co-workers, particularly emotional abuse and sexual harassment. Our results also indicate that the majority of workplace violence is not reported. We suggest that using the Broken Windows theory might be a useful tool to conceptualize why workplace violence occurs, and that this framework be used to begin to develop new violence prevention policies and strategies.     

Food safety certification regulations in the United States

Food handlers often lack food safety training. Adequate training is important because foodborne illness results in costs of $7.7 to $23 billion per year to consumers, the food industry, and the national economy. Generally, however, training is evaluated through standardized examinations for which a certificate is awarded. Many states have turned to mandatory certification, but regulations vary. This paper summarizes state regulations with respect to mandatory certification. Among states that mandate certification, most require one certified food safety manager per site. The certified safety manager need not be on site at all times and must be recertified at least every five years. Certification is accomplished by passing one of the four exams previously recognized by the Conference for Food Protection (CFP), three of which the Conference for Food Protection-American National Standards Institute (CFP-ANSI) now accredits.     

Healthcare use before and after a workplace injury in British Columbia, Canada

Objectives

There is growing evidence that occupational injuries influence workers'' emotional and physical wellbeing, extending healthcare use beyond what is covered by the Workers'' Compensation Board (WCB).

Methods

The authors used an administrative database that links individual publicly funded healthcare and WCB data for the population of British Columbia (BC), Canada. They examined change in service use, relative to one year before the injury, for workers who required time off for their injuries (lost time = LT) and compared them to other injured workers (no lost time = NLT) and individuals in the population who were not injured (non‐injured = NI).

Results

LT workers increased physician visits (22%), hospital days (50%), and mental healthcare use (43% physician visits; and 70% hospital days) five years after the injury, relative to the year before the injury, at a higher rate than the NI group. For the NLT workers, the level of increased use following the injury was between that of these two groups. These patterns persisted when adjusting for registration in the BC Medical Service Plan (MSP) and several workplace characteristics.

Conclusions

Although the WCB system is the primary mechanism for processing claims and providing information about workplace injury, it is clear that the consequences of workplace injury extend beyond what is covered by the WCB into the publicly funded healthcare system.     

Automobile safety regulations and death reductions in the United States.

The effectiveness of federal automobile safety standards was examined using detailed data on 236,000 vehicles in fatal crashes in the United States during 1975-1978. Controlling statistically for type of regulation, types of vehicles, and ages of vehicles, the federal motor vehicle safety standards were associated with substantial reductions in car occupant death per 100 million vehicle miles travelled, and some reductions in fatal collisions of the federally regulated vehicles with pedestrians, motorcyclists, and bicyclists. Some 37,000 fewer deaths occurred in 1975-1978 than would have been expected without the federal standards.     

Rates of intimate partner violence in the United States.

OBJECTIVES: Estimates of intimate partner violence in the United States based on representative samples have relied on data from one person per household or limited numbers of indicators from both partners. The purpose of this study was to estimate nationwide rates of intimate partner violence with data from both couple members by using a standardized survey instrument, the Conflict Tactics Scale. METHODS: A multistage probability sampling design was used to conduct separate face-to-face interviews in respondents' homes with both members of 1635 representative couples living in the 48 contiguous states. RESULTS: Both partners' reports were used to estimate the following lower- and upper-bound rates: 5.21% and 13.61% for male-to-female partner violence, 6.22% and 18.21% for female-to-male partner violence, and 7.84% to 21.48% for any partner-to-partner violence. CONCLUSIONS: High rates of intimate partner violence in the United States corroborate previous claims that the amount of intimate partner violence is substantial.     

Social capital and violence in the United States, 1974-1993

Social capital is a characteristic of communities. Cross-sectional studies have shown that social capital is inversely associated with homicide and violent crime. We hypothesized that variations in social capital in US states over time can predict variations in regional homicide mortality both across and within time periods. We analyzed serial cross-sectional data for measures of social capital and age-adjusted homicide rates between 1974 and 1993. We used perception of social trust and per capita membership in voluntary associations, obtained from responses to the General Social Surveys, as the principal measures of social capital. We controlled for potential confounding by mean levels of income, urbanization, and region. Measures of perceived trust were strongly inversely correlated with homicide rates in an aggregate cross-sectional analysis (r=-0.51, p<0.001) and also within each time period. Social capital was an independent predictor of rates of violence when controlling for income, region, and urbanization (p<0.001). Homicide rates also predicted levels of social capital in adjusted models (p<0.001). To investigate directionality of this relationship we developed Markov transition matrices that described the change in the states' levels of social capital and homicide across time intervals. Analysis of the transitional probabilities confirmed that a simple unidirectional association between social capital and violence was not sufficient to describe this association. There is likely an impact of violence on levels of perceived trust in communities that complements the hypothesized effect of social capital on homicide. We conclude that the relationship between social capital and violence over time is non-linear and dynamic. More complex analytic models describing the relationship between violence and ecological social determinants need to be considered.     

中国和美国UDI法规框架与实施分析

分析了中国和美国在医疗器械唯一标识(unique device identification,UDI)法规框架、发码机构、数据库、实施方式等方面的差异,指出了我国在发码机构退出机制以及初期实施UDI过程中部分企业存在对《医疗器械唯一标识系统规则》认识不足等问题并给出建议,为后续更深入开展UDI工作提供了建设性意见.     

Nonfatal physical violence, United States, 1994.

OBJECTIVES: Most surveillance and research efforts focus on severe violence, especially on homicides. Because less extreme forms of violence may be precursors to more extreme forms, the authors analyzed data from a national survey to describe the extent of nonfatal physical violence in the US. METHODS: The authors generated weighted national estimates from responses to a random-digit-dialed telephone survey. Respondents were asked if they had been "hit, slapped, pushed, or kicked by another person or hit with an object or weapon" in the preceding 12 months. Respondents were also asked how many times such incidents had occurred and, for the last such episode, their relationship with the perpetrator, whether they had been injured, and, if so, whether they had sought medical treatment. RESULTS: The authors estimate that approximately 15 million people, or 8% of the US adult population, experienced nonfatal physical violence, as defined for this study, during a 12-month period. Male gender, the 18-24-year-old age group, never having been married, being out of work or a student, and heavy drinking were associated with a higher likelihood of being assaulted. An estimated 75% of assaults were by a known person and 26% by a stranger. Women were more likely than men to be assaulted by current or former intimate partners; men were more likely than women to be assaulted by strangers. An estimated 18% of incidents resulted in injuries, and an estimated 7% required medical attention. CONCLUSIONS: Nonfatal physical violence is fairly common in the US and may lead to more than one million medical encounters each year.     

Societal cost of workplace homicides in the United States, 1992-2001

BACKGROUND: The Census of Fatal Occupational Injuries (CFOI) reported 8,672 workplace homicide victims between 1992 and 2001. Although rarely calculated, cost estimates are important for prevention and research efforts. METHODS: Societal costs were estimated using the cost-of-illness approach applied to CFOI data. The cost calculation model incorporated medical expenses, future earnings summed from the year of death until the year the decedent would have been 67, and household production losses (includes activities such as child care and housework). RESULTS: Workplace homicide had a total cost of nearly 6.5 billion dollars and a mean cost of 800,000 dollars between 1992 and 2001. The retail trade industry division had the highest number of homicides and total cost, 2.1 billion dollars, for males and 556,000 dollars for females. CONCLUSIONS: Estimates of the cost of work-related homicides can be used to improve occupational injury prevention and control program planning, policy analysis, evaluation of safety and health interventions, and advocacy for a safer work environment.     

Research needs in drinking water: a basis in regulations in the United States

Regulations are one of the primary drivers for research on contaminants in drinking water in the United States. Since the original Safe Drinking Water Act (SDWA), enacted in 1974, the United States Environmental Protection Agency (USEPA) has developed a series of drinking water regulations. These regulations are focused on protecting public health. When evaluating available information on whether or not to regulate a constituent in drinking water, USEPA considers available information on health effects and occurrence of the constituent. The authors provide their view of the research needed for these contaminants. For inorganics, more data are needed on perchlorate. For organics, greater treatment and health effects information is warranted for N-nitrosodimethylamine (NDMA), methyl tertiary butyl ether (MTBE) and pharmaceuticals and personal care products. Finally, more research is needed on analytical methods for noroviruses and other emerging pathogens.     

Alcohol misuse,firearm violence perpetration,and public policy in the United States

ObjectiveFirearm violence is a significant public health problem in the United States, and alcohol is frequently involved. This article reviews existing research on the relationships between alcohol misuse; ownership, access to, and use of firearms; and the commission of firearm violence, and discusses the policy implications of these findings.MethodNarrative review augmented by new tabulations of publicly-available data.ResultsAcute and chronic alcohol misuse is positively associated with firearm ownership, risk behaviors involving firearms, and risk for perpetrating both interpersonal and self-directed firearm violence. In an average month, an estimated 8.9 to 11.7 million firearm owners binge drink. For men, deaths from alcohol-related firearm violence equal those from alcohol-related motor vehicle crashes. Enforceable policies restricting access to firearms for persons who misuse alcohol are uncommon. Policies that restrict access on the basis of other risk factors have been shown to reduce risk for subsequent violence.ConclusionThe evidence suggests that restricting access to firearms for persons with a documented history of alcohol misuse would be an effective violence prevention measure. Restrictions should rely on unambiguous definitions of alcohol misuse to facilitate enforcement and should be rigorously evaluated.     

欧美国家健康信息隐私保护立法情况探析及对我国立法的启示

进入二十一世纪,电子病历成为医疗信息化建设的重中之重,而电子病历系统应用过程中出现的安全问题不容忽视,尤其是病人信息的隐私保护。要提升电子病历的安全性,不仅要依赖技术手段,更需要法律法规保障。本文通过介绍典型国家与地区健康信息隐私保护的立法模式与立法经验,为我国相关立法提供立法启示。     

Medical costs and productivity losses due to interpersonal and self-directed violence in the United States

BACKGROUND: Violence-related injuries, including suicide, adversely affect the health and welfare of all Americans through premature death, disability, medical costs, and lost productivity. Estimating the magnitude of the economic burden of violence is critical for understanding the potential amount of resources that can be saved if cost-effective violence prevention efforts can be broadly applied. From 2003 to 2005, the lifetime medical costs and productivity losses associated with medically treated injuries due to interpersonal and self-directed violence occurring in the United States in 2000 were assessed. METHODS: Several nationally representative data sets were combined to estimate the incidence of fatal and nonfatal injuries due to violence. Unit medical and productivity costs were computed and then multiplied by corresponding incidence estimates to yield total lifetime costs of violence-related injuries occurring in 2000. RESULTS: The total costs associated with nonfatal injuries and deaths due to violence in 2000 were more than $64.8 [corrected] billion. Most of this cost ($64.4 billion or 92%) was due to lost productivity. However, an estimated $5.6 billion was spent on medical care for the more than 2.5 million injuries due to interpersonal and self-directed violence. CONCLUSIONS: The burden estimates reported here provide evidence of the large health and economic burden of violence-related injuries in the U.S. But the true burden is likely far greater and the need for more research on violence surveillance and prevention are discussed.     

Fatal violence among spouses in the United States, 1976-85.

In this paper we examine patterns and trends in homicides between marriage partners in the United States for 1976 through 1985 using data from the Federal Bureau of Investigation's Supplemental Homicide Reports (FBI-SHR). We identified 16,595 spouse homicides accounting for 8.8 per cent of all homicides reported to the FBI-SHR during this 10-year period. The rate of spouse homicide for this 10-year period was 1.6 per 100,000 married persons. The risk of being killed by one's spouse was 1.3 times greater for wives than for husbands. Black husbands were at greater risk of spouse homicide victimization than Black wives or White spouses of either sex. The risk of victimization was greater for spouses in interracial than in intraracial marriages and increased as age differences between spouses increased. From 1976 through 1985, the risk of spouse homicide declined by more than 45.0 per cent for both Black husbands and wives but remained relatively stable for White husbands and wives. Demographic patterns in the risk of spouse homicide were similar to those reported for nonfatal spouse abuse suggesting that the causes of spouse homicide and nonfatal spouse abuse may be similar.