Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults

ObjectivesTo estimate occupational differences in COVID-19 mortality and test whether these are confounded by factors such as regional differences, ethnicity and education or due to non-workplace factors, such as deprivation or prepandemic health.MethodsUsing a cohort study of over 14 million people aged 40–64 years living in England, we analysed occupational differences in death involving COVID-19, assessed between 24 January 2020 and 28 December 2020.We estimated age-standardised mortality rates (ASMRs) per 100 000 person-years at risk stratified by sex and occupation. We estimated the effect of occupation on COVID-19 mortality using Cox proportional hazard models adjusted for confounding factors. We further adjusted for non-workplace factors and interpreted the residual effects of occupation as being due to workplace exposures to SARS-CoV-2.ResultsIn men, the ASMRs were highest among those working as taxi and cab drivers or chauffeurs at 119.7 deaths per 100 000 (95% CI 98.0 to 141.4), followed by other elementary occupations at 106.5 (84.5 to 132.4) and care workers and home carers at 99.2 (74.5 to 129.4). Adjusting for confounding factors strongly attenuated the HRs for many occupations, but many remained at elevated risk. Adjusting for living conditions reduced further the HRs, and many occupations were no longer at excess risk. For most occupations, confounding factors and mediators other than workplace exposure to SARS-CoV-2 explained 70%–80% of the excess age-adjusted occupational differences.ConclusionsWorking conditions play a role in COVID-19 mortality, particularly in occupations involving contact with patients or the public. However, there is also a substantial contribution from non-workplace factors.

Factors Influencing CAM-ICU Documentation and Inappropriate “Unable to Assess” Responses

Background Detecting delirium with standardized assessment tools such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is important, but such detection is frequently hampered by poor documentation and inappropriate “unable to assess” responses (in noncomatose patients). Objective To identify patient, clinical, and workplace factors that may impede or facilitate appropriate delirium assessment through use of the CAM-ICU, specifically documentation and inappropriate “unable to assess” responses. Methods An electronic health record–based data set was used to quantify CAM-ICU documentation and inappropriate “unable to assess” responses during 24 months. Associated patient (eg, age), clinical (eg, diagnosis), and workplace (eg, geographic location within the ICU, shift) factors were evaluated with multivariable regression. Results Of 28 586 CAM-ICU documentation opportunities, 66% were documented; 16% of documentations in alert or lightly sedated patients had inappropriate “unable to assess” responses. Night shift was associated with lower CAM-ICU documentation rates (P = .001), whereas physical restraints and location on side B (rather than side A) of the ICU were associated with higher documentation rates (P < .05 for both). Age older than 80 years, non-White race, intubation, and physical restraints were associated with more inappropriate “unable to assess” responses (all P < .05), as was infusion of propofol, midazolam, dexmedetomidine, or fentanyl (all P < .05). Conclusion Data from electronic health records can identify patient, clinical, and workplace factors associated with CAM-ICU documentation and inappropriate “unable to assess” responses, which can help target quality improvement efforts related to delirium assessment.

A Survey of Incivility in the OT Workplace

Date Presented 04/13/21 Incivility in health care has adverse effects on patient care coordination, patient outcomes, practitioner well-being, and organizational costs. This study examined the relationships between perceived incivility and practitioners’ demographics, workplace factors, and resilience. The highest rates of incivility were reported by practitioners with 2–10 years of experience, working in skilled-nursing or long-term care, and with lowest resilience. Practices for mitigating incivility are discussed. Primary Author and Speaker: Deborah J. Bolding Contributing Authors: Taniya Varughese, Allison King

: Development and validation of tool for screening occupational mental health and workplace factors influencing it

Introduction:Occupational mental health is one of the key entity for ideal work place. Earlier studies have identified certain workplace factors to influence the mental health of the worker. “Workload”, “Reward”, “Community”, “Control”, “Values” and “Fairness” are the key areas identified in occupational psychology that determine the mental health of the worker. An imbalance in these factors may lead to negative occupational mental health, i.e. burnout. The burnout, a psychological syndrome is combination of emotional exhaustion, depletion of compassion and sense of reduced accomplishment. To note, the concept of occupational mental health in nation with second largest workforce is nascent. Further, the utility of existing western tools in Indian context is limited by multiple factors such as less comprehensibly, culturally inappropriate, patented and other factors. Hence, a tool was developed to screen the occupational mental health and workplace areas. Methods and results:Conventional steps involved in psychological tool development, viz. construct identification, drafting of pertinent questions, content validation, field testing of questions and others were adopted. After series of steps, a tool for screening the occupational mental health consisting of 21 questions and screening the key constructs influencing the mental health at workplace (workplace assessment) consisting of 25 questions were developed. Each of these questions sought responses using a 3-point scale i.e. “Never”, “Sometimes” and “Always”. As intended, the questions were relatively simple, shorter, comprehensible and compliant (no rejections) as observed by the feedback obtained during the pilot (feasibility) study involving 58 consenting volunteers. The tool was explored on larger sample involving workforce from various occupational background in addition to screening of the general mental health using general health questionnaire 5 (GHQ 5). The screening tool exhibited adequate test - retest reliability, internal consistency / reliability (cronbach’s α > 0.73) and correlation (correlation coefficient > 0.6) with the general mental health in larger evaluation of 153 consenting workers.Conclusion: Present study attempted to develop tool for screening adverse occupational mental health (burnout) and workplace factors that are known to be detrimental for mental health. Considering the magnitude of workforce and relatively naïve the concept of occupational mental health in the country, a tool (such as the one reported in the study) for screening the mentioned constructs are need of the hour. Hence, the proposed simple and easy to administer tool, would aid in recognizing the burnout and aid in early diagnosis and management of those requiring intervention.

Health and wellness in the Australian coal mining industry: A cross sectional analysis of baseline findings from the RESHAPE workplace wellness program

Overweight and obesity has reach pandemic levels, with two-thirds (67%) of adult Australians classified as overweight or obese. As two of the most significant behavioral risk factors for obesity are modifiable (diet and exercise), there exists an opportunity for treatment through workplace health promotion initiatives. As one of Australia’s largest industries with its own unique workplace factors, the mining industry has previously reported higher than population levels of overweight and obesity. This represented an opportune setting to test the RESHAPE workplace wellness program. RESHAPE is an eight-step framework (based on the WHO ‘Health Workplace Framework and Model’) which aims to provide a sustained approach to wellness in the workplace. This paper presents baseline findings from a pilot study that aimed to implement RESHAPE at three mine sites in NSW, Australia, and investigates the issue of overweight and obesity in the coal mining industry. Across three mine sites, 949 coal miners were examined cross-sectionally on a range of workplace, wellness, health, diet, and exercise factors using a paper-based survey. This was a predominantly male sample (90.4%) with the majority (59.2%) of participants aged 25–44 years. Self-reported height and weight measures indicated that less than 20 percent (18.9%) of participants were in a healthy BMI range, while there were effectively equal numbers of overweight (40.9%) and obese (39.1%) participants. Only 3.5% of participants met the daily recommendation for vegetables (5 serves) and shift-workers had greater association with elevated BMI compared to non-shift workers (B = 1.21, 95% CI: 0.23, 2.20, p = 0.016). Poor nutrition is likely to be a key component in elevated levels of overweight and obesity within this industry, with workplace factors compounding challenges workers face in implementing health behavior change. Future studies would benefit from assessing diet and physical activity knowledge in relation to recommendations and serving sizes.

The importance of understanding burnout: an oncology nurse perspective

The challenges presented by the global COVID-19 pandemic have intensified the stressors placed on nurses, leading to burnout. Oncology nurse burnout is likely to be an increasingly significant issue for cancer services as the true cost of the pandemic is revealed. Delays in diagnosis and treatment of cancers are reported widely, inevitably leading to poor prognosis and more aggressive treatments for patients. Gaining a better understanding of oncology nurse burnout, its prevalence and causes as well as strategies to reduce or prevent it will help to improve patient care and support staff wellbeing during and after the pandemic. Methodology: A search of the literature related to oncology nurse burnout, covering North America and Europe over 5 years (August 2014-January 2020), resulted in 31 articles for review. None of the studies were carried out in the UK, suggesting a need for robust investigations into oncology nurse burnout in the British health service. Summary: The prevalence of burnout among oncology nurses before the COVID-19 outbreak appeared to be high and is likely to have increased as a result of the pandemic. However, the studies investigating oncology nurse burnout are small and cross-sectional, with low-quality methods. The literature suggests the major causes of burnout arise in the workplace, particularly aspects of the environment that prevent nurses from working according to their values. Although burnout is frequently attributed to workplace factors, interventions remain focused on individuals' coping mechanisms and rarely on the workplace factors that are known to cause it.

Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults

Objective: To estimate occupational differences in COVID-19 mortality, and test whether these are confounded by factors, such as regional differences, ethnicity and education or due to non-workplace factors, such as deprivation or pre-pandemic health. Design: Retrospective cohort study Setting: People living in private households England Participants: 14,295,900 people aged 40-64 years (mean age 52 years, 51% female) who were alive on 24 January 2020, living in private households in England in 2019, were employed in 2011, and completed the 2011 census. Main outcome measures: COVID-19 related death, assessed between 24 January 2020 and 28 December 2020. We estimated age-standardised mortality rates per 100,000 person-years at risk (ASMR) stratified by sex and occupations. To estimate the effect of occupation due to work-related exposures, we used Cox proportional hazard models to adjust for confounding (region, ethnicity, education), as well as non-workplace factors that are related to occupation. Results: There is wide variation between occupations in COVID-19 mortality. Several occupations, particularly those involving contact with patients or the public, show three-fold or four-fold risks. These elevated risks were greatly attenuated after adjustment for confounding and mediating non-workplace factors. For example, the hazard ratio (HR) for men working as taxi and cab drivers or chauffeurs changed from 4.60 [95%CI 3.62-5.84] to 1.47 [1.14-1.89] after adjustment. More generally, the overall HR for men working in essential occupations compared with men in non-essential occupations changed from 1.45 [1.34 - 1.56] to 1.22 [1.13 - 1.32] after adjustment. For most occupations, confounding and other mediating factors explained about 70% to 80% of the age-adjusted hazard ratios. Conclusions Working conditions are likely to play a role in COVID-19 mortality, particularly in occupations involving contact with COVID-19 patients or the public. However, there is also a substantial contribution from non-workplace factors, including regional factors, socio-demographic factors, and pre-pandemic health.