175 research outputs found
Promoting the occupational health and safety of health workers : enabling factors and barriers to the local implementation of internationally designed tools
No full textRecognizing a global shortage of health workers (HWs), particularly in low- and middle-income countries (LMICs), persistent calls to increase retention and recruitment of this essential workforce have been made. Attrition of HWs is driven in part by unsafe working conditions. To help promote and improve the occupational health and safety (OHS) of HWs, the International Labour Organization (ILO) and World Health Organization (WHO), two specialized agencies of the United Nations, developed HealthWISE. This quality improvement tool helps health facilities identify workplace hazards and develop and apply low-cost solutions. This dissertation examines the overriding question: ‘What are the enabling factors and barriers to the effective local implementation of internationally designed tools, to improve the OHS of HWs in high-risk areas?’ To achieve this, it first explores the roles of the ILO and WHO in promoting the OHS of HWs through 17 semi-structured expert interviews supplemented by a literature and document review. Second, it examines the enabling factors and barriers to the implementation of HealthWISE in seven hospitals in Mozambique, South Africa, and Zimbabwe using a multiple-case study and applying the i-PARIHS framework. Finally, it develops theories about how HealthWISE works to improve the OHS of HWs through a realist evaluation. Roles identified as appropriate for international organizations included raising awareness and advocating (for OHS improvements) as well as developing and supporting the application of tools (like HealthWISE). Factors that enabled efficacious implementation of HealthWISE included dedicated local team members who adapted HealthWISE to workers’ OHS knowledge and skill levels and to the cultures and needs of their workplaces. Initial program theories suggested that HealthWISE works by increasing HWs’ feelings of value, empowerment, and ownership over their personal health and safety, and by emphasizing the need to work with available resources – based on content developed by two recognized and trusted organizations. Reflecting on the roles of international organizations, the experience implementing HealthWISE, and the mechanisms underlying how HealthWISE works suggest that international organizations focus beyond the identification and development of strategies and tools to emphasize increased support from and strengthened engagement with stakeholders to contribute to and critically assess effective implementation processes.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat
Infection risk and mitigation strategies for severe acute respiratory syndrome coronavirus 2 among healthcare workers in British Columbia, Canada
No full textBackground: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posed a major challenge to the resilience of health systems worldwide. Central to the pandemic response was the safety of the healthcare workforce which was the focus of several mitigation strategies. The overarching aim of this dissertation was to assess SARS-CoV-2 infection risk and mitigation among healthcare workers (HCWs) in a Canadian health region by: 1) examining the influence of occupational and community-acquired risk factors on SARS-CoV-2 infection, and HCW perception of the adequacy of controls; 2) synthesizing evidence on the effectiveness of vaccine mandates in healthcare contexts; and 3) evaluating the impact of the healthcare vaccine mandate in risk mitigation among HCWs.
Methods: A matched case-control study with an embedded mixed method design was conducted using primary data of active duty HCWs who tested for SARS-CoV-2 up to 15 months into the pandemic. A systematic review was conducted on the impact of healthcare vaccine mandates globally. Secondary data on vaccination and testing in the regional HCW cohort was utilized for a cohort study on the impact of the vaccine mandate on vaccine uptake and infection risk.
Results: The case-control study found that while some occupational factors were associated with infection risk, community exposure was more predictive of infection. HCWs were overall satisfied with the mitigation strategies, with some concerns expressed on prioritization of personal protective equipment allocation and mental stress. The systematic review found that the healthcare vaccine mandates were broadly effective for increasing vaccine uptake, but impact on infection risk was less understood and concerns on inequity were highlighted. The cohort study indicated that the vaccine mandate in the region was associated with significant increase in coverage and infection risk reduction.
Conclusion: A universal precautions approach can mitigate occupationally induced infection risk while ensuring that HCWs in perceived low risk settings are not neglected during public health emergencies. Application of mitigation strategies should be based not just on their short-term impact, but with consideration of the broader benefit to the health system. Creating and effectively utilizing trust-building opportunities will yield dividends during future public health emergencies.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat
Auditing healthcare facilities against the National Core Standards for occupational health and safety and infection prevention and control: compliance, reliability and impact
No full textAuditing in health care has been recommended by many national organisations to improve patient safety and quality of care, despite inconclusive evidence to support its effectiveness. In South Africa, the National Core Standards for health establishments in South Africa (NCS) was published in 2011. The NCS recognises that staff are vital to ensuring that the health system delivers quality health care and therefore require protection against the risk of injury, infection and other occupational hazards, consistent with the South African Occupational Health and Safety act of 1993. The aim of this study was to determine: (a) the compliance of public sector primary healthcare (PHC) facilities with the NCS for occupational health and safety (OHS) and infection prevention and control (IPC), (b) the impact of the audits three years after baseline audits, at follow up self-assessment audits and (c) the reliability of self-assessment audits when compared to external audit results. This dissertation is divided in three parts. Part A is the study protocol which received ethics approval in March 2015. Part B is a structured literature review covering standards for health care, the impact and effectiveness of accreditation/certification/auditing in health care, interrater reliability and factors associated with OHS/IPC compliance. Previous studies have failed to address whether evaluating occupational health and safety or infection prevention and control standards using accreditation/certification in a primary healthcare, low and middle income setting is effective or reliable. Part C is the journal ready manuscript presenting the results of the study in the form of a manuscript for an article for a named peer reviewed journal. This was a cross-sectional study of NCS OHS/IPC audit data, with a longitudinal component, of a sample of public sector PHC facilities in the Western Cape province of South Africa between 2011 and 2015. Baseline PHC facility compliance with OHS/IPC measures was low. There was no significant improvement in compliance after three years. Poor inter-rater reliability indicates a large degree of measurement error. Practical implications of these results are the need to improve reliability of assessments and a process to convert low compliance scores into implemented improvement actions
Season 8 Episode 3: Moral Messages of Disney Films
No full textWhy do the words “it\u27s a Disney film” mean “it\u27s wholesome” to so many? Annalee Ward of the Trinity Christian College communication arts dept., and author of the book Mouse Morality: The Rhetoric of Disney Animated Film, shows host Karen Saupe how parents can take a closer look at these films and provide better guidance for young viewers. Episode #803
Improving well-being through food sovereignty : a meta-narrative literature review
No full textIndustrialized agriculture and food security interventions have failed to eliminate global hunger, while creating complex environmental, health, and well-being challenges. The food sovereignty movement, which recognizes the power imbalances and social inequities in the global food system, presents a new lens through which to design interventions to improve how agricultural practices impact individual and community well-being. This thesis project answered the following research question: how can food sovereignty frameworks incorporate assessments of health and well-being? This research contributes to the gap in our understanding of the importance of food sovereignty practices to health and well-being through a meta-narrative literature review. Four well-being narratives (environmental, physical, cultural-spiritual, and social-political-economic) were identified from the literature and used to develop a novel framework demonstrating the relationship between food sovereignty practices and multi-dimensional well-being outcomes. A set of n=37 indicators were developed and organized into four themes of environmental, physical, cultural-spiritual, and social-political-economic wellbeing, to assess the relationship between food sovereignty practices and multiple forms of well-being. This study demonstrates how the application of food sovereignty practices can influence the well-being of individuals, their environments, and communities. As well, the results of this work emphasize the importance of defining well-being holistically, rather than viewing well-being outcomes from a purely biomedical health perspective. This framework presents a way for future researchers, farmers, and agricultural organizations to begin measuring well-being outcomes that result from their food production practices.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat
Workers' compensation claims for occupational Tuberculosis in South African health care workers: A survey of process and outcomes
No full textBackground
Occupational TB is the most frequently reported occupational disease in health care workers (HCWs) in South Africa. With the emergence of drug resistant strains and their associated health risks, and the associated increased risk for contracting these strains for HCWs, it becomes increasingly important to ensure that the worker’s compensation system is functioning properly for this disease. Whilst many studies have captured the poor functioning of the compensation system for workers in general in South Africa, the closest proxy examining the compensation of HCWs compensation for occupational TB is a study reviewing practices of occupational health nurses responsible for these cases. Whilst examining occupational injuries, workers, in general, report negative experiences with workers’ compensation processes. This study aimed to investigate the experience of health care workers whose cases of occupational TB were reported via the Western Cape Government Health department (WCG:H) to the Compensation Fund of the Department of Labour for compensation claim purposes.
Methods
This study was a case series with retrospective description, with a qualitative component. Simple random sampling was done on a subset of the population of cases of occupational TB recorded on a database held by the WCG:H administrative office responsible for submitting claims on behalf of WCG:H employees to the Compensation Fund. The study aimed to interview at least 100 HCWs who had reported their occupational TB as per the above mentioned database. In anticipation of a low expected response rate, 300 cases were sampled. Claim status for this sample were evaluated. Utilising general details obtained, an attempt was made to contact each HCW for a telephonic interview consisting of both open and close-ended (qualitative) questions. Fifty-one interviewers were completed. Interviews comprised of a structured telephonic interview carried out by one of three interviewers. The questionnaire consisted of three main sections examining (a) the experience of benefits available for people getting an occupational disease; (b) the experience of the process of reporting a case of an occupational disease to the Compensation Fund and (c) the process of having developed occupational TB as a HCW.
Results
Nearly half of the 300 cases from the provincial database had no record found on claim status check on the Compensation Fund website (n = 131, 46%). For claims without resolution with either acceptance or repudiation, the median waiting period from date of submission to 31 Dec 2017 was 5.8 years (IQR 3.2 - 9.2). 51 of the 144 cases for which contact attempt was made, gave consent (35% consent rate). Just under one third (n = 15, 31%) of the interviewees did not access occupational leave for their TB. Three quarters (n = 39; 75%) of employees incurred medical costs either personally or by their personal medical aid in relation to their diagnosis and treatment of TB. 21 (42%) of the participants reported ongoing medical problems and one reported being compensated for this. HCWs’ experience of contracting TB was marked by the experiences of stigma, surprise in contracting TB and financial stress as a result of their diagnosis. In addition, the experience of reporting their cases for compensation purposes was marred by poor administration and communication from all parties involved in the process.
Conclusion
The workers’ compensation system, i.e. the whole process from reporting through to benefit provision, has again been found to have many deficiencies. In this instance, HCWs are not receiving compensation benefits rightfully due to them for occupational TB. The experiences of HCWs contracting TB have been described as mostly being negative. In these negative experiences remedies to the system can be sought. The administrative components of submitting a claim, both by the claimant and by WCG:H to the Compensation Fund, have been found in this study to have a number of obstacles and gaps. Reform in communication, record keeping and timeously checking of claim status and payment of relevant compensation are required from the provincial level. Dedicated occupational health services were recommended by participants as these were expected to improve the service to potential claimants, as well as provide a source of information about the diagnosis and compensation aspects
Health impacts of consuming shellfish contaminated with polycyclic aromatic hydrocarbons (PAHs), harvested from waters polluted by petroleum and industrial activities
No full textPolycyclic aromatic hydrocarbons (PAHs) are ubiquitous toxic chemicals in the environment. Human activities have resulted in water pollution and seafood contamination with PAHs. PAHs bioaccumulate in shellfish, and their ingestion leads to several health outcomes. However, the extent of contamination and actual risk to shellfish consumers is not widely known. Therefore, the primary goal of this thesis is to highlight the health impacts of this consumption by synthesizing the evidence related to the health impacts of PAHs oral exposure, shellfish contamination across the world, and the degree of risk imposed on consumers. Two Cochrane-style systematic reviews were conducted: a review on the health effects of oral exposure to PAHs; another review on shellfish PAH contaminations, and risk assessments globally; and methodological reflections from collaborative research in Burrard Inlet assessing shellfish contamination and health risk to consumers from the Tsleil-Waututh Nation. The first systematic review confirmed cancer, developmental defects, toxicities in the nervous system, immune system, endocrine system, reproductive system, heart, and liver, following PAHs oral exposure. The second review showed different ranges of shellfish contamination worldwide. Based on the risk assessments, shellfish harvested from 40% of the studied areas imposed considerable risks on consumers. In Burrard Inlet, PAH levels were measured in several samples that suggested elevated risk while identifying methodological complexities in defining the implications of these findings. This review showed high risks for consumers due to shellfish PAH contamination across many countries, which may be associated with serious health impacts. In addition to using more rigorous methodological approaches in evaluating contamination, unique characteristics of each population need to be acknowledged in risk assessments.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat
Transnational Communities and the Evolution of Global Production Networks: The Cases of Taiwan, China, and India
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