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AIMS: To assess the relation between violence prevention policies and work related assault. METHODS: From Phase 1 of the Minnesota Nurses' Study, a population based survey of 6300 Minnesota nurses (response 79%), 13.2% reported experiencing work related physical assault in the past year. In Phase 2, a case-control study, 1900 nurses (response 75%) were questioned about exposures relevant to violence, including eight work related violence prevention policy items. A comprehensive causal model served as a basis for survey design, analyses, and interpretation. Sensitivity analyses were conducted for potential exposure misclassification and the presence of an unmeasured confounder. RESULTS: Results of multiple regression analyses, controlling for appropriate factors, indicated that the odds of physical assault decreased for having a zero tolerance policy (OR = 0.5, 95% CI 0.4 to 0.8) and having policies regarding types of prohibited violent behaviours (OR = 0.5, 95% CI 0.3 to 0.9). Analyses adjusted for non-response and non-selection resulted in wider confidence intervals, but no substantial change in effect estimates. CONCLUSIONS: It appears that some work related violence policies may be protective for the population of Minnesota nurses.

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OBJECTIVE: Identify the exposure effects of job family, patient contact, and supervisor support on physical and non-physical work related violence. DESIGN: Cross sectional study of employees in a Midwest health care organization, utilizing a specially designed mailed questionnaire and employer secondary data. SUBJECTS: Respondents included 1751 current and former employees (42% response rate). RESULTS: Physical and non-physical violence was experienced by 127 (7.2%) and 536 (30.6%) of the respondents, respectively. Multivariate analyses of physical violence identified increased odds for patient care assistants (odds ratio (OR) 2.5, 95% confidence interval (CI) 1. 1 to 6.1) and decreased odds for clerical workers (OR 0.1, 95% CI 0.03 to 0.5). Adjusted for job family, increased odds of physical violence were identified for moderate (OR 5.9, 95% CI 2.1 to 16.0) and high (OR 7.8, 95% CI 2.9 to 20.8) patient contact. Similar trends were identified for non-physical violence (OR 1.4, 95% CI 1.1 to 2.0 and OR 1.7, 95% CI 1.3 to 2.3). Increased supervisor support decreased the odds of both physical (OR 0.7, 95% CI 0.6 to 0.95) and non-physical violence (OR 0.5, 95% CI 0.4 to 0.6), adjusting for job family and demographic characteristics. CONCLUSIONS: Increased odds of physical violence were identified for the job family of nurses, even when adjusted for patient contact. Increased patient contact resulted in increased physical and non-physical violence, independent of job family, while supervisor support resulted in decreased odds of physical and non-physical violence.

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AIMS: To identify the magnitude of and potential risk factors for violence within a major occupational population. METHODS: Comprehensive surveys were sent to 6300 Minnesota licensed registered (RNs) and practical (LPNs) nurses to collect data on physical and non-physical violence for the prior 12 months. Re-weighting enabled adjustment for potential biases associated with non-response, accounting for unknown eligibility. RESULTS: From the 78% responding, combined with non-response rate information, respective adjusted rates per 100 persons per year (95% CI) for physical and non-physical violence were 13.2 (12.2 to 14.3) and 38.8 (37.4 to 40.4); assault rates were increased, respectively, for LPNs versus RNs (16.4 and 12.0) and males versus females (19.4 and 12.9). Perpetrators of physical and non-physical events were patients/clients (97% and 67%, respectively). Consequences appeared greater for non-physical than physical violence. Multivariate modelling identified increased rates for both physical and non-physical violence for working: in a nursing home/long term care facility; in intensive care, psychiatric/behavioural or emergency departments; and with geriatric patients. CONCLUSIONS: Results show that non-fatal physical assault and non-physical forms of violence, and relevant consequences, are frequent among both RNs and LPNs; such violence is mostly perpetrated by patients or clients; and certain environmental factors appear to affect the risk of violence. This serves as the basis for further analytical studies that can enable the development of appropriate prevention and control efforts.

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The lack of compliance with universal precautions (UP) is well documented across a wide variety of healthcare professions and has been reported both before and after the enactment of the Occupational Safety and Health Administration's Bloodborne Pathogens Standard. Gershon, Karkashian, and Felknor (1994) found that several factors correlated significantly with healthcare workers' lack of compliance with UP, including a measure of organizational safety climate (e.g., the employees' perception of their organizational culture and practices regarding safety). We conducted a secondary analysis using data from a cross-sectional survey of a convenience sample of 1,746 healthcare workers at risk of occupational exposure to bloodborne pathogens to assess the validity and reliability of Gershon's measure of safety climate. Findings revealed no relationship between safety climate and employees' gender, age, education, tenure in position, profession, hours worked per day, perceived risk, attitude toward risk, and training. An association was demonstrated between safety climate and (1) healthcare worker compliance with UP and (2) the availability of personal protective equipment, providing support for the construct validity of this measure of safety climate. These findings could be used by occupational health professionals to assess employees' perceptions of the safety culture and practices in the workplace and to guide the institution's risk management efforts in association with U.P.

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1. A 10 step method for program evaluation can be used to evaluate the success of a program in meeting its major goals and objectives. This evaluation examined the 20 year impact of the Midwest Center for Occupational Health and Safety, a NIOSH supported Educational Research Center, on its alumni. 2. The majority of alumni (89%) reported the primary focus of their work after graduation was the provision of occupational and environmental health and safety products and services--consistent with the legislative intent of Educational Research Centers (ERC). 3. Alumni reported the most highly valued ERC products and services included interdisciplinary interactions during and after graduate school, research training, and the presence of the ERC as a regional focal point for occupational health and safety graduate and continuing education. 4. The program evaluation design and survey instrument employed in this study are recommended for adaptation by other ERCs or educational programs faced with the challenge of providing evaluation data with minimal resources.

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This pilot project employed a case study design consistent with that of Rice to describe the impact of violence on individuals who incurred a work related assault in 1992. Ten randomly selected subjects were interviewed from a population of 429 individuals reporting a work related assault that resulted in a wage loss claim. Half of the subjects had received permanency ratings, thought to be a measure of injury severity. The study hypothesis, stating the impact of the assault (e.g., pain and suffering, decrease in functioning) years after a work related assault was associated with the severity of the injury (i.e., permanency rating), was not supported by the data. However, individuals' health and quality of life 4 years after the assault were affected significantly and resulted in job changes, chronic pain, changes in functional status, and depression. The new hypothesis resulting from this study is employer support and mental health intervention immediately after an assault may prevent employee job changes and decrease mental health sequelae.

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Rates of interpersonal violence at the national level in the United States exceed those of other industrialized nations; evidence of violence exists at the state level as well. Yet, data that identify the magnitude of the problem, pertinent risk factors, and efficacy of intervention efforts are limited. Faculty at the University of Minnesota School of Public Health conducted a survey to assess the extent to which violence prevention research and programmatic efforts exist statewide. Study findings served as a basis for developing a relevant research agenda and prioritizing limited academic resources. This paper describes the survey and development of an academic-community partnership that fosters collaborative research on violence prevention that will hopefully contribute to control of the violence epidemic.

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BACKGROUND: This study was conducted to describe women's perceptions of their maternity leave policy and its implementation, maternity leave benefits, postpartum work experience, and factors that relate to returning to work. METHODS: Surveys were mailed to 436 married, recently employed, first-time mothers at 1, 3, 6, 9 and 12 months postpartum. RESULTS: Most respondents said they had written maternity leave policies they could understand, but they were not completely satisfied with their policies. The average 11.1-week maternity leave was considerably shorter than their 8-month ideal, and only 25.5% had the option of working part-time. A minority (35.8%) were allowed to use personal days to care for a sick infant. Most women were distressed about making child care arrangements. Compared with women who remained at home, those who returned to work complained of more respiratory, gynecologic, and breast symptoms. CONCLUSIONS: Relatively little is known about women's postpartum work experience. In this study, return to work after delivery was related to several demographic, occupational, and social factors and was associated with health problems and concerns about child care. With a majority of new mothers now returning to work, attention has recently been directed to factors that facilitate the merger of work and parenting roles. One such important factor is women's parental or maternity leave benefits, the focus of this study.

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1. The majority of occupational exposures to potentially infectious blood and body fluids occur via needlestick injury. The morbidity and mortality from these exposures is significant. 2. Models from Haddon and White can help identify strategies to decrease the probability of needlestick injury. 3. A review of research examining work practices mandated by the Bloodborne Pathogens Standard challenges their effectiveness. Principles identified by Robertson provide insight into why work practices may not prevent needlestick injuries. 4. Engineering controls may be more effective in preventing needlestick injuries. Analysis of type and potential impact of needlestick preventive devices, cost, training requirements, and acceptance is essential in product selection.

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OBJECTIVE: To examine changes in women's physical health during the first postpartum year. DESIGN: Participants completed surveys at 1, 3, 6, 9, and 12 months post partum. PARTICIPANTS AND SETTING: Four hundred thirty-six first-time mothers who gave birth at one of two St Paul, Minn, hospitals during a 12-month period and who met the criteria for the study. MAIN OUTCOME MEASURES: Physical symptoms and number of illness days experienced within the previous 2 weeks. RESULTS: Physical problems seen at a higher prevalence at 1 month post partum included breast symptoms, vaginal discomfort, fatigue, hemorrhoids, poor appetite, constipation, increased sweating, acne, hand numbness or tingling, dizziness, hot flashes, and illness days. Several of these disorders--hemorrhoids, dizziness, fatigue, and constipation--persisted beyond 1 month and were joined by other "late" problems, including respiratory symptoms, sexual concerns, and hair loss. Women who returned to the work force noted more symptoms of respiratory infections, and women with vaginal deliveries had a higher prevalence of hemorrhoids, vaginal discomfort, pain with intercourse, difficulty reaching orgasm, sinus problems, and acne. CONCLUSIONS: Recovery from childbirth often requires more than the 6 weeks traditionally allotted, and postpartum health appears to be affected by delivery type and work status.

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This study analyzed the roles, functions, and job satisfaction of 65 master's prepared occupational health nurses employed within the health care industry to compare nurses who function as internal consultants with those who function as external consultants. The only significant difference between groups was that external consultants were more involved in marketing and management functions, whereas internal consultants were more involved in direct care. The study hypothesis that occupational health nurses performing more management functions would report greater job satisfaction was not supported by the data. Study findings did support a theoretical model by Hardy, revealing that greater role certainty and more role adapting behaviors were significantly associated with job satisfaction.

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Legislative activity regarding parental and family medical leave has been intense, with heated debate, in both national and state political arenas. Proponents of legislation report that policy is needed because of women's increasing rate of labor force participation and the concomitant shortage of substitute infant care. Benefits of policy are presumed to include women's health and parent-child bonding. However, no direct empirical evidence exists to support these assumptions. Opponents of legislation say that the cost of policy is burdensome to employers. However, the General Accounting Office reports that the only measurable net costs to employers associated with the federal bill will be to cover the leave takers' health insurance premiums. This literature review examines the above issues and identifies a policy relevant research agenda, crucial to the development of rational and humane policy.

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To examine the relationship between participation in a wellness program and the amount of absenteeism and medical claims, seven years of retrospective absenteeism and medical claims records were collected for 207 employees (pre- and postwellness intervention) and entered into a database. A proportional stratified random sample of workers by wellness participation was selected. While there was no significant change in the amount of sick leave taken over time, a log transformation revealed a significant increase in the dollar amount of medical claims over time, particularly for the middle-aged group of employees. This confirms that wellness intervention slowed the rate of increasing claims among middle-aged participants after just three years of wellness intervention.

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1. The shiftworker's inability to adapt to shiftwork schedules can lead to a loss of physical and psychological well being, and can produce negative safety and performance consequences. 2. The factors that contribute to the intolerance of working shiftwork schedules are complex and interrelated and include host variables (i.e., circadian rhythms) and environmental variables (i.e., type of shifts worked). 3. The most direct and consistent effect of working shiftwork is the impairment of the quality and quantity of sleep. 4. Interventions should include a program that monitors workers' tolerance to shiftwork and provides information and recommendations for employees to effectively manage a lifestyle that incorporates nighttime work schedules.

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1. An employer's decision whether to drug test or not was found to correlate with the size of the company and how extensively the employer perceives a drug abuse problem exists among its work force. 2. A company's drug testing program must be designed, implemented, and evaluated within a medical-legal framework. This includes issues of: confidentiality, employee actions that trigger a drug test, the presence of a drug and alcohol policy, communicating the program to employees and unions, the employee's rights, the consequences of an employee's positive drug test, and the procedures to be followed when collecting a specimen. 3. Future studies need to explore the issue of dealing with job performance problems; in particular, the cost and effectiveness of employee drug testing vs. the use of discipline alone.

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