Length Of Service Research Articles

Association of the Length of Service in the 24/48 Shift of Firefighters of the State Fire Service in Wroclaw on Selected Serum Biochemical Parameters of Nutritional Status.

The aim of the study was to evaluate the association of the quality of diet as calculated by the Nutrient Rich Food index (NRF9.3), and length of service (LS) (≤10 years vs. >10 years) with selected serum biochemical parameters, the proportions of different lipid profile fractions and advanced glycation endproduct (AGE) values of 108 firefighters from the State Fire Service in Wroclaw. The LS officers > 10 years had significantly higher total cholesterol (211.50 (184.00-254.00) vs. 184.00 (166.00-194.00)), LDL (123.75 (108.20-167.90) vs. 105.18 (90.24-119.00)) non-HDL (151.70 (132.00-196.70) vs. 122.00 (106.00-140.00)), triglycerides (118.50 (96.00-158.00) vs. 78.00 (67.00-103.00)) and lower HDL concentrations (51.30 (45.60-56.70) vs. 58.00 (51.70-66.10)) compared to firefighters in the LS ≤ 10 years group. Significant differences between the seniority groups were also noted for all lipid profile ratios. Regardless of the officers' seniority, systolic blood pressure was observed at the highest normal level of 134.4 ± 14.4 in the LS ≤ 10 years group and 139.5 ± 14.3 in the LS > 10 years group. Advanced glycation endproduct values were significantly dependent on diet quality, as expressed by the NRF9.3 index and on the TG/HDL ratio, but not on seniority. Diet quality, as expressed by the NRF9.3 index, had a significant association with GLU and FI levels, and components of the lipid profile between seniority groups. As NRF9.3 increased, TG/HDL, LDL/HDL, TC/HDL, and non-HDL/HDL ratios decreased. AGEs were significantly affected by NRF9.3 and significantly associated with TG/HDL. Firefighters' diets, as assessed by the NRF9.3 index, had a significant association with predictors of insulin resistance, diabetes, and cardiometabolic predictors between seniority groups. The nutritional education of firefighters (and other professional groups working irregularly), especially those with longer tenure (e.g., >10 years), is necessary to prevent the development of, e.g., CVD, MetS, and T2DM, which contribute towards a reduced ability to perform professional duties.

Alternative Open Education System towardsa Professional National Police of the Republic of Indonesia: A Case Study of Police Officer Candidate School Students

This research was conducted to answer the questions "What is the current educational situation in Secapa Polri" and "How is the education system in Secapa Polri". Interest in researching this topic is based on the fact that the professionalism of the National Police is relatively low. This is marked with; The police's typical technical capabilities have decreased, they are no longer responsive in providing services to the community, tend to be militaristic, etc. which are thought to be caused by educational factors as stated by several experts who understand the Police. In connection with the research objectives, this study used 10 informants (5 students/former students and 5 supervisors/teaching staff). The research subjects were 400 Secapa Polri students from the 28th class of the 2000 academic year. Each of them was given a questionnaire to measure students' opinions and feelings towards educational system variables. The research results from qualitative data analysis revealed that the Secapa Polri educational institution was physically inadequate and gave the impression of being a closed educational institution; 11 month educational curriculum with many subjects(38 subjects), busy activities, minimal skills subject matter; the teaching and learning process is supported by personnel who are limited in quantity and quality, use of inappropriate learning methods; Student behavior is behavior obtained from a limited"model". Several of these characteristics indicate that Secapa Polri is an educational institution that implements a closed education system. Apart from that, the results of quantitative data analysis of students' opinions and feelings show that the mean of the education system variables is to the left of the average with the variations in the answers given tending to be homogeneous. This indicates a closed education system. There is similarity (consistency) between students' opinions and feelings towards the Secapa Polri education system. This further emphasizes that the education system at Secapa Polri is a closed education system. Considering the limitations of a study which cannot possibly reveal all the aspects studied, there are several things that can be discussed. There are similarities between the results of this research and the results of research conducted by the National Police Dislitbang and UGM, and the PTIK Working Group, namely that the National Police education curriculum needs to be adapted to societal developments. To find out how an effective and efficient education system is in forming professional police, it is necessary to develop a comparative study with police education that is at the same level as Secapa education in other countriesthat are already developed but have societal characteristics that are similar to Indonesian society. Use of theory developed with motivation theory as contained in Mc theory. Clelland (Gibson, et al,1997) and social judgment theory which assumes that a person's behavioral guidelines are based on judgment standards formed by previous experience, life and environment. Data analysis can be developed using regression analysis to see how big the contribution of student motivation, educational background, lengthof service, and education system is to the behavior of students resulting from certain education (SPN, Akpol, PTIK, Secapa, etc.). By expanding research problems, increasing research questions, enriching theories and theoretical frameworks and developing research methods, it is very likely that the results will be more representative and more useful for organizational development, especially accelerating the realization of a professional Police.

Association of the Length of Service of 24/48 Firefighters with the Quality of Their Diet and Selected Anthropometric Parameters.

The aim of the study was to examine the association of lengths of service (LS) ≤ 10 years and >10 years in 24/48 shifts with the quality of the observed diet based on the Nutrient Rich Food Index (NRF9.3) and selected anthropometric parameters of 130 firefighters of the State Fire Service (SFS) in Wroclaw, Poland. The study also analysed the individual components of the men's diets required to calculate the NRF9.3 index in both seniority groups. Men with LS > 10 years had statistically significant higher body weight (89.00 kg vs. 81.59 kg), body-fat level (22.80 kg vs. 17.95 kg), waist circumference (96.50 cm vs. 89.00 cm), body-fat percentage (21.94 ± 4.06% vs. 25.00 ± 5.45%), body mass index (BMI) (28.10 kg/m2 vs. 25.40 kg/m2) and waist-hip ratio (WHR) (0.84 0.92 vs. 0.84), compared to the LF ≤ 10 years group. In contrast, the quality of the men's dietary adherence, based on the calculated NRF9.3 index, did not differ between the study groups, and was 662.50 ± 103.1 and 664.78 for the LS ≤ 10 years and LS > 10 years groups, respectively. Based on a statistical analysis using the NRF9.3 diet quality index by tertile (NRF9.3-C), a leading and statistically significant association of LS > 10 years vs. ≤10 years was observed as to most of the anthropometric parameters studied. In contrast, the association of participants' diet quality, as assessed by the NRF9.3 index value, was insignificant for all anthropometric parameters studied.

Stavovi o važnosti specijalističkog usavršavanja kod medicinskih sestara

Introduction. For a considerable period, nursing was regarded as a female-dominated profession that operated under the supervision of physicians and lacked its own distinct domain of practice. Nursing is a profession that was for a long time seen as a female profession, under the direction of doctors and without its own field of activity. Today's complexity of treatment and health care requires specialized and experienced nurses to ensure quality outcomes for patients. Modern nursing faces many challenges, especially pandemics, inflexible working hours and lack of independence at work. The question is whether, by transforming the healthcare system, the role of nurses will also be reconsidered.Aim. To present the views of the nurses of the General Hospital of Šibenik-Knin County on the need for specialist training in nursing.Methods. The research was conducted in form of a survey questionnaire which was administered to a group of 146 nurses who were employed at the General Hospital of Šibenik-Knin County. It consisted of data on specialist education in nursing (the attitude of nurses on the need for specialization, their awareness of it). The analysis was performed in the statistical software SPSS 25.Results. Nurses with secondary vocational education predominate in the conducted research. They are mostly employed in the hospital department. They state a higher level of knowledge in a narrowly specialized field as the main motive for specialization.A statistically significantly higher number of participants expressed their intention to continuetheir education in the future and progress professionally.The limitation in this intention stems from the fact that the majority of participants are not familiar with the specialization program, even thoughtheir attitudes support specialization.Conclusion. On the basis of the conducted research,the results are reached which show that the nursesof the General Hospital of Šibenik-Knin County encouragespecialist education within the profession.The largest number of respondents believe that specializationin the nursing profession can lead to an increasein the quality of service, and the main reasonfor specialization is a higher level of knowledge ina narrowly specialized field of work. Also, the largestnumber of participants intend to continue theireducation, but most of them are not familiar with thepossibilities of specialization within the profession.Hypotheses that tested whether nurses' attitudestowards specialist education differ based on lengthof service, level of education and workplace were rejected.

The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis.

AimAcute pancreatitis is a diagnosis established by fulfillment of at least two out of three clinical features, including epigastric pain, elevated lipase, and/or radiographic evidence of acute pancreatitis. Computed tomography of the abdomen and pelvis (CTAP) is the gold standard imaging modality for evaluating acute pancreatitis. Although abdominal ultrasound (AUS) is increasingly utilized given the widespread availability and high sensitivity and specificity for detecting gallstone-related complications, including gallstone pancreatitis, the leading cause of acute pancreatitis in the US. However, recent literature has concluded that performing AUS following a negative CTAP rarely led to changes in management and imparted an increased length of service (LOS) in the ED. Our study investigated whether a similar relationship was observed when managing acute pancreatitis in the inpatient setting. We aimed to quantify how performing AUS influenced inpatient LOS for patients admitted for acute pancreatitis without radiographic evidence of acute pancreatitis on CTAP. We also aimed to quantify how AUS influenced the likelihood of subsequent intervention via endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy, including the relative impact of certain demographic or clinical features.MethodsA retrospective analysis was performed using a cohort of 6069 patient encounters extracted via the HCA Healthcare enterprise data warehouse (EDW) database. Inclusion criteria were all adult patients with an index admission for acute pancreatitis between January 1 and December 31, 2019, who underwent CTAP during admission. Patients younger than 18 years, with prior cholecystectomy, or without documentation of demographic or clinical data of interest were excluded. The primary outcome was to quantify how performing AUS within 48 hours impacted LOS for patients admitted for acute pancreatitis following negative CTAP. Secondary outcomes examined whether AUS changed management (i.e., per likelihood of subsequent ERCP or cholecystectomy). This included determining the influence of various demographic or clinical characteristics on the likelihood of intervention via ERCP or cholecystectomy. Linear regression was used to determine the effect of performing AUS on the duration of LOS. Logistic regression was used for covariate analysis based on demographic (BMI, sex, race, age) and clinical data (comorbid conditions, abnormal labs, and vital signs).ResultsPatients with acute pancreatitis who underwent AUS within 48 hours had a reduced LOS of 1.099 days. Patients who underwent AUS were 1.126 times more likely to undergo subsequent ERCP than those who received CTAP alone. Patients who received AUS following CTAP were also 2.711 times more likely to undergo subsequent cholecystectomy. Increasing age and BMI were correlated with an increased likelihood of ERCP and cholecystectomy. Males were less likely to undergo cholecystectomy (OR = 0.753) and ERCP (OR = 0.815) compared to females.ConclusionPerforming AUS within 48 hours following negative CTAP in this cohort of patients admitted for acute pancreatitis was associated with a decreased LOS. Furthermore, patients who underwent AUS were more likely to undergo ERCP and even more likely to undergo cholecystectomy. The likelihood of ERCP and cholecystectomy increased proportionally to both age and BMI. Females were more likely than males to undergo subsequent ERCP or cholecystectomy.

The Impact of Having a Child With Special Healthcare Needs on Length of Military Service.

In 2010, the National Survey of Children with Special Healthcare Needs revealed that parents of children with special healthcare needs (CSHCN) report employment decisions are influenced by healthcare coverage needs. The U.S. military healthcare system arguably offers service member parents of CSHCN with the most comprehensive, inexpensive, long-term healthcare in the country-potentially increasing their incentive to remain in the military. This study explored the effect of having a CSHCN on the length of parental military service. A retrospective cohort was formed using the Military Health System database from 2008 to 2018. Included children were <10 years in 2010 and received ≥1 year of military healthcare between 2008 and 2010. The Pediatric Medical Complexity Algorithm categorized children as having special healthcare needs via ICD 9/10 codes as having complex chronic (C-CD), non-complex chronic (NC-CD), or no chronic disease (CD). Families were classified by the child with the most complex healthcare need. Duration of military healthcare eligibility measured parental length of service (LOS). ANOVA and linear regression analysis compared LOS by category. Logistic regression determined odds of parental LOS lasting the full 8-year study length. Adjusted analyses controlled for child age and sex, and military parent sex, rank, and marital status. Over 1.45 million children in 915,584 families were categorized as per the algorithm. Of individual children included, 292,050 (20.1%) were CSHCN including those with complex chronic and non-complex chronic conditions. After grouping by family, 80,909 (8.8%) families had a child/children with C-CD (mean LOS 6.39 years), 170,787 (18.7%) families had a child/children with NC-CD (mean LOS 6.41 years), and 663,888 (72.5%) families had children with no CD (mean LOS 5.7 years). In adjusted analysis, parents of children with C-CD and NC-CD served 0.4 [0.37-0.42] and 0.33 [0.31-0.34] years longer than parents of children with no CD; odds of parents serving for the full study period were increased 33% (1.33 [1.31-1.36]) in families of children with C-CD and 27% (1.27 [1.26-1.29]) in families of children with NC-CD. Findings indicate that military parents of CSHCN serve longer military careers than parents of children with no chronic conditions. Continued provision of free, high-quality healthcare coverage for dependent children may be important for service member retention. Retaining trained and experienced service members is key to ensuring a ready and lethal U.S. military.

Effect of occupational exposure to heavy metals on the liver functions in persons working in cable manufacturing factory in Nnewi

Occupational exposure to hazardous metals or heavy metals has remained an issue of public health importance owing to the grave implications it has on human health. This study evaluated the effect of occupational exposure to heavy metals on the liver functions in persons working in a cable manufacturing factory in Nnewi. A total of 79 apparently healthy individuals comprising of 39 persons working in cable producing factory (test group) and 40 control participants aged between 18 and 56 years were recruited for the study. Five millilitres (5mls) of venous blood sample was collected from each individual into plain container for the evaluation of biochemical parameters. Serum total protein (TP), albumin (ALB), direct bilirubin (DB), total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activities were assayed for using standard laboratory methods. Results showed significant increases in the AST (27.552.08 Vs 9.150.13) and ALP (238.3724.40 Vs 20.700.48) activities and in levels of TP (7.820.27 Vs7.100.04) and DB (4.140.30 Vs 2.670.07) in cable factory workers when compared with the control subjects (p0.05). Furthermore, gender differences were observed in the values of DB, AST, and ALP compared with control. Results also showed no significant effects of age and length of service (LOS) on the liver function status of factory workers studied. Thus, this study revealed no liver impairment among the cable factory workers studied as a result of occupational exposure. This could be attributable to the short term duration of exposure of the factory workers. Keywords: Occupational exposure, Heavy metals, Liver, Liver functions, Cable factory, Age, LOS, Gender.

Knowledge and Confidence Level Among Emergency Healthcare Workers in Airway Management and Resuscitation of Suspected COVID-19 Patients: A Cross Sectional Study in Malaysia

This study aims to evaluate the knowledge and confidence of emergency healthcare workers (EHCW) in facing the COVID-19 pandemic. A cross-sectional online study using a validated questionnaire was distributed to doctors (MD), assistant medical officers (AMO), and staff nurses (SN) at an urban tertiary Emergency Department. It comprised of 40 knowledge and 10 confidence-level questions related to resuscitation and airway management steps. A total of 135 from 167 eligible EHCW were enrolled. 68.9% (n = 93) had high knowledge while 53.3% (n = 72) possessed high confidence level. Overall knowledge mean score was 32.96/40 (SD = 3.63) between MD (33.88±3.09), AMO (32.28±4.03), and SN (32.00±3.60), P= 0.025. EHCWs with a length of service (LOS) between 4-10 years had the highest knowledge compared to those with LOS <4-year (33.71±3.39 versus 31.21±3.19 P = 0.002). Airway-related knowledge was significantly different between the designations and LOS (P = 0.002 and P = 0.003, respectively). Overall, EHCW confidence level against LOS showed significant difference [F (2, 132) = 5.46, P = 0.005] with longer LOS showing better confidence. MD showed the highest confidence compared to AMO and SN (3.67±0.69, 3.53±0.68, 3.26±0.64) P = 0.049. The majority EHCW were confident in performing high-quality chest-compression, and handling of Personal Protective Equipment but less than half were confident in resuscitating, leading the resuscitation, managing the airway or being successful in first intubation attempt. EHCW possessed good knowledge in airway and resuscitation of COVID-19 patients, but differed between designations and LOS. A longer LOS was associated with better confidence, but there were some aspects in airway management and resuscitation that needed improvement.

Evaluation of some heavy metal levels in blood of lead acid battery manufacturing factory workers in Nnewi, Nigeria

Today, industrialization has been implicated in the generation of certain compounds which are potentially hazardous to human life. This is a cross sectional study designed to evaluate some heavy metal levels in blood of lead acid battery manufacturing factory workers in Nnewi, Nigeria. A total of 39 apparently healthy individuals in lead acid battery manufacturing factory aged between 19 and 56 years and 79 control individuals (comprising of 39 control individuals from Nnewi (N) and 40 control individuals from Elele (E) respectively) aged between 18 and 44 years were recruited for the study. Demographic data and body mass index (BMI) of participants were obtained using structured questionnaire and thereafter, 5ml of venous blood sample was collected from each individual for the evaluation of heavy metal levels (Pb, Ni, Cu, Zn, As and Se) using atomic absorption spectroscopy (AAS). Results showed that the factory workers had an average length of service (LOS) of 7.70±0.86 years and BMI which did not differ significantly when compared with the control groups (control N and E individuals) respectively (p&amp;#62;0.05). However, elevated levels of Ni, As and Pb and decreased levels of Cu, Zn and Se were observed in the blood of the factory workers compared with control N and E individuals respectively (p&amp;#60;0.05). Therefore, this study has shown that these individuals may be prone to heavy metal toxicity and possible depletion on some vital micronutrients which may have grave health consequences for individuals dwelling in this area.

Short Hospice Length of Service in a Comprehensive Cancer Center.

Background: The benefits of hospice for patients with advanced cancer are well established. Short hospice length of service (LOS) is a marker of poor quality care and patient and family dissatisfaction. Interventions based on behavioral science might reduce suboptimal hospice use. Objective: To assess effects of peer comparisons on rates of short hospice LOS for cancer patients at a tertiary comprehensive cancer center. Design: Pre-post design utilizing a peer-comparison feedback intervention comparing individual oncologist hospice data. Setting: Urban, academic, comprehensive cancer center in Maryland. Measurements: Hospice enrollment rate. Median hospice LOS and percentage short hospice LOS (defined as ≤7 days). Results: Sixty oncologists received the intervention. Before the intervention, 394 patients enrolled in hospice for a period of 21 months (18.76 enrollments per month). Median hospice LOS was 14.5 days. After the intervention, 418 patients enrolled in hospice for 14 months (29.85 enrollments per month). Median hospice LOS was nine days. The percentage of patients experiencing a short hospice LOS increased from 33.3% to 43.5%. Conclusions: The methods are not sufficient to conclude that the intervention does not improve hospice use. A substantial number of patients with cancer who used hospice had LOS ≤7 days, a marker of poor quality. Using peer comparison in combination with additional behavioral interventions should be considered to improve end-of-life care.

Hospice length of service in patients with advanced gastrointestinal cancers treated at an NCI-designated cancer center.

812 Background: Hospice Length of service (LOS) is a Quality Oncology Practice Initiative (QOPI) measure, and an established metric of end-of-life (EOL) care. Short hospice LOS is associated with lower-quality EOL care, poor symptom control, and patient and caregiver dissatisfaction. Oncologist- and/ or system-specific factors may contribute to shorter hospice LOS. Methods: We conducted a retrospective chart review of patients with advanced gastrointestinal (GI) cancers referred to hospice from a comprehensive cancer center in 2018, and compared data to 2015. We analyzed LOS under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7 days), and examined the variation between individual oncologists within the GI oncology division. The coefficient of variation (Cv) represents degree of variability between oncologists, and was calculated based on median LOS for each oncologist. Mean and SD of oncologist LOS were calculated. Cv was defined as SD/mean; Cv &gt; 100% is typically considered a high variance distribution. Results: A total of 114 patients with advanced GI cancers were discharged to hospice in 2015, and 115 patients in 2018. The median age of patients was 66 years, 47% women, and 80% white. The number of GI oncologists were 9 in both years and median patients per oncologist were 12 in 2015, and 13 in 2018. The median hospice LOS was 16 days in 2015, which decreased to 9 days in 2018. The %LOS ≤ 7 days increased from 25% in 2015 to 47% in 2018. The Cv% was &lt; 100% in both 2015 (63%) and 2018 (44%). Conclusions: In this retrospective study of hospice LOS among patients with advanced GI cancer at a single cancer center, median hospice LOS declined, and %LOS ≤ 7 days increased from 2015 to 2018. We did not find significant variation in hospice referral patterns between oncologists within the GI oncology division. These data point to system level factors responsible for sub-optimal hospice LOS. We will present our data at division meetings, and use mixed-methods design for investigating and eventually addressing barriers to low hospice LOS.

Evaluation of heavy metal levels in blood of cable manufacturing factory workers in Nnewi

Introduction of Study: Heavy metals are toxic and have adverse effects on human health depending on the intensity and duration of exposure. Materials and Methods: This is a cross sectional study designed to assess the heavy metal levels in blood of cable manufacturing factory workers in Nnewi, Nigeria. A total of forty (40) apparently healthy individuals from the cable manufacturing factory (the exposed group) aged between 19 and 56 years and 79 control individuals (comprising of 39 control individuals from Nnewi (N) and 40 control individuals from Elele (E) respectively) aged between 18 and 44 years were recruited for the study. The body mass index (BMI) and length of service (LOS) of participating individuals were obtained using structured questionnaire and thereafter, 10ml of venous blood sample was collected from each individual for the evaluation of heavy metal levels (Pb, Ni, Cu, Zn, As and Se) using atomic absorption spectroscopy (AAS). Results: There was no significant difference in Body mass index (BMI) of factory workers compared with control subjects (P>0.05). There were significant increases in the mean levels of Ni, As and Pb and decreases in Cu, Zn and Se levels in cable manufacturing factory workers than in controls (p respectively. However, no significant statistical correlations were found between metal levels in factory workers and age as well as LOS (p>0.05). Conclusion: This study has shown a possible metal toxicity and deficiency of microelements in the subjects studied and these may impact negatively on human health. Keywords: Cable manufacturing factory workers, Factory effluents, Heavy metals, Body mass index (BMI), Age, Length of service (LOS).

Assessment of heavy metal levels in blood of metal forging factory workers in nnewi, Anambra state, Nigeria

Background: Heavy metal toxicity has proved to be a major threat to human health as several health risks are associated with it. Materials and Methods: This is a cross sectional study designed to assess the heavy metal levels in blood of metal forging factory workers in Nnewi, Anambra State, Nigeria. A total of eighteen (18) apparently healthy subjects from the exposed group (metal forging factory) aged between 19 and 56 years and 79 control subjects (comprising of 39 control subjects from Nnewi (N) and 40 control from Elele (E) respectively) aged between 18 and 44 years were recruited for the study. The body mass index (BMI) and length of service (LOS) of the subjects were obtained using structured questionnaire and thereafter, 10ml of venous blood sample was collected from each individual for the assessment of heavy metal levels (Pb, Ni, Cu, Zn, As and Se) using atomic absorption spectroscopy (AAS). Results: The result revealed that the body mass index (BMI) of the metal forging factory workers differed significantly compared with control N subjects (24.75±0.38) and E subjects (23.58±0.67) (p5.74±1.21 years. There were significant increases in the mean levels of Ni, As and Pb and decreases in Cu, Zn and Se levels in the metal forging factory workers compared with control subjects (p Conclusion: This study showed elevated levels of Ni, As and Pb and decreased levels of Cu, Zn and Se in the blood of metal forging factory workers. Keywords: Heavy metal, Metal forging factory, Body mass index (BMI), Length of Service (LOS).

Assessment of heavy metal levels in blood of metal fabricating factory workers in Nnewi, Nigeria

Introduction of Study: Heavy metal contamination or toxicity poses serious deleterious effects to human health. Materials and Methods: This is a cross sectional study designed to assess the heavy metal levels in blood of metal fabricating factory workers in Nnewi. A total of 39 apparently healthy individuals in the exposed group (metal fabricating factory workers) aged between 19 and 56 years and 79 control individuals (comprising of 39 control individuals from Nnewi (N) and 40 control individuals from Elele (E) respectively) aged between 18 and 44 years were recruited for the study. Demographic data and anthropometric indices (BMI) of participating individuals were obtained using structured questionnaire and thereafter, 10ml of venous blood sample was collected from each individual for the evaluation of heavy metal levels (Pb, Ni, Cu, Zn, As and Se) using atomic absorption spectroscopy (AAS). Results: This showed that these workers had an average length of service (LOS) of 11.92±2.77 years with no significant difference in body mass index (BMI) of factory workers compared with control N and E individuals (p>0.05) respectively. Ni, As and Pb levels and Cu, Zn and Se levels were significantly elevated and reduced respectively in factory workers than in controls (p0.05). Conclusion: This study showed elevated levels of Ni, As and Pb and decreased levels of Cu, Zn and Se in the blood of metal fabricating factory workers and this demands urgent attention. Keywords: Metal fabricating factory, Factory workers, Heavy metals, Body mass index (BMI), Age, Length of service (LOS).

Prevalence and distribution of musculoskeletal disorders in firefighters are influenced by age and length of service

Introduction: The objective of this cross-sectional study is to describe the prevalence and severity of self-reported musculoskeletal disorders (MSDs) in firefighters and how these vary by demographics and length of service (LOS). Methods: A cohort of 294 active-duty firefighters completed a body diagram to indicate the location and pain intensity of their MSK complaints. Where painful sites were indicated, they completed the relevant region-specific self-report disability measure – Neck Disability Index (NDI), Roland Morris Disability Questionnaire (RMDQ), Lower Extremity Functional Scale (LEFS), or the Short Form of Disabilities of the Arm, Shoulder and Hand (QuickDASH) – to quantify severity. Prevalence was determined from the body diagrams and severity from the site-specific self-report questionnaires. Differences in MSK severity based on demographics or LOS were determined using ANOVA. Results: The 294 active-duty firefighters had a mean age of 42.6 (SD 9.7) years and mean duration of service of 15.1 (SD 10.1) years. The prevalence of neck, back, upper-limb, and lower-limb complaints was 20%, 33%, 44%, and 45% respectively. Firefighters 42 years or older reported significantly more severe lower-extremity disability (median (IQR) LEFS: 71 (65, 77) vs. 75 (69.5, 78.5), p=0.03) and more severe back disability (median (IQR) RMDQ: 2 (1, 3) vs. 1 (0, 2), p=0.04). Firefighters with 15 years or more of firefighting service reported significantly more severe lower extremity disability (median (IQR) LEFS: 71 (64, 77) vs. 76 (70, 79), p=0.0005). Firefighters reporting &gt;1 MSDs were significantly older than firefighters reporting no MSD ( F(5,285)=3.3, p=0.002). Discussion: The rate of MSDs is high in firefighters, and their severity is elevated with greater age and LOS, suggesting cumulative exposures/injuries and highlighting the need for ongoing assessment of the musculoskeletal system and interventions to reduce injury throughout firefighters' careers.

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer.

The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.

Clinic-Based Outpatient Palliative Care Before Hospice Is Associated With Longer Hospice Length of Service

ContextOutpatient nonhospice palliative care has been shown to provide many benefits to patients facing advanced illness, but such services remain uncommon in the U.S. Little is known about the association between clinic-based outpatient palliative care consultation and the timing of hospice enrollment. ObjectivesTo determine whether there are differences in hospice length of service (LOS) between patients who were seen vs. patients who were not seen in an outpatient palliative care clinic before enrollment in hospice. MethodsUsing a retrospective study of medical records, a “prior palliative care clinic” group was formed of those hospice patients who had had a nonhospice clinic-based outpatient palliative care consult before hospice admission (n = 354). For those patients, “control” hospice patients without prior clinic-based palliative care were chosen who were matched by age, gender, median income of their zip code, and diagnostic group. Both groups were restricted to patients who died while enrolled in hospice. LOS for these two groups was compared using standard statistical methods of survival analysis. ResultsPrior palliative care clinic patients had a median LOS of 24 days, whereas control patients had a median LOS of 15 days (95% CI for difference between the medians 5–13 days). The difference between the LOS distribution curves was statistically significant by the log-rank test (P < 0.001). ConclusionHospice patients who had clinic-based outpatient palliative consults before hospice enrollment tended, on average, to have a longer LOS in hospice than patients who did not.

Determining the impact of age and LOS on job satisfaction: a case study of Pakistan automotive industry

This research was conducted to ascertain the impact of age and length of service (LOS) on job satisfaction in engineers of Pakistan public sector. Field survey was conducted using job satisfaction survey (JSS) questionnaire having closed-ended questions. Multistage sampling was conducted using a combination of cluster sampling, stratified sampling and random sampling techniques. Power and Precision software was used to determine the sample size. JSS questionnaires were administered amongst 225 electrical and mechanical engineers from five public sector organizations. 158 usable questionnaires were received and data were analyzed in SPSS. Statistical analyses showed existence of an open mouth U-shaped relationship between LOS/age and job satisfaction. It was found that age moderates relationship between LOS and job satisfaction. Non-responsiveness of senior engineers led to one of the limitations of this study. Results of this study can be used for policy-making decisions.

Redistribution, insurance and incentives to work in Latin-American pension programs

AbstractWe present a new database of social security indicators for 11 Latin-American countries designed to show how much they promise to pay in return to contributions. These are based on micro-simulations according to existing norms. We use response-surface analysis to characterize simulation results. Our results indicate that most programs are progressive. The length of service (LOS) has a strong impact on the expected returns to contributions. In several programs, the expected rates of return exhibit striking discontinuities in the LOS, mostly due to vesting period conditions. This implies these programs may be exacerbating income risk.

Clinicians' Perceptions of Usability of an Electronic Medical Record (EMR) OverTime

The study evaluated clinicians' usability perceptions of an electronic medical record (EMR) over time in a large east coast research medical center. The descriptive retrospective longitudinal design used secondary data obtained from a performance measurement plan. Electronic survey data were collected at five different points in time over four years. The anonymous responses made matching of the 1148 individuals impossible so thirty cases were defined grouping clinicians by age category, gender, and role. Each response was considered to be a repetition of measurement of the case. The research questions explored the overall patterns of change in usability related to an EMR implementation, the short term and long term change in usability, and if the patterns of usability were influenced by frequency of use, gender, age, length of service (LOS), or role. The short term impact included evaluations at baseline, four months, and 16 months after the implementation of an EMR. The long term impact included evaluations before, four months, and 16 months following a system upgrade. Linear mixed model analysis was used to examine patterns of change over time including the contribution of frequency of use and user characteristics on the outcome variables. Each variable had curvilinear and linear patterns following the initial EMR implementation but not after the system upgrade. Usefulness, ease of use, supports clinical care, and supports research had significant linear and/or quadratic changes over the short term but no significant changes in long term except for ease of use. Frequency of use was a significant predictor for usefulness and supports clinical care but not for ease of use. Age, LOS, and role contributed significantly to usefulness, ease of use and supports clinical care but gender did not. Role and LOS combined were significant predictors for usefulness, supports clinical care, and ease of use over the short term. The findings indicate significant short term changes related to the initial EMR implementation but not the upgrade. This had implications for system development related to education, clinical practice and research.