Public Safety Workers Research Articles

Hepatitis C among Public Safety Workers–Assessment of Risk and Strategies for Prevention

Hepatitis C among Public Safety Workers–Assessment of Risk and Strategies for Prevention

Hepatitis C among Public Safety Workers–Assessment of Risk and Strategies for Prevention

Hepatitis C among Public Safety Workers–Assessment of Risk and Strategies for Prevention

Risk factors for physical assault: State-managed workers’ compensation experience

Background The estimation of incidence and evaluation of risk factors associated with nonfatal occupational assault injuries have rarely been documented in a statewide population context. A state-managed workers’ compensation system can provide estimates of incidence of such injuries and allow evaluation of risk factors. Methods Using claims data from the state-managed West Virginia Workers’ Compensation, the incidence rates of workplace injuries resulting from physical assault were estimated for the period 1997–1999. Data on potential risk factors were obtained from the claim-related electronic data files, and the risk associated with each factor was assessed using proportional injury ratios (PIRs). Results During the study period, 2122 compensated injuries were associated with workplace violence. The incidence of assault injuries was 108.2 cases per 100,000 employee years. Women sustained a higher incidence than men. Healthcare workers, public safety workers, and teachers accounted for almost 75% of all assault injuries. Workers in these occupations also differed from each other with regard to seasonality and timing of assault, perpetrator–victim relationship, and types of injury. Evidence of gender–occupation interaction indicated higher risk of assault injury in men compared to women across the three leading occupations. Nighttime work shifts were associated with greater risk of assault for female healthcare workers (PIR=1.8; 95% confidence interval, 1.09–2.87). Conclusion The healthcare sector sustained the bulk of assault injuries in West Virginia. Although the majority of healthcare-sector employees were women, the risk of assault injuries was higher in male employees. Risk factors and injury characteristics identified in this study, particularly for three high-risk occupations, should help develop strategies for preventing workplace violence. Protecting female healthcare workers on night-shift duty, especially in nursing home settings, appears to be an important target for intervention.

Occupational exposures and risk of hepatitis B virus infection among public safety workers.

We conducted a questionnaire and seroprevalence survey to determine the frequency and type of occupational exposures (OEs) and the risk of hepatitis B virus (HBV) infection experienced by public safety workers (PSWs). Of the 2910 PSWs who completed the survey, 6.8% reported at least one OE in the previous 6 months, including needlestick (1.0%), being cut with a contaminated object (2.8%), mucous membrance exposure to blood (0.9%), and being bitten by a human (3.5%). The rate of OE varied by occupation with 2.7% of firefighters, 3.2% of sheriff officers, 6.6% of corrections officers, and 7.4% of police officers reporting > or = 1 OE (P < 0.001). The HBV infection prevalence was 8.6%, and after adjustment for age and race, it was comparable to the overall US prevalence and did not vary by occupation. By multivariate analysis, HBV infection was not associated with any OEs, but it was associated with older age, being nonwhite, and a previous history of a sexually transmitted disease. This study demonstrated that although OEs are not uncommon among PSWs, HBV infection was more likely to be associated with nonoccupational risk factors. Administration of hepatitis B vaccine to PSWs early in their careers will prevent HBV infection associated with occupational and non-OEs.

Hepatitis C in urban and rural public safety workers.

A sample of 719 Oregon public safety personnel (police officers, firefighters, and corrections officers) was tested for hepatitis C virus (HCV) antibody after completing a risk questionnaire. Seven of nine positive enzyme immunoassay tests (78%) were confirmed with recombinant immunoblot assay, yielding confirmed prevalence estimates of 1.2% (95% confidence interval, 0.4 to 2.8%) among the 406 firefighters and emergency medical technicians, and 0.7% (95% confidence interval, 0.1 to 2.6%) in 274 corrections personnel. No cases were observed in the 29 participating police officers. Self-reports of the number of workplace exposures to blood were not associated with HCV positivity, and the number of years of public safety employment seemed to be slightly less for HCV-positive subjects. Two of the seven (28.6%) HCV-positive individuals reported having at least one nonoccupational risk factor (odds ratio, 4.3; 95% confidence interval, 0.4 to 27.1), suggesting the greater relative importance of nonoccupational exposures.

Hepatitis C Screening and Prevalence Among Urban and Rural Public Safety Workers in Oregon

Hepatitis C Screening and Prevalence Among Urban and Rural Public Safety Workers in Oregon

Congress Boosts Budget For MH Research, Treatment

Back to table of contents Previous article Next article Government NewsFull AccessCongress Boosts Budget For MH Research, TreatmentChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:1 Feb 2002https://doi.org/10.1176/pn.37.3.0002In December Congress approved a 15 percent increase in funding for the National Institutes of Health (NIH), which will allow it to continue expanding its research portfolio in Fiscal 2002. President George W. Bush immediately signed the federal spending measure into law.The increase of nearly $3 billion—which gives NIH a total budget of $23 billion—drew praise from APA and other members of the Mental Health Liaison Group for being nearly half a billion dollars more than what Bush and the House of Representatives had recommendedRoughly 1 percent of that increase is slated for non-NIH activities, leaving the NIH with a funding increase of 14 percent, according to Lizbet Boroughs, an associate director of the APA Division of Government Relations.The Mental Health Liaison Group and the Ad Hoc Group on Research Funding, of which APA is also a member, have advocated each year for specific increases in the NIH budget with the goal of doubling the total budget over a five-year period ending next fiscal year. The Ad Hoc Group on Research Funding was successful in obtaining increases of 15 percent in FY 1999 and FY 2000 and 14 percent in FY 2001 and FY 2002.The Senate typically passes higher increases for NIH than does the House. The conference agreement reflects the average between the two bodies’ recommendations. In 2001 the Senate passed an increase for NIH of 16.5 percent, for which the Ad Hoc Group on Research Funding had advocated, but the House passed the president’s requested increase of 13.5 percent; the difference was split in conference.Similar budget compromises were reached last December for the three institutes involved in mental health and addictive disorders. The budget for the National Institute of Mental Health (NIMH) was increased 13 percent, for a total of $1.249 billion; the budget for the National Institute on Drug Abuse (NIDA) was increased 12 percent, for a total of $888 million; and the budget for the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was increased by 12 percent, for a total of $384 million, according to the final conference agreement. Last year’s increases were 14 percent for NIMH and NIDA, and 16 percent for NIAAA.Jeremy Lazarus, M.D., chair of APA’s Joint Commission on Government Relations, commented to Psychiatric News, “We are pleased with the substantial increases for these institutes and mental health and substance abuse treatment and prevention. Congress is increasingly aware of the importance of research and treatment of those with mental illness or substance abuse. We applaud their approval of the increases that will advance research and treatment of our patients.”As the Senate and House began the appropriations process last spring, members of APA’s Academic Consortium visited key representatives and aides on Capitol Hill (Psychiatric News, May 4, 2001) to convey the message that medical research can significantly improve people’s lives.“Patient advocates described to congressional aides how they have benefited from the newer medications,” said Boroughs. “A veteran with schizophrenia said he went from being homeless and in and out of hospitals to working part time and living independently.”The budget for the Substance Abuse and Mental Health Services Administration (SAMHSA) was increased by roughly 6 percent, to $3.138 billion for FY 2002. The FY 2002 budget for the Center for Mental Health Services (CMHS), which is part of SAMHSA, is $832 million, representing an increase of 6 percent. Specific programs within CMHS were also increased:• The Mental Health Block Grant, which is administered by the states to fund programs serving people with severe mental illnesses and children with severe emotional disturbances.• The Projects for Assistance in Transition From Homelessness (known as PATH), which is another state-administered grant program to fund community-based services for homeless individuals with mental illness.• Programs of Regional and National Significance, which include funding for new national initiatives. These include the jail-diversion program that would fund treatment and community supports for nonviolent criminal offenders with severe mental illnesses, research and treatment of youth with posttraumatic stress disorder, the development of model suicide-prevention programs, mental health counseling of public safety workers, and mental health education and services to senior citizens.• The Children’s Mental Health Program, which grants funding to states to provide community-based services to children with serious emotional disorders.• The Youth Violence Prevention Program, which funds state efforts to reduce school-based violence through early intervention and treatment.Congress approved a 5 percent increase for the Center for Substance Abuse Treatment within SAMHSA, for a total FY 2002 budget of $2.017 billion. The Center for Substance Abuse Prevention had a budget increase of 13 percent, for a budget of $198 million. ▪ ISSUES NewArchived

Hepatitis C screening and prevalence among urban public safety workers.

This study examines the prevalence of anti-hepatitis C virus by using an enzyme-linked immunoassay test (EIA-2) in 2447 volunteers (including 1560 police, 678 fire, and 209 emergency medical service personnel) and a self-reported questionnaire on potential occupational and non-occupational risk factors. Subjects consisted of 76% men, 54.8% blacks, and 40.3% whites. Twenty-eight individuals (1.1%) tested positive, with prevalence rates of 1.1% and 1.3%, respectively, among blacks and whites. Although firefighters and emergency medical service workers had a higher prevalence (2.3% and 2.8%) than police (0.6%), the overall prevalence was lower than that typical of urban populations. In a multivariate analysis, the most important risk factors were behavioral, with no significant occupational exposure risk observed. Previously reported racial differences were not detected in this study, most likely because the subjects were of similar socioeconomic status.

Proposed Recommendations for Research on Biochemical Markers for Problematic Drinking

Biochemical markers can serve as valuable tools in screening for problematic drinking, determining whether a health problem is likely alcohol related, and monitoring alcoholics for relapse during and after treatment. Furthermore, biochemical markers can assist in forensic investigations; in identification of public health, safety, and transportation workers who may drink excessively and who, as a result, may put others at risk; in evaluation of efficacy of treatments for alcohol abuse; and in recognition of early phase alcohol-related tissue damage. Within all of these contexts, a biochemical marker or set of markers may corroborate verbal reports or may provide valuable independent information on alcohol use when an individual is unable or unwilling to offer valid data about alcohol consumption.

Immune response to intramuscular revaccination after primary intradermal vaccination against hepatitis B.

We studied the immune response to (re)vaccination with three 1-mL doses of recombinant hepatitis B vaccine administered intramuscularly on days 0, 30, and 180 to 75 public safety workers (PSWs) who had not developed antibody to hepatitis B surface antigen (anti-HBs) after three intradermal doses of hepatitis B vaccine; to 45 PSWs who had initially developed antibody but did not have detectable levels 11 months after intradermal vaccination; and to 16 hepatitis B-susceptible PSWs. Levels of anti-HBs were measured on days 14 and 210 after the first intramuscular dose. Overall, 46 (61%) of 75 PSWs in the initial-nonresponse group, 43 (96%) of 45 PSWs in the lost-response group, and 5 (31%) of 16 PSWs in the new-vaccinee group had anti-HBs titers of > or = 10 mIU/mL on day 14. On day 210 (after three doses), the figures were 62 (89%) of 70 PSWs in the initial-nonresponse group, 43 (98%) of 44 PSWs in the lost-response group, and 15 (94%) of 16 PSWs in the new-vaccine group. We conclude that persons who do not seroconvert after intradermal vaccination should receive three doses of hepatitis B vaccine by the intramuscular route.

OSHA Compliance Issues: Bloodborne Pathogens and Public Safety Workers: A Performance-Based Training Approach

OSHA Compliance Issues: Bloodborne Pathogens and Public Safety Workers: A Performance-Based Training Approach

Chlamydia Pneumoniae: To the Editor

We appreciate Dr. Hahn's interest in our article (Chest 1993; 104:208-13) and agree that our observation of a high Chlamydia pneumoniae seroprevalence rate in a municipality's public safety workers does not guarantee an equally high rate in the general population. We had hypothesized previously that person-to-person transmission of infectious agents might be enhanced in firefighters as a result of their military barracks-like working conditions (1) and anticipated that firefighters would have a higher seroprevalence to Cpneumoniae than other public safety workers, such as police. Unexpectedly, we found that police officers who do not work together in such close proximity, had a Cpneumoniae seroprevalence rate virtually identical to that of firefighters (84 percent vs 85 percent, police vs firefighters, respectively, for IgG≥1:16). While this data did not support our original study hypothesis, it did suggest that Rhode Island could have a high background seroprevalence to Cpneumoniae. Community wide epidemics of Cpneumoniae infection have been described and as we noted in the Discussion section could be a plausible explanation for the high seroprevalence in our study. We could neither prove nor disprove this hypothesis because no prior serosurveys for Cpneumoniae had been done in our area, and sera collected from other groups at the same time as our study was not available for determination of Cpneumoniae antibody levels. Chlamydia PneumoniaeCHESTVol. 105Issue 6PreviewTo the Editor Full-Text PDF

PREDICTORS OF POOR RESPONSE TO HEPATITIS B VACCINE.

Hepatitis B vaccine is not always effective, but because postvaccination testing is not done routinely, vaccine failure is not always detected. These two studies identify risk factors for vaccination failure. In the first study, researchers tested 528 Connecticut public safety workers (mostly white, male firefighters) who received a three-dose series …

Addressing cognitive defenses in critical incident stress

AbstractWhile it is presumed that public safety workers have always used cognitive defenses to cope with traumatic experiences, this process has lacked systematic study. The author asserts that the use of ego defenses is common, necessary for daily functioning and not necessarily pathonomic or in need of therapeutic confrontation. This article makes an attempt to organize some of the literature in the area, raise questions that need to be studied, and argue strongly for future research.

Addressing cognitive defenses in critical incident stress

While it is presumed that public safety workers have always used cognitive defenses to cope with traumatic experiences, this process has lacked systematic study. The author asserts that the use of ego defenses is common, necessary for daily functioning and not necessarily pathonomic or in need of therapeutic confrontation. This article makes an attempt to organize some of the literature in the area, raise questions that need to be studied, and argue strongly for future research.

Inadequate Immune Response Among Public Safety Workers Receiving Intradermal Vaccination Against Hepatitis B—United States, 1990-1991

The Immunization Practices Advisory Committee (ACIP) recommends that hepatitis B vaccine be administered by the intramuscular (IM) route (1). However, since November 1990, public safety departments have reported to CDC at least four instances of poor immune response among public safety workers vaccinated against hepatitis B by the intradermal (ID) route of administration.

From the Centers for Disease Control. Inadequate immune response among public safety workers receiving intradermal vaccination against hepatitis B--United States, 1990-1991

From the Centers for Disease Control. Inadequate immune response among public safety workers receiving intradermal vaccination against hepatitis B--United States, 1990-1991

PROCEDURES TO PROTECT HEALTH-CARE WORKERS FROM HIV INFECTION: CATEGORY I (HEALTH-CARE) WORKERS

At the heart of the recommendations to prevent HIV transmission in workers who perform high-risk tasks are the universal blood and body fluid precautions. These precautions are meant to be followed by all health-care workers in the care of all patients and by public safety workers (e.g., firefighters, police officers, and correctional facility personnel) whenever they perform specific tasks that expose them to blood, body fluids, or tissues. Universal precautions apply to blood, semen, vaginal secretions, body tissues, cerebrospinal fluid, synovial fluid, pleural fluids, peritoneal fluid, pericardial fluid, and amniotic fluid. These fluids have either been implicated in HIV transmission or their risk of transmission is unknown. Other fluids or excretions are excluded from universal precautions because epidemiologic studies have failed to implicate them in HIV transmission. These include feces, nasal secretions, sputum, sweat, tears, urine, vomitus, breast milk, and saliva, unless they contain visible blood. However, routine precautions (handwashing, gloves, etc.) to prevent exposure to other diseases transmitted by these media should be followed. Other precautions are directed at health-care workers who perform specialized at-risk procedures, e.g., surgeons, dentists, laboratory workers, etc. In general, recommendations for these workers include the universal precautions plus additional emphasis on the use of barrier measures. Although the risk of environmentally mediated HIV transmission is negligible, it is theoretically possible, and recommendations to kill or inactivate HIV on environmental surfaces should be followed. Fortunately, HIV is easily inactivated in the environment. The cheapest and most convenient method is a 1:10 or 1:100 dilution of household bleach.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitudes of BCLS instructors about mouth-to-mouth resuscitation during the AIDS epidemic

We surveyed 5,823 American Heart Association Virginia Affiliate basic cardiac life support (BCLS) instructors to assess the impact that the acquired immunodeficiency syndrome (AIDS) epidemic has had on their attitudes, beliefs, and behaviors with respect to the training and performance of mouth-to-mouth (MTM) ventilation. The response rate by those whose mail survey could be delivered to a valid address was 41% (women, 63%; men, 37%; mean age, 38 +/- 1 years; health care providers, 87%; laypersons, 11%; and public safety workers, 2%). Of those surveyed, 49% had performed CPR within the past three years. Of these, 40% reported having hesitated to provide MTM ventilation at least once. Of those who had hesitated, more than one half identified fear of exposure to disease as the reason for their hesitation. Forty percent of all respondents had witnessed another provider hesitate to provide MTM ventilation. When presented with mock rescue scenarios, the majority of respondents indicated that they would not perform or would hesitate to perform MTM ventilation on most adult strangers. More than half felt that there was some risk of contracting AIDS from ventilating a manikin, and 71% said that their attitudes about providing CPR to strangers had changed as a result of the AIDS epidemic. We conclude that concern about AIDS appears to be adversely affecting the attitudes, beliefs, and self-reported behaviors of BCLS instructors in Virginia regarding the use of MTM ventilation on strangers.

Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public-Safety Workers

Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public-Safety Workers Laboratory Medicine, Volume 20, Issue 11, 1 November 1989, Pages 783–798, https://doi.org/10.1093/labmed/20.11.783 Published: 01 November 1989