Service Staff Research Articles

INNOVATION MODEL OF HUMAN RESOURCES TRAINING AND DEVELOPMENT FOR THE HOTEL INDUSTRY FROM THE ASEAN STANDARD FRAMEWORK: A CASE IN NAKHON RATCHASIMA PROVINCE, THAILAND

From the current global changes and the rapid development of innovation and technology, personnel development according to the previous approach may be insufficient for work. It is necessary to increase the skills of the workforce and improve work efficiency for higher quality. This research aims to study the training and development of human resources in the hotel industry in Nakhon Ratchasima Province at present, to study innovations in training and human resource development in the hotel industry and the ASEAN hotel industry standard framework, and to propose the innovation model for training and development of human resources in the hotel industry from the ASEAN standard framework. The findings suggest implementing the innovation model of resources training and development in the hotel industry by integrating modern technology and training techniques into use in developing staff in various forms that are in accordance with the ASEAN standard framework and hotel service standards to increase the hotel service quality and staff performance. The quantitative approach was employed by using structural equation modeling for path analysis. The data was collected by using questionnaires from 400 samplings from hotel staff in Nakhon Ratchasima Province. The model is consistent with empirical material in statistical significance. It can confirm that seven significant factors directly affect service performance which are job rotation, blended learning, practice training, classroom training, study tour for learning, learning through playing games, and teaching respectively and the new model was proposed for innovative development and training for the hotel staff. This research proposes an innovation process for hotels to implement the use of technology and techniques for human resources training and development. It can increase staff service performance, lead to positive guest experience and satisfaction, and lead to hotel revenue. However, the potential, the different hotel contexts and characteristics, and its organizational culture should be considered for the implementation.

Student mental health support: A qualitative evaluation of new well-being services at a UK university

ABSTRACT Increasing numbers of UK students now seek mental health support while at university. Clear evidence for the best configuration of student support services is lacking. Most service evaluations have focused on counselling – with little evaluation of low-intensity support services such as non-clinical mental health and well-being teams or student accommodation welfare support. This qualitative study addresses that gap, examining student and staff experiences of new well-being advisers in academic departments and halls of residence at one UK university in 2018, marking a step-change in welfare support delivery. Using reflexive thematic analysis with data collected in 40 focus groups and interviews approximately 18 months after service launch, five themes were identified: Trusted Friend; Joined Up Approach; Proactive versus Reactive; Belonging; and My University Cares. The well-being advisers offered timely, low-intensity support as an accessible, approachable addition to academic, clinical and online provision. However, evidence showed operational challenges such as data-sharing between academic, professional and support service staff. The volume of students seeking support also appeared to compromise resource intended for preventative and community-building work, particularly in student accommodation. Concerns remained for students who do not seek help, with findings underlining the importance of issues of belonging, connection and representation in relation to well-being support. Notably, this highly visible well-being investment appeared to shift a negative cultural narrative which was undermining student and staff confidence to one of greater reassurance of support. Our conclusions have implications for student support service configuration and emphasise the importance of a whole university well-being approach.

‘In the shower crying…but we came back in the following day and did it all again’. Distress and resilience in care home staff during the COVID-19 pandemic– A qualitative interview study

BackgroundCare homes (long-term care facilities) were profoundly impacted early in the COVID-19 pandemic, both in terms of resident mortality and restrictions for infection control. This study investigated the impact on the emotional well-being of care home staff of challenges faced at this time, and the strategies used to manage them.MethodsSemi-structured interviews conducted October 2020-June 2021 with care home staff and health service staff working with them explored the impact of the early waves of the COVID-19 pandemic (March 2020-June 2021). Interview data were analysed using reflexive thematic analysis.ResultsInterview participants were 16 care home staff and 10 health service staff. Analysis generated four key themes: 1)Anxiety and distress, 2)Overwhelming workload, 3)Pulling through; and 4)Resilience in a time of crisis. Care home staff experienced Anxiety and distress due to uncertainty of what to expect; witnessing illness and deaths of residents; concerns regarding their own health, and sometimes feeling their work was under-recognised. They also experienced an Overwhelming workload due to infection control measures, caring for sick residents and reduction in external healthcare support. Our theme of Pulling through reflects the peer support and problem-solving strategies with which care home staff managed the impact of the pandemic, along with a sense of responsibility and meaning towards their work. An overarching theme of Resilience in a time of crisis drew on the other three themes and describes how many staff managed, maintained, and often increased their work despite the challenges of the pandemic. Participants also described increasing emotional fatigue as the pandemic continued.ConclusionsThis paper builds on literature on the emotional impact of the pandemic on care home staff, also exploring ways that staff responded to this impact. These findings can help inform planning for future crises including disease outbreaks, and raise important questions for further work to develop pandemic preparedness in care homes and beyond. They also raise wider questions about the current cultural status of care work, which may have exposed care home staff to greater risk of distress, and which contrasts with the professionalism and responsibility shown by staff in response to pandemic challenges.

The pronunciation of students’ names in higher education: identity work by academics and professional services staff

ABSTRACT Changes in the national, linguistic and ethnic profiles of students in UK higher education mean that students’ names are also likely to have become increasingly culturally diverse. In this article, we develop new empirical and theoretical understandings about how student-facing staff working in higher education in England experience cultural diversity in students’ names and the accompanying uncertainty of how some names should be pronounced. Using data from our qualitative studies we show that staff typically framed the pronunciation of names as an equalities issue, including in terms of power relations between themselves and students. Drawing on theorisations of identities as social processes, we analyse the ‘front stage’ and ‘backstage’ activities used by staff to manage the pronunciation of students’ names. We argue that, through these equality-framed activities, staff are doing ‘identity work’ in relation to their own selves and, importantly, also for students whose named-linked identities are minoritised within the ‘whiteness’ and ‘Englishness’ of higher education institutions in England. We conclude that, to support the pioneering identity work already undertaken by individual staff, policymakers in higher education should develop and implement ‘whole institution’ initiatives in recognition of the pronunciation of students’ names as a key equality, diversity and inclusion issue.

Legal Needs Arising in Mental Health Settings and Staff Capability and Support to Respond.

Legal issues are known to affect and be affected by mental health. But to what extent do legal issues surface in mental health settings and what do staff feel they need to support clients experiencing these issues? These questions were explored by a national mental health service interested in the potential for health justice partnership with local community based legal services. A survey of 999 frontline staff of a national mental health organisation. 146 staff (15%) responded from 70 service sites across Australia, including peer support workers (47%), support workers (20%), team leaders (17%) and clinicians (15%). Staff identified a wide range of legal issues experienced by their clients (commonly referred to by staff as consumers), most commonly credit, debt and social security issues, housing, family law and family violence. Two-thirds (67%) of respondents indicated that they spent around 50% or more of their time 'responding to these types of issues'. Respondents indicated that they need more support to address legal issues facing their clients, particularly more knowledge of other services, connections with professionals in other organisations and connections with community. They also felt they could benefit from additional processes, tools, and resources, and time to manage their case load. While there is an emerging field of research exploring the legal capability of citizens, this study explores what mental health service staff feel they need to support consumers experiencing legal issues that can interact with mental health.

States' investment in recovery support services: An exploratory analysis

IntroductionRecovery support services (RSS), while not yet precisely defined, nevertheless have a longstanding role in managing chronic illnesses including substance use disorders (SUDs). This exploratory study is the first to identify the amounts of money that states invest from Substance Abuse and Mental Health Services Administration (SAMHSA) Block Grants; SAMHSA discretionary grant and state-appropriated sources; the types of organizations from which RSS are purchased; and the non-financial supports states provide for RSS. MethodsThe study is a mixed method exploratory analysis, based on three data sources: content analysis of all 51 (Washington, D.C. included) Substance Abuse Block Grant (SABG) state applications; in-depth interviews with a purposive sample of ten states and one territory; and a structured electronic survey sent to all SABG recipients. Forty states and 2 territories returned a total of 42 questionnaires from 56 possible states and territories (75%). Thirty-two of the responding states provided complete FY2022 financial data. ResultsStates reporting financial data spent $412 million from SABG, SAMHSA discretionary grants, and state appropriations for RSS. An estimate based on extrapolating regionally grouped per capita spending averages to non-responding state populations projected $775 million spent from these sources for all states. The study also calculated per capita and SUD prevalent population expenditures from these sources for each state. States purchase services from recovery community organizations and SUD treatment organizations in equal proportions, as well as from statewide recovery support organizations, educational institutions, hospitals, community health centers, and justice system organizations. Purchased services are not uniformly defined, but include community centers, peer staff, housing, and other support services. States provide non-financial support in forms that include technical assistance, community engagement, practice guidelines, and regulatory frameworks. ConclusionsThis first report of states' investments establishes a baseline to serve as a reference point for future analysis of these expenditures, as well as a foundation to which other sources of RSS funding such as Medicaid and other state and federal (e.g. HRSA, CDC, DOJ) dollars may be added. Uniform definitions for RSS will be necessary to support future reporting, accountability, and research. Finally, newly formed peer-based provider organizations need particular attention in order to be sustainable.

Prevalence of visual impairment in patients sustaining proximal hip fracture after a simple fall

According to epidemiological studies, the 30% of aged 75 years and older is having impaired vision and most of the cases these patients are not in contact of the hospital care staff and community eye services. The visual assessment of older people is essential and helps to minimize the issues related to fall that led to critical problem. The proper vision is required for regain independence and improve the patient’s overall wellbeing. This kind of situation is leading the individual to unintentional injury which is higher among the visually impaired people compared to fully sighted population. Moreover, there are two major reasons for visual impairment that are more susceptible.The study aims to analyze the prevalence of visual impairment in patients sustaining proximal hip fracture after a simple fall at SCB Medical College and Hospital, Cuttack, Odisha.The current study has been conducted at SCB Medical College and Hospital, Cuttack, Odisha. All inpatients of the orthopaedic rehabilitation wards were recuperating from the surgical repair of a fractured neck of femur aged 75 years and above. and all the visual impairment assessed at Ophthalmology OPD. Moreover, the investigator has also invited the patients who sustained their fracture after a simple slip, trip and fall. Apart from this, the mental test of these participants was also done to analyze the ability. In this test the score of seven and above was considered for allowing the patients to take part in the study. There was a full ocular examination of anterior and posterior segment performed by the ophthalmologist using the slit-lamp bio microscope and indirect ophthalmoscope.Visual impairment of criteria 1 sensitivity was 93% and specificity was 91%. Moreover, the likelihood ratio of positive results was 11 and negative result was 0.05. For the criteria 2 the sensitivity was 97% and specificity was 86%. Moreover, the likelihood of positive results was 6 and negative result was 0.02. Apart from this detection of potentially remedial visual impairment sensitivity was 69% and specificity was 91%. The likelihood ratio of positive result was 8 and negative result was 0.2.The vision test and proper ocular examination were underestimated the extent of vision impairment in older adults. As per the outcome of the study, the visual impairment is common in elderly patients with a history of falls. Moreover, the study has suggested that to measure the visual acuity of all elderly patients recuperating from a proximal hip fracture after a simple fall.

AI- and Employee-Based Customer Services in Restaurants: Customer Engagement Leading to Loyalty During the Covid-19 Pandemic

This study aims to examine the extent to which customers’ perceptions of AI and employee services evaluations, influence their engagement with restaurant service delivery, which in turn drives customer loyalty during the COVID-19 pandemic. Data were gathered from 527 respondents via an onsite survey from restaurants providing both AI and human staff services. A partial least squares structural equation modelling (PLS-SEM) technique was used to formulate hypotheses and develop the model. The results of this study contrast with previous research which states that customers tend to appreciate AI services rather than human staff. The AI-based service performance value and trust in the AI-based service and system had a strong effect on customer engagement, whereas employee-based service support significantly explained substantial variance in customer engagement. Interestingly, customer engagement with AI-based services had a negative impact on loyalty. While customer engagement with employee-based services had a positive impact, this impact was not significant with regard to loyalty. One possible explanation for this result is that restaurant businesses preferred to use AI-based services that replaced human-based services in order to provide contactless options during the COVID-19 outbreak. Additionally, restaurant image positively moderates the link between service evaluation and customer engagement with AI service and negatively moderates the effects of service evaluation on customer engagement with employee services.

Reintroducing face-to-face support alongside remote support to form a hybrid stop smoking service in England: a formative mixed methods evaluation

BackgroundDuring the COVID-19 pandemic, United Kingdom (UK) stop smoking services had to shift to remote delivery models due to social distancing regulations, later reintroducing face-to-face provision. The “Living Well Smokefree” service in North Yorkshire County Council adopted a hybrid model offering face-to-face, remote, or a mix of both. This evaluation aimed to assess the hybrid approach’s strengths and weaknesses and explore potential improvements.MethodsConducted from September 2022 to February 2023, the evaluation consisted of three components. First, qualitative interviews involved 11 staff and 16 service users, analysed thematically. Second, quantitative data from the QuitManager system that monitored the numbers and proportions of individuals selecting and successfully completing a 4-week quit via each service option. Third, face-to-face service expenses data was used to estimate the value for money of additional face-to-face provision. The qualitative findings were used to give context to the quantitative data via an “expansion” approach and complementary analysis.ResultsOverall, a hybrid model was seen to provide convenience and flexible options for support. In the evaluation, 733 individuals accessed the service, with 91.3% selecting remote support, 6.1% face-to-face, and 2.6% mixed provision. Remote support was valued by service users and staff for promoting openness, privacy, and reducing stigma, and was noted as removing access barriers and improving service availability. However, the absence of carbon monoxide monitoring in remote support raised accountability concerns. The trade-off in “quantity vs. quality” of quits was debated, as remote support reached more users but produced fewer carbon monoxide-validated quits. Primarily offering remote support could lead to substantial workloads, as staff often extend their roles to include social/mental health support, which was sometimes emotionally challenging. Offering service users a choice of support options was considered more important than the “cost-per-quit”. Improved dissemination of information to support service users in understanding their options for support was suggested.ConclusionsThe hybrid approach allows smoking cessation services to evaluate which groups benefit from remote, face-to-face, or mixed options and allocate resources accordingly. Providing choice, flexible provision, non-judgmental support, and clear information about available options could improve engagement and match support to individual needs, enhancing outcomes.

Evaluating the effectiveness of trauma-informed care training delivered to staff in community Older Adult Mental Health Services

PurposeBy older adulthood, the majority of individuals will have experienced at least one traumatic event. Trauma-informed care (TIC) is proposed to improve effectivity of health-care provision and to reduce likelihood of services causing retraumatisation. This study aims to assess the effectiveness of staff training in TIC in older adult services.Design/methodology/approachTIC training was delivered across eight Older Adult Community Mental Health Teams in the same UK organisation. Questionnaires were administered before and after training: a psychometrically robust measure, the Attitudes Related to Trauma-Informed Care, was used to assess TIC-related attitudes, and a service-developed scale was used to measure changes in TIC competence. Data was analysed using linear mixed effects modelling (LMM). Qualitative data regarding the impact of training was gathered one month after training through a free-text questionnaire.FindingsThere were 45 participants, all of whom were white British. LMM on pre- and post-data revealed that staff training significantly increased competencies across all measured TIC domains. Overall, staff attitudes were also significantly more trauma-informed after training. Qualitatively, staff identified time as the only additional resource required to deliver the skills and knowledge gained from training.Practical implicationsTraining was found to be effective in increasing TIC-related skills and attitudes. Organisations aiming to become trauma-informed should consider staff training as one aspect of a wider development plan.Originality/valueTo the best of the authors’ knowledge, this paper is the first to examine TIC training for staff working in Older Adults Mental Health Services. Recommendations for services aiming to develop a trauma-informed culture have been provided.

Successful Management of Neutropenic Sepsis Is Key to Better Survival of Patients With Blood Cancer in Sri Lanka: Real-World Data From the Resource-Limited Setting.

Sepsis is the main cause of nonrelapse mortality, and there are no published data on applicability of supportive care protocols from high-income countries such as Sri Lanka. The aim of the study was to investigate management and mortality of neutropenic episodes among Hemato-Oncology patients. Retrospective analysis of clinical characteristics, management, morbidity, and mortality of neutropenic Hemato-Oncology patients presented to the Lanka Hospital Blood Cancer Centre from January 1, 2019 to December 31, 2019 was performed. A total of 169 neutropenic episodes were identified; 115 (68%) of such episodes were related to chemotherapy. Acute leukemia, lymphoproliferative disorders, and plasma cell disorders accounted for 23%, 69%, and 8% of patients, respectively. The median age of patients who had sepsis was 56 years, whereas that of those who had no sepsis was 53 years (P = .49). The median time to neutropenia was 9 days for those in the sepsis group compared with 8 days in the group that had no sepsis (0.64). The median neutrophil count in the group that had sepsis was 0.06, whereas it was 0.69 in the group that had no sepsis (P ≤ .05). The median time to commencement of antibiotics was 20 minutes. To our knowledge, this is the only documented study related to outcome and successful applicability of western supportive care protocols to Sri Lankan patients with neutropenia. In this study, we have shown that neutropenic sepsis can be successfully managed in the setting of limited resources with service development, following guidelines and staff training.

Impact of the design of adult mental health inpatient facilities on healthcare staff: a mixed methods systematic review

ObjectivesMental health inpatient facilities are increasingly focusing on creating therapeutic, person-centred care environments. However, research shows that this focus may have unintended consequences for healthcare staff. Designs that do not...

Ethnic inequalities among NHS staff in England: workplace experiences during the COVID-19 pandemic

ObjectivesThis study aims to determine how workplace experiences of National Health Service (NHS) staff varied by ethnicity during the COVID-19 pandemic and how these experiences are associated with mental and...

‘The worst day of my life’: Foster carers’ experiences of allegations

Appropriate allegation investigations within social care are paramount to protect children. However, many allegations are unsubstantiated ( Biehal et al., 2014 ) and result in stress and anxiety for fostering families ( Adams, Hassett and Lumsden, 2018 ), financial uncertainty ( Boffey, Stanton and Thomas, 2019 ), unplanned endings and foster carers leaving their role ( Adams, Hassett and Lumsden, 2018 ). There is little research into the prevalence, nature and outcomes of allegations against foster carers. This UK-based study uses The Fostering Network’s State of the Nation’s Foster Care (SOTN) 2021 survey and analyses responses from 3,352 UK foster carers and 99 fostering service staff. Qualitative findings reflect six themes: (1) emotional impacts, (2) financial implications, (3) independent support, (4) social services involvement, (5) understanding allegations, and (6) children being removed or foster carers leaving their role. Quantitative findings show only 25% of those experiencing an allegation believed they were sufficiently communicated with, only 20% believed specified timescales were adhered to, 57% did not receive independent support, and 36% said no support was offered to children in their home. Poor information-sharing and lack of support were found to have exacerbated the stress experienced.

The COVID-19 ambulance response assessment (CARA) study: a national survey of ambulance service healthcare professionals' preparedness and response to the COVID-19 pandemic.

The COVID-19 pandemic placed significant demand on the NHS, including ambulance services, but it is unclear how this affected ambulance service staff and paramedics in other clinical settings (e.g. urgent and primary care, armed services, prisons). This study aimed to measure the self-perceived preparedness and impact of the first wave of the pandemic on paramedics' psychological stress and perceived ability to deliver care. Ambulance clinicians and paramedics working in other healthcare settings were invited to participate in a three-phase sequential online survey during the acceleration (April 2020), peak (May 2020) and deceleration (September/October 2020) phases of the first wave of COVID-19 in the United Kingdom. Recruitment used social media, Trust internal bulletins and the College of Paramedics' communication channels, employing a convenience sampling strategy. Data were collected using purposively developed open- and closed-ended questions and the validated general health questionnaire-12 (GHQ-12). Data were analysed using multi-level linear and logistic regression models. Phase 1 recruited 3717 participants, reducing to 2709 (73%) by phase 2 and 2159 (58%) by phase 3. Participants were mostly male (58%, n = 2148) and registered paramedics (n = 1992, 54%). Mean (standard deviation) GHQ-12 scores were 16.5 (5.2) during phase 1, reducing to 15.2 (6.7) by phase 3. A total of 84% of participants (n = 3112) had a GHQ-12 score ≥ 12 during the first phase, indicating psychological distress. Participants that had higher GHQ-12 scores were feeling unprepared for the pandemic, and reported a lack of confidence in using personal protective equipment and managing cardiac arrests in confirmed or suspected COVID-19 patients. Most participants reported psychological distress, the reasons for which are multi-factorial. Ambulance managers need to be aware of the risks to staff mental health and take action to mitigate these, to support staff in the delivery of unscheduled, emergency and urgent care under these additional pressures.

What are the key influences and challenges around weight management faced by patients in UK adult secure mental health settings? A focused ethnographic approach

ObjectivesExcess weight is highly prevalent in secure (forensic) mental health services and impacts negatively on patients’ physical and mental health. This study sought to identify the key influences and challenges...

Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences.

Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers. This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention. The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach. Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation. The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial.

Effects of Front Desk Staff Service Quality on Customer Satisfaction in Some Selected Hotels in Tamale Metropolis

The hotel sub-sector provides a plethora of services to stimulate the growth of the tourism sector. As a result, numerous governments offered a lot of incentives to support the growth of the hotel businesses in Ghana. However, it seems most of the hotels in the hospitality industry including those in Tamale Metropolis are not meeting the quality standards expected of them in connection with service delivery, good customer relationships, sufficient facilities, and provision of confidence and trust of services offered. The study, therefore, examined the effects of front desk staff service quality on customer satisfaction in some selected hotels in Tamale Metropolis. The SERVQUAL Model served as the study's foundation. The study employed cross-sectional survey design. Multi-stage sampling strategy was used. A convenient sampling approach was employed to select the 2 hotels in the Metropolis for the research. Statistical Package for Social Sciences (SPSS) version 22 was used to analyze the data. The study found that guests had a positive perception of front desk staff at the two hotels. However, most of the guests did not have confidence that front desk staff inspire visitors, and that information about the two hotels was not sufficiently available. It was further revealed that front desk staff service quality significantly affects customer satisfaction. However, treatment equality, attention to details, and front desk staff language proficiency were the factors the front desk staff lack. The study recommends hoteliers engage highly motivated front desk staff; capacity building of front desk staff on how to inspire visitors to attract more customers; and training of front desk staff on how to be more attentive to guests' needs and preferences in order to improve the guest stay and overall experience.

Occupational exposure to particulate matter and staff sickness absence on the London underground

The London Underground (LU) employs over 19,000 staff, some of whom are exposed to elevated concentrations of particulate matter (PM) within the network. This study quantified the occupational exposure of LU staff to subway PM and investigated the possible association with sickness absence (SA).A job exposure matrix to quantify subway PM2.5 staff exposure was developed by undertaking measurement campaigns across the LU network. The association between exposure and SA was evaluated using zero-inflated mixed-effects negative binomial models.Staff PM2.5 exposure varied by job grade and tasks undertaken. Drivers had the highest exposure over a work shift (mean: 261 µg/m3), but concentrations varied significantly by LU line and time the train spent subway.Office staff work in office buildings separate to the LU network and are unexposed to occupational subway PM2.5. They were found to have lower rates of all-cause and respiratory infection SA compared to non-office staff, those who work across the LU network and are occupational exposed to subway PM2.5. Train drivers on five out of eight lines showed higher rates of all-cause SA, but no dose–response relationship was seen. Only drivers from one line showed higher rates of SAs from respiratory infections (incidence rate ratio: 1.24, 95% confidence interval 1.10–1.39). Lower-grade customer service (CS) staff showed higher rates of all-cause and respiratory infection SA compared to higher grade CS staff. Doctor-certified chronic respiratory and cardiovascular SAs were associated with occupational PM2.5 exposure in CS staff and drivers.While some groups with higher occupational exposure to subway PM reported higher rates of SA, no evidence suggests that subway PM is the main contributing factor to SA. This is the largest subway study on health effects of occupational PM2.5 exposure and may have wider implications for subway workers, contributing to safer working environments.

The non-conveyance of trauma patients in Swedish emergency medical services: a retrospective observational study of the trauma population not transported to an emergency department

IntroductionDue to a systemic modification in Swedish emergency medical services (EMS) staffing in recent years, the nature of the Swedish EMS has changed. Transport to an emergency department (ED) is no longer the only option. Referrals and non-conveyance form a growing part of EMS assignments. Trauma is one of the most common causes of death and accounts for 17% of Swedish EMS assignments. The aim of this study was to describe the characteristics and clinical outcomes of non-conveyed trauma patients who were assessed, treated and triaged by the EMS to gain a better understanding of, and to optimise, transport and treatment decisions.MethodsThe study had a descriptive, retrospective and epidemiologic design and was conducted by reviewing EMS and hospital records for 837 non-conveyed trauma patients in the southwest of Sweden in 2019.ResultsThree in four non-conveyed trauma patients did not seek further medical care within 72 h following EMS assessment. The patients who were admitted to hospital later were often older, had suffered a fall and had a medical history. Half of all the incidents occurred in a domestic environment, and head trauma was the major complaint. Less than 1% of the studied patients died.ConclusionMost of the non-conveyed trauma patients did not seek further medical care after being discharged at the scene. Falling was the most common trauma event, and for the older population, this meant a higher risk of hospital admission. The reasons for falls should therefore be investigated thoroughly prior to non-conveyance decisions. Future studies should focus on the reasons for non-conveyance and measure the morbidity and invalidity outcomes rather than mortality.