Understanding the Role of Family-Specific Resources for Immigrant Workers

Very few studies to date have examined immigrant workers’ (i.e., workers who were not born in the United States) experiences of the work-family interface. In a sample of healthcare workers across two time points, the present study evaluates the role of different family-specific resources for immigrant workers compared to native-born workers (i.e., workers born in the U.S.). The results suggest that family-specific support from coworkers is especially beneficial for reducing immigrant workers’ experiences of family-to-work conflict. For both native-born and immigrant workers, those who experience more family-specific support from supervisors and coworkers, and those who work in an organization that does not expect workers to sacrifice their family or personal life for work (i.e., has perceptions of a positive organizational work-family climate), have lower work-to-family conflict and lower family-to-work conflict. Thus, family-specific support from coworkers, supervisors, and the organization have beneficial effects for workers, with coworker support being especially helpful for immigrant workers, which provides important insights for future work-family research and practice with increasingly diverse workforces

Alert at Work? Perceptions of Alertness Testing and Recommendations for Practitioners

Around-the-clock, 24/7 operations are common in many industries, yet contribute to employee fatigue, which can have grave consequences for worker safety, public health, and the environment. Alertness testing is one option for identifying and mitigating issues related to fatigue at work. We review alertness testing options, including fatigue risk management systems and app-based tools, and share results from a study evaluating employee and manager perceptions of alertness testing. Despite a growing body of research on the validity of app-based alertness tests, it is also critical to understand how these tools are perceived by workers and management. To investigate perceptions of alertness testing, mixed-method data were collected from organizations across four safety-sensitive industries (i.e., a mining company, fire department, and two construction companies) that were in the process of implementing an alertness testing platform. Results suggest that employees and managers are open to and optimistic about implementing new alertness testing safety tools. Employees in work environments with strong managerial support for safety were particularly open-minded to alertness testing at work. However, some employees and managers expressed reluctance towards alertness tests. We provide recommendations for how occupational health and safety professionals can effectively select alertness tests and implement alertness testing. Ethical considerations related to identifying whether workplace alertness testing is needed, and how to protect employees and their data, are discussed

Beyond Just Resilience: the Important Role of Work-Family Resources for Military Service Members

The military has allocated extensive resources to improve service member resilience in an effort to decrease the impact of stressors on health and well-being. Previous research has linked resilience to various positive outcomes (e.g., physical and mental health, job satisfaction) and has established that service members face unique and challenging work-family experiences. However, the importance of resilience to work-family experiences remains underexplored. Drawing on conservation of resources theory, this study examines the relationships between resilience (i.e., the ability to bounce back from stressors) and work-family outcomes, and whether organizational work-family resources of work-family climate perceptions and family-supportive supervisor behavior moderate these relationships. Based on a sample of 417 Army National Guard service members from 10 workgroups, and using a multilevel path model, we found that more resilient service members experience lower family-to-work conflict and greater work-to-family enrichment. Further, the relationship between resilience and family-to-work enrichment was significant and stronger for service members who perceive their work climate as family-supportive compared to the relationship for those who do not. Improving resilience in military personnel may help to facilitate positive work-family experiences, but resilience is likely most beneficial when organizational work-family resources (i.e., a family-supportive work climate) are also available

Disparities in management patterns and outcomes of patients with non-ST-elevation acute coronary syndrome with and without a history of cerebrovascular disease

Cerebrovascular (CVD) disease is commonly associated with coronary artery disease and adversely affects outcome. The goal of the present study was to examine the temporal management patterns and outcomes in relation to previous CVD in a contemporary real-world spectrum of patients with acute coronary syndrome (ACS). From 1999 to 2008, 14,070 patients with non-ST-segment elevation ACS were recruited into the Canadian Acute Coronary Syndrome I (ACS I), ACS II, Global Registry of Acute Coronary Events (GRACE/GRACE(2)), and Canadian Registry of Acute Coronary Events (CANRACE) prospective multicenter registries. We stratified the study patients according to a history of CVD and compared their treatment and outcomes. Patients with a history of CVD were older, more likely to have pre-existing coronary artery disease, elevated creatinine, higher Killip class, and ST-segment deviation on admission. Despite presenting with greater GRACE risk scores (137 vs 117, p \u3c0.001), patients with previous CVD were less likely to receive evidence-based antiplatelet and antithrombin therapies during the initial 24 hours of hospital admission. They were also less likely to undergo in-hospital coronary angiography and revascularization. These disparities in medical and invasive management were preserved temporally across all 4 registries. Patients with concomitant CVD had worse in-hospital outcomes. Previous CVD remained an independent predictor of in-hospital mortality (adjusted odds ratio 1.43, 95% confidence interval 1.06 to 1.92, p = 0.019) after adjusting for other powerful prognosticators in the GRACE risk score. However, it was independently associated with a lower use of in-hospital coronary angiography (adjusted odds ratio 0.70, 95% confidence interval 0.60 to 0.83, p \u3c0.001). Underestimation of patient risk was the most common reason for not pursuing an invasive strategy. Revascularization was independently associated with lower 1-year mortality (adjusted odds ratio 0.48, 95% confidence interval 0.33 to 0.71, p \u3c0.001), irrespective of a history of CVD. In conclusion, for patients presenting with non-ST-segment elevation-ACS, a history of CVD was independently associated with worse outcomes, which might have been, in part, because of the underuse of evidence-based medical and invasive therapies

Rationale, design, implementation, and baseline characteristics of patients in the DIG trial: A large, simple, long-term trial to evaluate the effect of digitalis on mortality in heart failure

This article provides a detailed overview of the rationale for key aspects of the protocol of the Digitalis Investigation Group (DIG) trial. It also highlights unusual aspects of the study implementation and the baseline characteristics. The DIG trial is a large, simple, international placebo-controlled trial whose primary objective is to determine the effect of digoxin on all cause mortality in patients with clinical heart failure who are in sinus rhythm and whose ejection fraction is less than or equal to 0.45. An ancillary study examines the effect in those with an ejection fraction > 0.45. Key aspects of the trial include the simplicity of the design, broad eligibility criteria, essential data collection, and inclusion of various types of centers. A total of 302 centers in the United States and Canada enrolled 7788 patients between February 1991 and September 1993. Follow-up continued until December 1995 with the results available in Spring 1996

Apixaban versus Enoxaparin for Thromboprophylaxis in Medically Ill Patients

BACKGROUND: The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin. METHODS: In this double-blind, double-dummy, placebo-controlled trial, we randomly assigned acutely ill patients who had congestive heart failure or respiratory failure or other medical disorders and at least one additional risk factor for venous thromboembolism and who were hospitalized with an expected stay of at least 3 days to receive apixaban, administered orally at a dose of 2.5 mg twice daily for 30 days, or enoxaparin, administered subcutaneously at a dose of 40 mg once daily for 6 to 14 days. The primary efficacy outcome was the 30-day composite of death related to venous thromboembolism, pulmonary embolism, symptomatic deep-vein thrombosis, or asymptomatic proximal-leg deep-vein thrombosis, as detected with the use of systematic bilateral compression ultrasonography on day 30. The primary safety outcome was bleeding. All efficacy and safety outcomes were independently adjudicated. RESULTS: A total of 6528 subjects underwent randomization, 4495 of whom could be evaluated for the primary efficacy outcome--2211 in the apixaban group and 2284 in the enoxaparin group. Among the patients who could be evaluated, 2.71% in the apixaban group (60 patients) and 3.06% in the enoxaparin group (70 patients) met the criteria for the primary efficacy outcome (relative risk with apixaban, 0.87; 95% confidence interval [CI], 0.62 to 1.23; P=0.44). By day 30, major bleeding had occurred in 0.47% of the patients in the apixaban group (15 of 3184 patients) and in 0.19% of the patients in the enoxaparin group (6 of 3217 patients) (relative risk, 2.58; 95% CI, 1.02 to 7.24; P=0.04). CONCLUSIONS: In medically ill patients, an extended course of thromboprophylaxis with apixaban was not superior to a shorter course with enoxaparin. Apixaban was associated with significantly more major bleeding events than was enoxaparin. (Funded by Bristol-Myers Squibb and Pfizer; ClinicalTrials.gov number, NCT00457002.)