Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs

Initiation of antihypertensive monotherapy and incident fractures among Medicare beneficiaries

Abstract Background Research suggests antihypertensive medications are associated with fractures in older adults, however results are inconsistent and few have examined how the association varies over time. We sought to examine the association between antihypertensive class and incident non-vertebral fractures among older adults initiating monotherapy according to time since initiation. Methods We used a new-user cohort design to identify Medicare beneficiaries (≥ 65 years of age) initiating antihypertensive monotherapy during 2008–2011 using a 20% random sample of Fee-For-Service Medicare beneficiaries enrolled in parts A (inpatient services), B (outpatient services), and D (prescription medication) coverage. Starting the day after the initial antihypertensive prescription, we followed beneficiaries for incident non-vertebral fractures. We used multinomial logistic regression models to estimate propensity scores for initiating each antihypertensive drug class. Using these propensity scores, we weighted beneficiaries to achieve the same baseline covariate distribution as beneficiaries initiating with angiotensin-converting enzyme inhibitors. Lastly, we used weighted Cox proportional hazard models to estimate hazard ratios (HRs) of having an incident fractures according to antihypertensive class and time since initiation. Results During 2008–2011, 122,629 Medicare beneficiaries initiated antihypertensive monotherapy (mean age 75, 61% women, 86% White). Fracture rates varied according to days since initiation and antihypertensive class. Beneficiaries initiating with thiazides had the highest fracture rate in the first 14 days following initiation (438 per 10,000 person-years, 95% confidence interval (CI): 294–628; HR: 1.40, 0.78–2.52). However, beneficiaries initiating with calcium channel blockers had the highest fracture rate during the 15–365 days after initiation (435 per 10,000 person-years, 95% CI: 404–468; HR: 1.11, 1.00–1.24). Beneficiaries initiating with angiotensin-receptor blockers had the lowest fracture rates during the initial 14 days (333 per 10,000 person-years, 190–546, HR: 0.92, 0.49–1.75) and during 15–365 days after initiation (321 per 10,000 person-years, 287–358, HR: 0.96, 0.84–1.09). Conclusion The association between antihypertensives and fractures varied according to class and time since initiation. Results suggest that when deciding upon antihypertensive therapy, clinicians may want to consider possible fracture risks when choosing between antihypertensive drug classes

Pregnant driver-associated motor vehicle crashes in North Carolina, 2001–2008

Motor vehicle crashes are the leading cause of maternal injury-related mortality during pregnancy in the United States, yet pregnant women remain an understudied population in motor vehicle safety research

Adverse Pregnancy Outcomes Following Motor Vehicle Crashes

Motor vehicle crashes are a leading cause of serious trauma during pregnancy, but little is known about their relationships with pregnancy outcomes

Biomarkers of incident radiographic knee osteoarthritis: Do they vary by chronic knee symptoms?

To explore prognostication of incident radiographic knee osteoarthritis (OA) with OA-related biomarkers in a large sample of African-American and Caucasian men and women

Reporting Crime Victimizations to the Police and the Incidence of Future Victimizations: A Longitudinal Study.

Law enforcement depends on cooperation from the public and crime victims to protect citizens and maintain public safety; however, many crimes are not reported to police because of fear of repercussions or because the crime is considered trivial. It is unclear how police reporting affects the incidence of future victimization.To evaluate the association between reporting victimization to police and incident future victimization.We conducted a retrospective cohort study using National Crime Victimization Survey 2008-2012 data. Participants were 12+ years old household members who may or may not be victimized, were followed biannually for 3 years, and who completed at least one follow-up survey after their first reported victimization between 2008 and 2012. Crude and adjusted generalized linear mixed regression for survey data with Poisson link were used to compare rates of future victimization.Out of 18,657 eligible participants, 41% participants reported to their initial victimization to police and had a future victimization rate of 42.8/100 person-years (PY) (95% CI: 40.7, 44.8). The future victimization rate of those who did not report to the police (59%) was 55.0/100 PY (95% CI: 53.0, 57.0). The adjusted rate ratio comparing police reporting to not reporting was 0.78 (95%CI: 0.72, 0.84) for all future victimizations, 0.80 (95% CI: 0.72, 0.90) for interpersonal violence, 0.73 (95% CI: 0.68, 0.78) for thefts, and 0.95 (95% CI: 0.84, 1.07) for burglaries.Reporting victimization to police is associated with fewer future victimization, underscoring the importance of police reporting in crime prevention. This association may be attributed to police action and victim services provisions resulting from reporting

Employee and Customer Injury During Violent Crimes in Retail and Service Businesses

Objectives. We sought to compare the frequency and risk factors for employees and customers injured during crimes in retail (convenience, grocery, and liquor stores) and service businesses (bars, restaurants, motels). Methods. A total of 827 retail and service businesses in Los Angeles were randomly selected. Police crime reports (n=2029) from violent crimes that occurred in these businesses from January 1996 through June 2001 were individually reviewed to determine whether a customer or an employee was injured and to collect study variables. Results. A customer injury was 31% more likely (95% confidence interval [CI]=1.11, 1.51) than an employee injury during a violent crime. Customer injury was more frequent than employee injury during violent crimes in bars, restaurants, convenience stores, and motels but less likely in grocery or liquor stores. Injury risk was increased for both employees and customers when resisting the perpetrator and when the perpetrator was suspected of using alcohol. Customers had an increased risk for injury during crimes that occurred outside (relative risk [RR]=2.01; 95% CI=1.57, 2.58) and at night (RR=1.79; 95% CI=1.40, 2.29). Conclusions. Security programs should be designed to protect customers as well as employees

Workplace violence victimization in young workers: An analysis of the US National Crime Victimization Survey, 2008 to 2012.

BACKGROUND: The aim of this study was to measure the frequency of workplace violence (WPV) victimization in 16 to 24-year olds in the United States and compare rates by occupation and demographics. METHODS: As an open cohort, participants 12 years or older in the National Crime Victimization Survey were interviewed at 6-month intervals over a 3-year period from 2008 to 2012. WPV victimization rates were calculated. Weighted, multilevel Poisson regression was used to compare WPV victimization rates by occupation and demographics. RESULTS: The rate of WPV victimization was 1.11 incidents per 1000 employed person-months (95% confidence interval: 0.95-1.27). The highest rates of WPV were in protective service occupations (5.24/1000 person-months), transportation (3.04/1000 person-months), and retail sales (2.29/1000 person-months). Compared with their respective counterparts, lower rates of WPV victimization were found among younger, black, and rural/suburban workers. CONCLUSIONS: Findings identify occupations and target populations in need of future research and evidence-based interventions to improve the working conditions for young workers

Additional file 1: of Volunteering in adolescence and young adulthood crime involvement: a longitudinal analysis from the add health study

Directed acyclic graph (DAG) representing the association between adolescent volunteering and adulthood crime. (PNG 57 kb