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Introduction
Publications
Publications (197)
Purpose
The large burden of silicosis and tuberculosis (TB) in the South African mining industry, coupled with an under-resourcing of the compensation agencies responsible for certifying occupational lung disease, have resulted in serious backlogs. This work aimed to measure the efficiency gains from triaging occupational lung disease claims using...
BACKGROUND: For over one hundred years, the gold mining sector has been a considerable source of tuberculosis (TB) and silicosis disease burden across Southern Africa. Reading chest radiographs (CXRs) is an expert and time-intensive process necessary for the screening and diagnosis of lung disease and the provision of evidence for compensation clai...
BACKGROUND : South Africa has adopted strategies to prevent workplace transmission of diseases, including tuberculosis (TB). Occupational health and safety (OHS), and infection prevention and control (IPC), are essential in combatting human immunodeficiency virus (HIV) and TB in the workplace. We evaluated the effect of a multi-faceted policy, prac...
Worldwide, interest is increasing in community-based arts to promote social transformation. This study analyzes one such case. Ecuador's government, elected in 2006 after decades of neoliberalism, introduced Buen Vivir (‘good living’ derived from the Kichwan sumak kawsay), to guide development. Plans included launching a countrywide programme using...
Introduction
Effective tuberculosis (TB) infection prevention and control (IPC) measures including education and training are crucial in limiting the spread of TB in healthcare settings. We aimed to explore how well HCWs adhere to TB IPC practices, the nature and extent of training related to TB IPC across demographic and occupational factors.
Met...
Introduction
Although information systems (IS) have been widely applied to address health concerns worldwide, few initiatives address workers health and safety. This is especially the case in the health sector, an area the High Level Commission on Health Employment and Economic Growth acknowledged to be in need of attention, particularly in low and...
Introduction
A particular sub-population known to be at high risk of tuberculosis (TB) infection is health workers, with rates of infection estimated at 2–5 times that of the general population. Evidence indicates that Infection control practices are poorly implemented. The objective of this study was to investigate perceptions of knowledgeable inf...
Introduction
With over 7400 employees in 346 laboratories and 3 national institutes across South Africa, the National Health Laboratory Service (NHLS) faces the challenge of how to provide occupational health, biosafety and biosecurity services with limited resources. The Occupational Health and Safety Information System (OHASIS) was initially deve...
Setting:
A provincial tertiary hospital in Gauteng province, South Africa, with a high burden of tuberculosis (TB) patients and high risk of TB exposure among health care workers (HCWs).Objective:To determine HCWs' adherence to recommended TB infection prevention and control practices, TB training and access to health services and HCW TB rates.Desi...
Health scholars have long been calling for a new approach to understanding and responding to public health challenges, recognizing the dynamic influence of social and ecological processes and the importance of respecting different ways of knowing. With daunting new challenges to collective health, we sought to ascertain how future generations of pu...
Background
Health workers (HWs) in resource-limited settings are at high-risk of exposure to tuberculosis (TB) at work. The aim of this study was to estimate the rate of TB disease among HWs in the Free State Province of South Africa between 2002 and 2012 and to compare demographic and clinical characteristics between HWs and the general population...
Background
Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State P...
Setting:
Twenty-eight public hospitals in the Free State Province, South Africa.
Objective:
To examine the association between tuberculosis (TB) infection control (IC) scores in Free State hospitals and the incidence of TB disease among health care workers (HCWs) in 2012.
Design:
A cross-sectional survey and mixed-methods analysis of TB IC pol...
Introduction:
N95 filtering facepiece respirators are used by healthcare workers when there is a risk of exposure to airborne hazards during aerosol-generating procedures. Respirator fit-testing is required prior to use to ensure that the selected respirator provides an adequate face seal. Two common fit-test methods can be employed - qualitative...
Academics from diverse disciplines are recognizing not only the procedural ethical issues involved in research, but also the complexity of everyday “micro” ethical issues that arise. While ethical guidelines are being developed for research in aboriginal populations and low-and-middle-income countries, multi-partnered research initiatives examining...
Background:
Occupational tuberculosis (TB) continues to plague the healthcare workforce in South Africa. A 2-year cluster randomized controlled trial was therefore launched in 27 public hospitals in Free State province, to better understand how a combined workforce and workplace program can improve health of the healthcare workforce.
Objective:...
Background. The dual burden of tuberculosis and human immunodeficiency virus (HIV) is severely impacting the South African healthcare workforce. However, the use of on-site occupational health services is hampered by stigma among the healthcare workforce. The success of stigma-reduction interventions is difficult to evaluate because of a dearth of...
Health workers are at high risk of acquiring infectious diseases at work, especially in low and middle-income countries (LMIC) with critical health human resource deficiencies and limited implementation of occupational health and infection control measures. Amidst increasing interest in international partnerships to address such issues, how best to...
Objective:
Healthcare workers (HCWs) in South Africa are at a high risk of developing active tuberculosis (TB) due to their occupational exposures. This study aimed to systematically quantify and compare the preferred attributes of an active TB case finding program for HCWs in South Africa.
Methods:
A Best-Worst Scaling choice experiment estimat...
Background: Integration of HIV care into primary health care (PHC) clinics is a strategy used in
South Africa to expand access to antiretroviral therapy (ART) while maximising health system
resources. However, how patients at PHC clinics perceive changes in their healthcare after
integration is unknown.
Methods: In Free State, South Africa, we admi...
Background: The integration of HIV care into primary health care (PHC) clinics is a strategy to
expand access to antiretroviral therapy (ART). However, integration may compromise PHC service
delivery within weak health systems. We designed a study to examine changes in PHC service
provision (pre and postintegration) in public sector PHC clinics in...
Fear of stigma and discrimination among health care workers (HCWs) in South African hospitals is thought to be a major factor in the high rates of HIV and tuberculosis infection experienced in the health care workforce. The aim of the current study is to inform the development of a stigma reduction intervention in the context of a large multicompon...
Background
Focus on “social determinants of health” provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of “risk factors” related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, h...
Background: Healthcare workers have increased risks due to continued exposure to patients with infectious diseases, particularly TB and Hepatitis B. This study assessed workplace conditions and practices regarding air- and blood-borne infections in public hospitals in the Free State.
Methods: Workplace audits were conducted in intensive care, medi...
Background: Many high-HIV burden countries are increasingly integrating HIV-care into Primary Health Care (PHC) clinics to improve access to HIV treatment and strengthen people-centered health systems. However, little is known about successes and challenges of policy implementation in this context. This study aims to identify successes, challenges...
Background:
Community-based cluster-randomized controlled trials (RCTs) are increasingly being conducted to address pressing global health concerns. Preparations for clinical trials are well-described, as are the steps for multi-component health service trials. However, guidance is lacking for addressing the ethical and logistic challenges in (clu...
Although non-specific low back pain (LBP) is known to be multifactorial, studies from across the globe have documented their higher prevalence in nurses. This systematic review was conducted to ascertain whether this much-documented association constitutes a causal relationship, and whether there is a discernible threshold of exposures associated w...
With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of...
Background:
Joint health and safety committees (JHSCs) are widely acknowledged as important to a healthy and safe work environment. However, it is also generally believed that having a JHSC is necessary but not sufficient; the JHSC must be effective.
Methods:
A systematic review was undertaken to find empirical studies regarding the effectivenes...
Abstract The health service sector has a vital role to play in delivering human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment and care, yet evidence indicates that healthcare workers (HCWs) themselves lack adequate access to HIV and TB services. HCWs are also at increased risk from TB and other infectious diseases at work...
Background:
Although information systems (IS) have been extensively applied in the health sector worldwide, few initiatives have addressed the health and safety of health workers, a group acknowledged to be at high risk of injury and illness, as well as in great shortage globally, particularly in low and middle-income countries.
Methods:
Adaptin...
Safety climate, specifically employees’ perceptions of management’s commitment to safety, plays a vital role in the adoption of safe work practices. Infection control training contributes to safety climate and is a visible sign of organizational commitment to safety. Time constraints, shift work, and demanding workloads limit health-care workers’ a...
Chronic pesticide poisoning is difficult to detect. We sought to develop a low-cost test battery for settings such as Ecuador's floriculture industry. First we had to develop a case definition; as with all occupational diseases a case had to have both sufficient effective dose and associated health effects. For the former, using canonical discrimin...
To collect baseline data on infectious diseases and antibiotic use in two Andean indigenous communities in Ecuador in order to determine the feasibility and acceptability of applying an ecosystem approach to address associated problems.
In visits to 65 households with children under age 5 years, environmental risk factors for infectious diseases we...
The Sustainably Managing Environmental Health Risk in Ecuador project was launched in 2004 as a partnership linking a large Canadian university with leading Cuban and Mexican institutes to strengthen the capacities of four Ecuadorian universities for leading community-based learning and research in areas as diverse as pesticide poisoning, dengue co...
Globalization has been accompanied by the rapid spread of infectious diseases, and further strain on working conditions for health workers globally. Post-SARS, Canadian occupational health and infection control researchers got together to study how to better protect health workers, and found that training was indeed perceived as key to a positive s...
Studies in the literature do not show clear evidence supporting the relationship between pain and depressive symptoms in individuals experiencing acute/subacute pain compared to those experiencing chronic pain. However, more information is needed about which variables act as mediators in the pain-depression relationship in people having acute/subac...
To consider how Cuba's acknowledged achievement of excellent health outcomes may relate to how health determinants are addressed intersectorally.
Our team of Canadian and Cuban researchers and health policy practitioners undertook a study to consider the organization and practices involved in addressing health determinants in 2 municipalities (1 ur...
Many agencies recommend that health care workers wear N95 filtering facepiece respirators (N95-FFR) to minimize occupational exposure to bioaerosols, such as tuberculosis and pandemic influenza. Published standards outline procedures for the proper selection of an N95-FFR model, including user seal checks and respirator fit-testing. Some health off...
To investigate the effectiveness of a risk assessment system in reducing the risk of violence in an acute care hospital in the Canadian province of British Columbia.
Hospital violence incident rates (number of incidents/100,000 work hours) were calculated and compared pre, during and post implementation of the Alert System, a violence risk assessme...
The intimate interdependence of human health and the ecosystems in which we are embedded is now a commonplace observation. For much of the history of public health, this was not so obvious. After over a century of focus on diseases, their biologic causes and the correction of exposures (clean water and air) and facilitation of responses (immunizati...
Introduction Workplace disability prevention is important, but stakeholders can differ in their appreciation of such interventions.We present a responsive evaluation of a workplace disability prevention intervention in a Canadian healthcare organization. Three groups of stakeholders were included: designers of the intervention, deliverers, and work...
Intersectoral action on health determinants has long been recognized as an important factor in achieving better population health. Nevertheless, there is no process that provides empirical evidence to policy-makers on the extent of intersectoral collaboration. We aimed to fill this gap by conducting case studies in two municipalities in Cuba, a cou...
As universities increasingly rely on external sources of research funding, researchers worldwide are realizing that if their work is financially supported by organizations with distinct political or financial interests, they risk their careers if their results deviate from the interests of their funding partners. This article presents a case that i...
Background to the Debate
This PLoS Medicine Debate examines the different approaches that can be taken to tackle neglected tropical diseases (NTDs). Some commentators, like Jerry Spiegel and colleagues from the University of British Columbia, feel there has been too much focus on the biomedical mechanisms and drug development for NTDs, at the expe...
The Healthy Hospital Project, an international collaboration, aimed to strengthen Ecuador's capacity to promote healthier and safer hospitals by reducing occupational transmission of infectious diseases. Team members conducted a needs assessment to identify workplace hazards and health risks in three hospitals. A survey of health care workers' know...
In British Columbia (BC), Canada, all health care facilities must have a written staff policy on influenza immunization that includes notice that non-immunized staff can be excluded from work without pay during an influenza outbreak in the facility. In light of this policy, our objectives were to explore the views of BC health care workers (HCWs) r...
Healthcare workers face difficult working conditions, particularly where HIV and tuberculosis add to understaffing. Questionnaires, workplace assessments, and discussion groups were conducted at a regional hospital in South Africa to obtain baseline data and input from the workforce in designing interventions. Findings highlighted weaknesses in kno...
The need to transcend disciplinary boundaries in the teaching of environmental studies has become increasingly obvious. It has been particularly recognized that the relationship between environmental factors and human health needs to be taught much more broadly at universities. An international collaborative effort was begun to develop a course to...
The high rate of violence in the healthcare sector supports the need for greater surveillance efforts.
The purpose of this study was to use a province-wide workplace incident reporting system to calculate rates and identify risk factors for violence in the British Columbia healthcare industry by occupational groups, including nursing.
Data were ext...
This paper examines two innovative educational initiatives for the Ecuadorian public health workforce: a Canadian-funded Masters programme in ecosystem approaches to health that focuses on building capacity to manage environmental health risks sustainably; and the training of Ecuadorians at the Latin American School of Medicine in Cuba (known as Es...
Ensuring good infection control practice in health care facilities is a constant concern, yet evidence shows that the compliance of health care professionals with proper procedures is lacking, despite the existence of guidelines and training programs. An online infection control module was developed to provide ready access to training. Controversy...
This article discusses the extent of resource allocation to Occupational Health (OH) to prevent infectious disease exposure and transmission in British Columbia (B.C.). It also characterizes the delineation of roles and responsibilities within OH services in B.C. health care settings and highlights areas where improvements to current OH programs co...
We used observational evaluation to assess the ability of an online learning course to effectively transfer knowledge on personal protective equipment (PPE) selection and removal. During orientations for new hospital staff, 117 participants applied either airborne, droplet, or contact precautions in mock scenarios. Postcourse, all 3 scenarios demon...
Few studies have audited the resources available to infection control (IC) and occupational health (OH) to promote safe work behaviour, whilst comparing audited findings with perceptions by healthcare workers (HCWs). We aimed to determine the IC and OH resources available and compare this with HCWs' perception of resources, following an outbreak of...
A longitudinal study was conducted in three long-term care facilities to evaluate the effectiveness and cost benefit of overhead lifts in reducing the risk of musculoskeletal injury among healthcare workers. Analysis of injury trends spanning 6 years before intervention (1996-2001) and 4 years after intervention (2002-2005) found a significant and...
The ability of communities to respond to the pressures of globalization is an important determinant of community health. Tourism is a rapidly growing industry and there is an increasing concern about its health impact on local communities. Nonetheless, little research has been conducted to identify potential mitigating measures. We therefore took a...
Health care workers have high risk of exposure to human blood and body fluids (BBF) from patients in acute care and residents in nursing homes or personal homes.
This analysis examined the epidemiology for BBF exposure across health care settings (acute care, nursing homes, and community care). Detailed analysis of BBF exposure among the health car...
The objective of this pilot project was to determine whether engaging critical care unit staff in designing and implementing enhancements to the practice environment would positively impact the clinical environment and staff outcomes. The project used a one-group pre-post test design and a participatory action process. Significant changes in the pr...
This article outlines the steps taken to deliver standardized infection control and occupational health training to all healthcare workers across a Canadian health authority, using an online module developed by a multidisciplinary team. The course had to meet a diverse variety of learner needs, be relevant to day-to-day practice, be accessible, as...
Many work injuries and their associated disabilities are preventable, but effective prevention requires coordinated action by multiple stakeholders. In trying to achieve coordinated action occupational health practitioners can learn valuable lessons from systems theory, knowledge transfer and action research. Systems theory provides a broad view of...
To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada.
Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full-time equivalent (FTE) positions. Poisson regres...
Incidence of occupational injury is anticipated to be high among cooks and food service workers (CFSWs) because of the nature of their work and the types of raw and finished materials that they handle.
Incidents of occupational injury, resulting in lost time or medical care over a period of 1 year in two health regions were extracted from a standar...
To characterize the social and environmental risk factors associated with the presence of Aedes aegypti in order to improve community dengue control.
A case-control study with 'cases' being households with entomologically confirmed A. aegypti infestation; personal interviews in Central Havana, a densely populated inner city area characterized by ov...
The results of the implementation of a strategy to improve training in environmental health risk assessment and management in Cuba, with a new problem-focused, community-based holistic, transdisciplinary approach based on interactive methods were provided. The National Institute for Hygiene, Epidemiology and Microbiology's environmental health teac...
The authors developed and evaluated a comprehensive participatory ecosystem health approach for preventing the transmission of dengue, the most prevalent vector-borne disease in Cuba and the Latin America-Caribbean region. The integrated surveillance system central to this initiative encompassed three main subsystems (environmental; entomological;...
Few incidence studies of workplace injuries among community health workers exist, and evidence regarding the effectiveness of interventions in this population is lacking.
To determine the incidence of workplace injury among community health workers in British Columbia; to identify predictors of injury; and to assess the effectiveness of a multicomp...
The purpose of this study was to assess determinants of healthcare worker (HCW) self-reported compliance with infection control procedures. A survey was conducted of HCWs in 16 healthcare facilities. A strong correlation was found between both environmental and organizational factors and self-reported compliance. No relationship was found with indi...