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Author: WorkCare

  • What’s Up With Super Bowl Monday Blahs?

    What’s Up With Super Bowl Monday Blahs?

    A petition started by a New York teenager on Change.org asking the National Football League to move the 2021 Super Bowl from Sunday to Saturday, potentially with an earlier start time, now has more than 70,000 signatures.

    Arguments in favor of this proposal include economic benefits, giving kids a chance to see more of the game before bedtime and fewer work absences due to the “hangover effect.”

    High work absence rates on Super Bowl Monday (“Smunday”) are a cultural phenomenon. Here are some examples:

    • The 2020 Super Bowl Fever Survey commissioned by The Workforce Institute at Kronos Incorporated and conducted by The Harris Poll estimates that 17.5 million employed U.S. adults may miss work on Feb. 3, a record number since the institute began tracking absences in 2005.
    • About 11.1 million employees are expected to take approved time-off, allowing their employers to make scheduling adjustments. Investigators say that leaves about 4.7 million who will call in sick, 1.5 million who just won’t show up, and nearly 8 million who are going to wait and see how they feel.
    • Nearly a quarter of business professionals (23 percent) surveyed think Monday after the Super Bowl should be a national holiday, according to a Captivate Office Pulse study of 360 U.S. white-collar employees. In addition, 14 percent of respondents said they expect to be hung over or “extra tired;” among younger workers it was 26 percent. Captivate estimates companies lost $484 million in productivity on Super Bowl Monday last year.
    • Fox Sports, which is broadcasting the game, is offering viewers the chance to win a $10,000 bonus by taking off Monday and then tweeting #SuperMonday.

    Based on the Workforce Institute’s findings, executive coaching firm Challenger, Gray & Christmas, Inc., estimates this year’s Super Bowl could cost employers over $5.1 billion in lost productivity during Super Bowl week through post-game Monday. This includes costs associated with lost days, game-related sideline conversations while on the clock, and arriving late or leaving work early.

    Are Reported Injuries Lower?

    Naturally, our curiosity was piqued. At WorkCare we wondered if fewer work-related injuries were reported on the day after the Super Bowl because there are less people at work. So, the WorkCare analytics team checked the number of injuries reported to WorkCare’s Incident Intervention 24/7 telehealth triage center on Super Bowl Monday in comparison to non-holiday Mondays in January and February over a seven-year period (2013 to 2019). No significant difference was found.

    This inquiry leaves us to speculate about the reasons: Perhaps employees who watched the game are more susceptible to injury because they lost sleep or are recovering from celebratory over-indulgence. Some employees may push themselves to compensate for absent colleagues, or they may have worked hard on Sunday and are tired out from serving or filling in for football fans.

    Employers may want to consider conducting their own investigations to determine exactly how many and what types of employees show up for work on Monday, and for developing .interventions to reduce potentially negative consequences.

    The Super Bowl is an American institution that presents some unique challenges for employers, reminding us of the need for year-round injury prevention and absence management strategies that take into account company culture and workforce diversity. A solid game plan will likely help improve business results, employee morale and health outcomes.

  • New Employees Who Get Injured More Likely to Have Recurrences

    New Employees Who Get Injured More Likely to Have Recurrences

    A study at an academic medical center found that employees who experienced a work-related injury within their six months of employment were more than twice as likely to have three or more lost-time injuries for the duration of their tenure.

    Findings from the study, Do Work-Related Lost-Time Injuries Sustained Early in Employment Predict Multiple Lost-Time Injuries Throughout Employment? published in the October 2019 edition of the Journal of Occupational and Environmental Medicine, are based on 5,906 injuries followed from 1994 to 2017, or 1,046,218 person years.

    Researchers found that the odds ratio of having three or more lost-time injuries was 2.12 for employees having their first lost-time injury within the first six months of employment versus those injured after that, controlling for demographics and employment duration. For each increasing year before the first lost-time injury, the probability of having three or more lost-time injuries decreased by 13 percent.

    The authors concluded that employment duration before the first lost-time injury may be used to predict future lost-time injuries without detailed information of underlying risk factors.

    What’s the Significance?

    WorkCare’s Executive Chairman and Chief Medical Officer Peter P. Greaney, M.D., says a number of factors can contribute to the occurrence of an injury early in a person’s employment. For example, there may be a poor match between the employee and essential job functions, insufficient training or misalignment between the employee’s personal characteristics and the company’s culture.

    According to Dr. Greaney, a board-certified occupational physician, a training or cultural issue is usually the byproduct of a systemic employer approach that rarely gets fixed, in turn increasing the likelihood of an initial injury and a recurrence. Once a person becomes injured, he or she learns how the system works and identifies perceived benefits derived from that condition – such as monetary, days away from work, job accommodation, medications (possibly including opioids), and attention (positive or negative) from supervisors and managers, friends and family. The bottom line is that some needs are met.

    As life crises emerge, the employee reverts to behavior that was positively reinforced from earlier experiences. An injury event does not have to be contrived. It may be all subconscious and driven by pain mechanisms.

    Related Research

    Related research supports the use of preventive interventions, including training, to address correlations between early employment and injury risks. Here are three examples:

    • 1. Among 58,271 workers who experienced 10,260 injuries, those with job tenure of less than six months showed higher relative injury risk compared to employees with job tenure of more than two years. Relative injury risk was 41 percent higher among workers under age 30 and 22 percent higher among people over 40. Authors’ conclusion: “If institutions don’t adopt appropriate prevention policies, injury risk is likely to increase, especially among young people.”
    • 2. A 10-year study of the association between job tenure and lost-time claim rates found significantly higher rates among workers with shorter job tenure. Authors’ conclusion: Elevated risk among new workers suggests the need to improve training, reduce exposures, promote permanent employment, and monitor work injury trends and risk factors.
    • A 2014-15 study of Tennessee construction workers found 44.5 percent of reported injuries were sustained by workers with tenure of one year or less. The three most common types of injuries (strain, laceration and contusion) accounted for 62 percent of the top ten types of injuries. Authors’ conclusion: The importance of new employee “on-boarding” orientation cannot be over emphasized. Contents should include injury incidence data and training for temporary workers.
    A WorkCare Solution

    WorkCare’s Incident Intervention® program supports immediate reporting of non-emergency work-related injuries and early telehealth intervention by occupational physicians and nurses, optimally within the “golden hour” following onset. About 75 percent of the time employees elect to follow self-care guidance at the first-aid level and are able to safely go back to work in a full or temporarily modified capacity. Those who choose to visit a clinic or are referred to a local provider by a WorkCare clinician are positioned to receive the right care, at the right time, in the right setting. Only a small percentage of incidents result in lost work time.

    In all cases, a positive initial injury care experience helps improve outcomes and reduce the likelihood of injury recurrence.

  • In Recognition of Labor Day

    In Recognition of Labor Day

    On Labor Day, we invite you to join WorkCare in deep reflection on the importance of protecting and promoting the health of the employees we depend on to sustain our businesses, families and communities across the country.

    We are currently experiencing – and anticipating a growing emphasis on – the implementation of Total Worker Health programs.that address physical and mental health aspects of employee fitness on and off the job. In essence, the customary pledge to send employees home in the same condition in which they arrived at work is undergoing re-examination.

    Employees who are tired, have chronic diseases, are depressed or anxious, have drug and alcohol addictions, or who are in pain tend to be less productive and have higher rates of accidents and injuries than those who are not. Conversely, those who make healthy lifestyle choices such as getting regular exercise, eating nutritious foods, sleeping seven to nine hours a night, and not smoking benefit from being in a workplace that supports their goals. Consequently, the “whole person” approach to employee health management is gaining momentum.

    The Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health promote programs that combine health protection with health promotion. An understanding of both physical and mental health aspects of health and how to best manage them is required.

    We believe astute employers will be investing in technological solutions, including artificial intelligence, to help identify and mitigate injury and illness risk to control their costs while improving quality of life for employees. Primary, secondary and tertiary interventions that span the care continuum can be customized to meet specific needs, such as those of older employees or people with chronic diseases or pain that impairs function.

    The goal is to reduce exposure risk and protect employees from harm with effective preventive strategies. When an injury or illness occurs, it’s important to intervene in a way that decreases the likelihood of an individual getting sucked into the vortex of avoidable disability.

    Work-related disability is often not medically justified, yet it is a relatively frequent occurrence. Unnecessary lost work time costs employers millions of dollars each year while simultaneously setting workers back financially, socially, psychologically and physically.

    The evidence clearly shows that most injured employees get better faster if they keep working through their recovery period. Data show that injured or ill employees who never lose time from work have better long-term outcomes than those who do. For those who miss work, the odds for a return to full employment after six months of absence because of a work-related disability are less than 50 percent.

    The fast-paced, rapidly changing workplace presents a complex set of demands that requires employers to take innovative approaches to employee health management in conjunction with proven environment, health and safety (EH&S) programs.

    Employers have the power to promote healthy lifestyle choices and influence change in human behavior. In the workplace, there are daily opportunities to educate and incentivize employees in ways that encourage them to take responsibility for their own health. To engage and empower employees as health care consumers, experts say employers must implement innovative technology and communication strategies that interface seamlessly with vendor resources across the care continuum.

  • Preventive Massage: First Aid, Not Medical Treatment

    Preventive Massage: First Aid, Not Medical Treatment

    There’s a tendency to think of first aid as injury care, but it also applies to injury prevention.

    Under federal OSHA definitions, massage and exercise guidance are listed as first aid injury prevention measures. However, when a provider prescribes specific therapeutic exercises in response to a work-related injury or illness, it is medical treatment and becomes OSHA-recordable.

    To clarify ambiguities in specific situations, the Occupational Safety and Health Administration periodically issues Letters of Interpretation. On May 23, 2019, OSHA responded to an inquiry from Sharon Dunn, PT, PhD, president of the American Physical Therapy Association (APTA), who requested written guidance on the use of soft tissue management (massage).

    There was a concern that when applied by physical therapists, massage would be considered medical treatment and not first aid. More specifically, the APTA wanted to know if various forms of massage could be performed at the first-aid level by therapists who do not have certification in Active Release Techniques (ART), an approach which has already been interpreted by OSHA as first aid.

    In its response, OSHA notes that:

    • Section 1904.7(b)(5)(ii) defines “using massages” as first aid for recordkeeping purposes.
    • A determination about whether to record soft tissue cases is no different than it is for any other type of injury or illness.
    • Professional status of the person providing soft tissue massage does not have any effect on what is considered first aid or medical treatment.

    What This Means for WorkCare Clients

    The letter of interpretation confirms what we already knew: WorkCare Industrial Massage – non-invasive techniques performed onsite by trained professionals to relieve an employee’s musculoskeletal discomfort before it becomes an injury in need of medical treatment – may be provided without worrying about triggering OSHA-recordable medical treatment.

    Similar principles apply to other WorkCare employee health management solutions, including Bio-Ergonomic Surveillance using wearable technology, Stretch & Flex exercises and health coaching recommended by our certified Athletic Trainers and occupational physicians, as part of comprehensive injury prevention programs.

    In addition, it means our collaborative team, including occupational physicians, nurses, athletic trainers, massage therapists, physical therapists and other skilled professionals, have the opportunity to reach more employees with preventive interventions to help them stay healthy and safe on the job and improve their quality of life.

  • Telemedicine is When Technology Touches You

    Telemedicine is When Technology Touches You

    A general sense of ambivalence surrounds the use of telemedicine. There is a perception that a meaningful physician-patient relationship cannot be developed when the physician doesn’t physically touch the person in need of care.

    According to some experts, communications technology, in general, is impeding human connection. For example, in her book Alone Together, sociologist Sherry Turkle correlates our technologically networked society with the decline of empathy and relationship. Touch is believed to be integral to forming associations, and it has been found to have healing properties when used with the deliberate intent to impart warmth, understanding and compassion.

    Health care delivery today is less deliberate and more distracted than it once was, regardless of whether touch is part of an encounter. We have evidence that physician-patient partnerships are not being actualized, and that healing is impaired as a result.

    Oxytocin and Human Connection

    I believe that telemedicine can help bridge the gap between patient and physician, and restore healing to the practice of medicine. Oxytocin is a key contributor to the formulation of human connection.

    Oxytocin is a neurotransmitter that functions in our internal calm-and-connect system. This system works in opposition to the fight-or-flight response that is triggered in times of stress, including injury and illness. Oxytocin levels increase when we are gently or lovingly touched by a person with whom we intend to affect a connection. It has been widely studied in bonding between mother and infant, and it is often referred to as the “cuddle hormone.”

    Activation of the calm-and-connect system is important to the practice of medicine because it moves people toward a state of relaxation, receptivity and healing.

    Making Eye Contact

    Intentional touch is not the only trigger for the release of oxytocin. According to Dr. Kerstin Uvas, author of The Oxytocin Factor, eye contact has the same physiologic effect as touch. Mutual gaze has been found to be as important as physical touch in mother-child bonding.

    Researchers typically study these correlations indirectly by introducing the hormone oxytocin as an exogenous substance because it is nearly impossible to study the release of the neurotransmitter within tissues of the human body. Studies in which men have been given oxytocin suggest the extended length of eye contact and increased amounts of oxytocin are directly correlated.

    Eye contact can also help build alliances because it signals to the receiver that the speaker is available and confident. It is difficult to lie about our emotions from the nose up; the eyes are typically a “tell” for insincerity or lying, or for authentic empathy, compassion, interest and intent. Direct and brief eye contact attunes the brain to a mode that encourages interaction between people. The amount of eye contact someone receives during a conversation has been shown to be directly proportional to the amount he or she will engage in discussion.

    Because eye contact is just as important to building an alliance and communicating empathy as a physical touch, it is a meaningful substitute for creating a partnership in the physician-patient relationship. The use of tele-video is an adaptation of technology in a way that propels meaningful exchange forward.

    Rather than being distracted by an electronic medical record on a laptop in the treatment room, the telemedicine physician is able to make eye contact with the patient, creating an atmosphere of receptivity despite the virtual connection. In this way, all of the benefits of eye-contact can be fully realized by a physician who is adequately trained in the art of empathic communication: There is a forging of alliance, an exchange of information, an increase in the receptivity and interaction of the patient, and adherence to treatment plans and overall improved outcomes.

    Telemedicine physicians touch patients – not physically but meaningfully and directly. In this way, telemedicine is improving the practice of medicine.

  • Occupational Burnout – Part 2: A Cumulative Trauma Disorder

    Occupational Burnout – Part 2: A Cumulative Trauma Disorder

    This is the second part of a two-part blog post by WorkCare Associate Medical Director Brittany Busse, M.D.

    In Part 1 of this post, I promised to explain how I reached the conclusion that occupational stress is a cumulative trauma injury. Allow me to walk you through three related inherent truths.

    Health at Work

    The first truth is that a positive state of health occurs when a person has a balanced sense of physical, mental and social well-being. Without this balance at work, employees cannot achieve whole health. Work is important because it occupies so much of our time, helps defines us, makes us part of a larger community and gives us purpose.

    Meanwhile, in many professions health status is strongly influenced by the expectations of and interactions with peers and superiors. In addition to following clearly defined rules, many employees feel obligated to comply with unspoken expectations of conduct, such as being virtually available 24/7, performing jobs outside of their skill set to cover for others or doing personal tasks for their boss.

    Studies show that expectations of availability, even if only perceived by the employee and not directly stated, lead to symptoms of burnout and have a direct impact on health balance.

    Interdependence

    The second truth is that all aspects of health are interdependent. Consequently, a dysfunction in one aspect will affect functioning in other aspects. Here’s an example:

    An employee is suffering from a higher level of social stress than he is capable of processing. His emotional distress stimulates neurotransmitters and hormones that affect his physical health. The employee experiences an immune system response that makes him susceptible to illness. When he gets sick and has to take time off work to recover, he loses income and a sense of connection, in turn creating rather than relieving stress, which in turn impacts his health.

    Baseline Variances

    The third truth is that baseline levels of health, abilities and thresholds for reaching a level of dysfunction vary by individual. The physical health threshold is easily recognized and acknowledged. For instance, an employer may make adjustments to match a worker’s physical capabilities or modify repetitive tasks.

    But mental and social health baseline measures are not as readily apparent. In most cases, workplace stress management strategies focus on the individual employee’s responsibility to improve his or her own resiliency and coping mechanisms rather than changing the circumstances that cause stress. Employees are told to get more and better-quality sleep, meditate or get regular exercise. The employee is left with little to no agency in requesting that accommodations be made.

    When we acknowledge these three truths, we can then work together to devise effective solutions for occupational burnout. As with other cumulative trauma syndromes, it is important for the employee to recognize his or her own abilities, baseline and threshold for dysfunction, and feel empowered to communicate this information to their employer without fear of retaliation or judgment

    This will likely require a cultural change in workplaces where a lack of mental and emotional resilience is seen as a character defect. With an understanding of individual capabilities, the employer can make adjustments to help the employee achieve physical, emotional and social health balance. For example, more employees may be hired to help relieve 24/7 expectations.

    An effective burnout prevention and treatment plan focuses on both responsibility and empowerment. Employees must feel free to speak up without fear of retaliation or shame in the workplace, while employers must be prepared to listen with compassion and without judgment.

    When efforts are made to keep the employee health triad in balance, then we will be much better equipped to take these necessary steps forward together.

  • Occupational Burnout – Part 1: Who (or What) is Responsible?

    Occupational Burnout – Part 1: Who (or What) is Responsible?

    his is the first part of a two-part blog post by WorkCare Associate Medical Director Brittany Busse, M.D.

    It’s no wonder job burnout is trending on social media and being discussed at occupational health and safety conferences.

    The World Health Organization (WHO) recently expanded on its definition of occupational burnout as a syndrome (not as a medical condition) in the International Classification of Diseases 11th Revision (ICD-11), the global gold standard for diagnostic information. In ICD-11, the WHO defines job burnout as:

    “A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

    It lists three related characteristics:

    • Feelings of energy depletion or exhaustion
    • Increased mental distance from one’s job, or feelings of negativism or cynicism toward one’s job
    • Reduced professional efficacy

    According to a WHO statement: “Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.” In an interesting related development, the organization reports it plans to embark on the development of evidence-based guidelines on mental well-being in the workplace.

    Underlying Causes

    The underlying causes of occupational burnout symptoms are not well-understood. However, many researchers believe burnout syndrome is related to chronically elevated levels of the adrenal hormone cortisol, which eventually leads to adrenal fatigue and insensitivity of body tissues to cortisol.

    Chronically elevated cortisol levels and cortisol insensitivity can lead to immune system and other body system dysfunctions that are associated with the development of conditions ranging from heart disease and stroke, to autoimmune disease and cancer. This suggests that occupational burnout is either a cause of disease or a disease in and of itself.

    According to the WHO, other mental health diseases – such as anxiety, depression, and other adjustment and mood disorders – must be ruled out before a diagnosis of burnout can be made, indicating that these other conditions arise organically and cannot necessarily be blamed on occupational stress.

    Cost of Burnout

    We know that the cost of occupational burnout is high. It is believed to be especially prevalent in certain types of professions, including health care and public safety (e.g., medical, police, fire, emergency response and military personnel).

    Among physicians alone, an estimated $4.6 billion in annual costs related to physician turnover and reduced clinical hours may be attributed to burnout in the U.S., according to a study published in Annals of Internal Medicine. Given the risk of occupational burnout among all types of professions, the costs to employers, employees and society, in general, may be incalculable.

    Who is Responsible?

    Considering that burnout is so costly in terms of financial loss, social consequences and personal well-being, it seems reasonable to ask the question: Whose responsibility is it is to manage an employee’s level of stress?

    I answer this question in Part 2 of this blog post. I base my response on the assertion that occupational burnout syndrome is a cumulative trauma injury, and that it is both the employer’s and the employee’s responsibility to work together to prevent and effectively manage burnout symptoms.

  • Do You Hear Marijuana Impairment Red Flags Flapping?

    Do You Hear Marijuana Impairment Red Flags Flapping?

    Some recently published articles have raised red flags for me – as they should for employers and fellow physicians who are Medical Review Officers (MROs) – with respect to state legalization of medical and recreational marijuana use.

    Colorado Emergency Cases

    One flag popped up when the Annals of Internal Medicine published a study based on a review of emergency visits at a Denver, Colo., hospital in which cannabis use was denoted on the medical record. As you likely know, Colorado voters approved use of medical marijuana in 2000, followed by recreational use in 2012 (effective in 2014).

    The study examined acute illness in connection with cannabis use between Jan. 1, 2012, and Dec. 21, 2016. Among 9,973 visits, 26 percent were at least partially attributed to cannabis use, with 9 percent of those cases involving edible varieties. Inhaled cannabis was associated with intractable vomiting in nearly 20 percent of the emergency visits studied. Conditions associated with edibles included acute psychiatric symptoms, intoxication and cardiovascular complaints.

    One patient presented in the emergency department with a cannabis-caused problem about every other day in 2012. By the end of the study period, there were two to three encounters a day. Lest you think that pot-seeking tourists caused the increase, nine out of 10 patients were Colorado residents.

    Canadian Findings

    The next flag up on the pole is a study from the Canadian Medical Association, which found that cannabis use by drivers increased the odds of having a traffic accident by almost 2.5 times when compared to non-users. The presence of cannabis was determined by measuring metabolite in blood, urine or saliva samples.

    Eleven case-control studies were reviewed. No studies that looked at workplace injuries with cannabis use were found by the reviewers, but they found that the increased odds of having a traffic accident while using cannabis can be indirectly applied to safety-sensitive work (as they have been in previous studies).

    …And in New York City

    A third flag was raised when the New York City Council adopted a precedent-setting municipal law banning pre-employment drug screening for marijuana.

    The legislation, Prohibition of drug testing for pre-employment hiring procedures, has been sent to Mayor Bill de Blasio for his expected signature. Once the law is enacted, employers who are hiring prospective employees to work in New York City will have one year to modify their testing policies before it goes into effect.

    Under the Compassionate Care Act, medical marijuana is legal in New York state for patients who are certified by medical practitioners as having serious conditions. The state has not legalized recreational use of marijuana.

    The NYC bill prohibits private and public employers, labor organizations, employment agencies and their agents from requiring a prospective employee to submit to testing for the presence of tetrahydrocannabinols (THC), the active ingredient in marijuana, as a condition of employment in the city. Exceptions are provided for safety- and security-sensitive jobs, and those tied to a federal or state contract or grant. For example, the law permits testing of law enforcement officers, commercial drivers, childcare providers, and anyone in a “position with the potential to significantly impact the health or safety of employees or members of the public,”

    As employers try to get their heads around this development in New York City, it may be helpful to understand that some policy-makers perceive pre-employment testing as discrimination against marijuana users.

    Test Doesn’t Show Impairment

    As I have noted in previous posts, a pre-employment test only tells the employer that the applicant used cannabis within the past month, not whether they are impaired. It is important to recognize that the purpose of workplace drug testing is to create a safe work environment, not to determine which employees use cannabis. While cannabis produces impairment, a drug test is not currently capable of identifying who is actually impaired at the time of the test, only that the individual has used cannabis previously.

    Determining impairment from cannabis requires observation of characteristic signs and behaviors by a medical provider, in addition to confirmation by drug testing. Saliva will indicate more recent use of cannabis (in terms of hours), whereas urine can indicate use from weeks to a month or more – not answering whether the individual is impaired. As voters, states and local governments become more tolerant of cannabis use, employers will continue to be faced with challenges when using drug testing in hiring decisions.

    Federal interpretations of marijuana as an illegal substance are not expected to be relaxed. Only the prescribed use of Marinol (dronabinol), an FDA-approved cannabinoid for the treatment of AIDS and cancer patients, is allowed. Meanwhile, employers are advised to continue to keep abreast of changes in the status of state and local laws permitting marijuana use, and obtain legal and medical recommendations on appropriate workplace drug testing policies.

    Dr.  Jacobs is Vice President/Clinical Lead, Medicals Exams & Travel, and an Associate Medical Director at WorkCare, Inc.

  • Safety Month Reminder: Ladder Use a Routine but Risky Job Function

    Safety Month Reminder: Ladder Use a Routine but Risky Job Function

    Posted by Jeffrey Jacobs, M.D., M.P.H.

    Superstition holds that walking under a ladder is bad luck.

    Falling from a ladder is far more than bad luck: It can result in real-life pain, suffering, disability and even death.

    Annual national estimates of ladder-related fatalities range from 100 to 300, while more than 500,000 Americans are treated for ladder-related injuries. The cost of injuries is at least $24 billion in work loss, medical care, legal liability, and pain and suffering, according to the U.S. Consumer Product Safety Commission.

    In 2017, March was declared National Ladder Safety Month to heighten awareness, reinforce training, and educate homeowners and workers about safe ladder use. The American Ladder Institute (ALI), a major supporter of Ladder Safety Month, provides related recommendations.

    Safe Ladder Use

    Before an employee uses a ladder, a fitness evaluation is recommended. This typically occurs during a post-offer or annual physical examination. An assessment may include weight, body mass index,  cardiac index or Framingham Cardiac Risk calculations, and/or human performance evaluations (e.g., ladder climbing ability, grip strength, step tests). Findings may be used to exclude individuals whose safety could be compromised while climbing due to health conditions such as cardiac disease, uncontrolled seizure disorders, neurological conditions that impact balance and coordination, and use of medication or illegal substances that impair function.

    In the workplace, ALI advises employers to identify potential worksite hazards. For example, overhead power sources present an electrocution risk. (Aluminum ladders have an electrical conduction property.) In addition, when choosing the type of ladder to use (e.g., step, extension, platform, step stool, extension or folding), the surface it will be placed on must be considered. Is it soft, hard, uneven or level terrain? Proper ladder length must also be addressed.

    Safety Tips
    How far up?

    An employee should never stand on the cap or next-highest rung of a stepladder because of balance issues. For extension ladders, the top three rungs should not be used.

    What about weight?

    Ladder duty ratings measure the upper limit weight capacity that a ladder can safely support. Capacity calculations include the user’s body weight and the weight of clothing and footwear, personal protective equipment, tools, and supplies being carried and/or stored on the ladder. It’s important  to remember that weight measurements taken during a post-offer physical may not include added items. The ladder duty rating is found on the side of the ladder and ranges from light duty (up to 200 pounds) to extremely heavy duty (up to 375 pounds).

    What does OSHA recommend?

    The Occupational Safety and Health Administration’s basic ladder safety training recommendations include:

    • Avoiding electrical hazards
    • Maintaining three points of contact while climbing  (two hands and a foot or two feet and a hand)
    • Never shaking, shifting or moving a ladder while someone is on it
    • Always securing the top or bottom of the ladder to prevent displacement on unstable or uneven surfaces
    • Setting up the ladder at the correct angle

    For more suggestions, refer to OSHA’s Quick Card on Portable Ladder Safety and the OSHA/National Institute for Occupational Safety and Health’s fall prevention and ladder safety smartphone app.

    Ladder climbing is often an essential job function. A thorough physical assessment, training and monitoring on safe use is essential to help prevent injuries and fatalities…and they may even ward off bad luck.

    Dr. Jacobs is Vice President/Clinical Lead of WorkCare’s Medical Exams & Travel division and an Associate Medical Director.

  • Change in Health Behaviors Depend on Timing

    Change in Health Behaviors Depend on Timing

    “And while the future’s there for anyone to change,

    Still you know it seems
    It would be easier sometimes to change the past”

    – Jackson Browne, Fountain of Sorrow

     

    Posted by Jeffrey Jacobs, M.D., M.P.H.

    If you read my previous blog post, you’ll know that I recently attended an ORCHSE conference that has provided me with plenty of food for thought.

    One session I attended reminded me of these lines from a song by Jackson Browne. What does his 1970’s-era, plaintive ballad about an imminent romantic break-up have to do with positive behavioral change?

    We all know that when we are trying to make health-oriented behavior changes for ourselves or encouraging them in work colleagues, friends and family members, it’s extremely hard to overcome the past. Health beliefs, behaviors and coping skills are hardwired in our brains. Even when we receive sound guidance for positive change that we should intuitively appreciate, we often don’t make constructive progress.

    At the ORCHSE meeting, Greg McGloughlin, CEO of HBD International, offered the “Secret Sauce” for successfully becoming more engaged in the process of making healthy behavior the norm.

    McLaughlin cited three important factors involved in driving behavior change:

    1. We should be aware that behavior change is a process that involves multiple stages before success can be achieved. According to the transtheoretical model of behavior change developed by Prochaska and DiClemente in the early ’80s, individuals must first be at a stage where they are ready to change.

    2. The message has to be delivered and received at the correct time in order to begin and successfully achieve behavioral change. A person in the precontemplative or contemplative phase simply isn’t ready to overcome the barriers necessary to succeed, no matter how well-crafted the health promotion message. However, once the individual is ready, McGloughlin recommends that the message be short and compelling. Experience and studies show that too much information can often overwhelm individuals and discourage them from trying.

    McGloughlin shared the following message as an example. The tag line, “Do you service your car more regularly than you service your health?” really resonated with me.

    For health educators and employers, he recommends introducing one or two core messages/educational strategies around a single health goal, such as quitting smoking, walking for exercise or improving nutrition. He advises against introducing five or six content areas with multiple related recommendations

    3. The message should be frequently repeated (at least monthly) in order for it to gain traction. Scientific literature shows that the percentage of the message that is remembered is highest immediately after it is received and drops precipitously (almost 90 percent forgotten) within seven weeks. With monthly sessions, the percentage of message remembered remains at 20 to 25 percent. Reinforcing the message/behavior incrementally increases and remains higher than messaging given every two months (50 percent remembered with monthly sessions vs. 25 percent with bi-monthly sessions).

    Even armed with this knowledge, changing health behavior still remains a tough row to hoe.

    However, health educators and employers may be more successful at encouraging positive change by timing the dissemination of simple-yet-memorable messages with a call to action at appropriate intervals and aiming them at employees who are in a stage where they likely to be receptive.

    From Jackson Browne’s perspective, putting these theories into practice may make it more feasible to change the future, but that’s in another one of his songs (Doctor My Eyes)!

    Jeffrey Jacobs, M.D., M.P.H., is Vice President (clinical lead), Medical Exams & Travel, and an Associate Medical Director at WorkCare.

    Acknowledgement: HBD International provided the graphs/illustrations for this blog.