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  • Recognizing Occupational Health Needs of Asian Americans, Native Hawaiians and Pacific Islanders

    Recognizing Occupational Health Needs of Asian Americans, Native Hawaiians and Pacific Islanders

    May is Asian American, Native Hawaiian and Pacific Islander (AAPI) Heritage Month – giving us a chance to recognize the cultural contributions and occupational health needs of employees who identify with one or more of these populations.

    The U.S. Bureau of Labor Statistics reports that the AAPI population’s employment ratio is higher than the national average across all racial-ethnic groups, largely because of favorable working-age demographics. The AAPI population comprises one of the nation’s fastest growing racial/ethnic groups, projected to represent 6.2 percent of the total U.S. population by 2025 and 8.9 percent by 2050.

    In the 2000 U.S Census:

    • 6 million people identified as AAPI
    • 1 million identified as Asian in combination with another race
    • 690,000 people identified as Native Hawaiian or Other Pacific Islander (NHPI)
    • Nearly 900,000 people identified as NHPI in combination with another race
    • 267,330 people identified as Asian and Hispanic and 67,948 people identified as NHPI and Hispanic

    Asian Americans

    The Asian American racial group is defined as people with origins in East Asia, Southeast Asia or the Indian subcontinent. The U.S. Department of Health and Human Services’ Office of Minority Health cites infrequent medical visits, language and cultural barriers, and lack of insurance coverage as health care access challenges for this population. Asian Americans are at risk for cancer, heart disease, stroke, diabetes and accidental injuries, and they have a higher prevalence of chronic obstructive pulmonary disease, hepatitis B, HIV/AIDS, tuberculosis, liver disease and smoking when compared to non-Hispanic white people.

    Native Hawaiians & Pacific Islanders

    NHPI populations comprise a racial group with origins in Hawaii, Guam, Samoa and other Pacific Islands. The Office of Minority Health reports that Native Hawaiian/Pacific Islanders have higher rates of smoking, alcohol consumption and obesity when compared to other populations. Leading health risks include cancer, heart disease and accidental injuries. Hepatitis B, HIV/AIDS and tuberculosis are also more prevalent in NHPI populations than they are in the white population.

    Experts say that understanding the physical and mental health needs of the AAPI demographic is important because of the vast heterogeneity of the group, cultural beliefs, and the emphasis frequently placed on connections between the mind and body.

    What Can Employers Do?

    Tweet This: Employers are encouraged to create targeted occupational health, safety and mental health interventions for AAPI adolescents and young adults entering the workforce and programs to meet the needs of all employees who identify with these racial and ethnic groups. Heritage Week is just one of many opportunities to honor racial and ethnic diversity by supporting cross-cultural engagement in the workplace.

    Here are some recommended resources:

    Contact us to learn about the ways WorkCare’s occupational health clinicians and subject matter experts can help your company protect and promote employee health.

  • COVID Public Health Emergency Ends…Now What?

    COVID Public Health Emergency Ends…Now What?

    The federal COVID-19 public health emergency declaration that was issued on Jan. 31, 2020, was lifted today, marking a transition to “sustainable public health practice.”

    The decision is based on declining rates of infection and collective measures that have been put into place to help prevent and manage the spread of disease, according to a Department of Health and Human Services fact sheet. Meanwhile, the World Health Organization (WHO) ended its Public Health Emergency of International Concern for COVID-19 on May 5. A WHO committee cited declines in hospitalizations and intensive care unit admissions and high levels of population immunity to SARS-CoV-2, the virus that causes COVID, as reasons for shifting to long-term pandemic management.

    What Happens Now?

    The U.S. Centers for Disease Control and Prevention (CDC) reports:

    • COVID vaccines will continue to be provided at no cost to adults and children.
    • Insurance providers will no longer be required to waive costs or provide free COVID-19 tests. (Refer to the CDC’s No-Cost COVID-19 Testing locator)
    • Medications such as Paxlovid to help prevent serious symptoms will remain available for free while supplies last. After that, the price consumers will pay and be reimbursed for medications will be determined by the manufacturer and health insurers.
    • The CDC and its partners will continue to monitor the impact of COVID and the effectiveness of prevention and control strategies. The way related data are collected and reported will change over time.

    WorkCare Recommendations

    While it’s understandable why everyone is breathing a sigh of relief, it’s advisable for employers to continue to maintain workplace infectious disease prevention programs and protocols, remain vigilant and be prepared to respond to any type of respiratory illness outbreak.

    We expect some WorkCare clients to have their human resource teams manage return-to-work after a COVID-related absence the same way they manage other kinds of illnesses, such as the flu. Employers who do not want to assume that responsibility may continue to use WorkCare for return-to-work evaluations via our secure WorkMatters portal or engage with our medical concierge service in special circumstances.

    “The end of the public health emergency is not an end to CDC recommendations,” WorkCare Associate Medical Director Isabel Pereira, D.O., M.P.H., reminds us. “A minimum five-day day isolation period with a positive COVID test and return to work with a high-quality mask through the 10-day mark (the full contagious period) is still recommended.”

    To help prevent COVID outbreaks, voluntarily wearing an N-95 or KN-95 mask as a precautionary measure, especially in crowded public places, is an option. Dr. Pereira recommends self-masking if ill and testing three-to-seven days from the start of symptoms. (The CDC recommends testing on day five or six.) As feasible, it’s advisable for employees to work from home at the start of symptoms, whether it’s influenza or COVID, because those are the most contagious days.

    WorkCare also recommend following CDC guidance for vaccination: Anyone over age 65 who has already been vaccinated and received a booster shot is advised to get a second booster if it has been more than four months since they received their first bivalent booster. Immunocompromised adults of any age are advised to get a second booster after two months.

    WorkCare physicians track public health developments, including the spread of animal-borne and human-borne viruses that could impact working populations. To learn more, contact us at info@workcare.com.

    Related Resources

    Did You Know?

    The U.S. Food and Drug Administration has approved use of a respiratory syncytial virus (RSV) vaccine for the prevention of this lower respiratory tract disease in people over age 60. Although RSV typically causes mild, cold-like symptoms, it can be deadly to the elderly, young children, and people with chronic heart or lung disease or weakened immune systems.

  • OSHA Launches Fall Protection National Emphasis Program

    OSHA Launches Fall Protection National Emphasis Program

    The Occupational Safety and Health Administration (OSHA) has launched a national emphasis program to help prevent falls, the leading cause of fatal workplace injuries.

    The program will focus on reducing falls among employees who work at heights in all industries. The targeted enforcement program is based on OSHA’s enforcement history and Bureau of Labor Statistics data that show 680 of 5,190 work-related fatalities reported in 2021 (13 percent) were associated with falls from heights.

    The new program features an educational component. It allows OSHA compliance officers to open inspections when they observe someone working unsafely at height and to leave the site after offering educational resources when they determine an inspection is not necessary.

    At construction sites, violations of fall protection standards are cited most often by OSHA. While the national emphasis program is for all industries, it was launched on May 1 in connection with the 10th Annual National Safety Stand-Down to Prevent Falls in Construction and the construction industry’s Safety Week (May 1-5).

    Falls are Costly

    The emotional and financial cost of lives lost due to preventable falls is incalculable, and related injuries are often serious. Fall survivors can suffer concussions, fractures, cuts and contusions, sprains, strains or tears that affect their quality of life and productivity.

    According to the National Safety Council’s Injury Facts, falls to a lower level are the third leading cause of workplace fatalities and the fifth leading cause of injuries resulting in days away from work. Factors considered by the NSC in relation to falls to a lower level include:

    • The incident involves impact between the worker and source of the fall
    • The injured person’s movement produced the injury
    • The motion of the person and the force of impact were generated by gravity

    In an analysis of 2020 data, the NSC found that injuries caused by falls to a lower level resulted in a median of 20 days away from work. Service-providing industries accounted for 64 percent of injuries due to falls to lower levels. By comparison, goods-producing industries accounted for 36 percent; trade, transportation and utilities 33 percent; and construction 22 percent.

    The 2022 Liberty Mutual Safety Index identifies falls to a lower level as the fourth leading cause of serious disabling workplace injuries – at an estimated cost of $5.07 billion a year for U.S. employers. (The top three causes were overexertion during material handling, falls on the same level and struck by an object or equipment.)

    Fall Prevention

    OSHA requires covered employers to have fall protection plans and provide training, personal protective equipment (PPE), and solutions such as safety nets or guardrails, as needed, to help prevent falls. Fall protection is required at elevations of 4 feet or higher in general industry workplaces, 5 feet in shipyards, 6 feet in the construction industry and 8 feet in longshoring operations. Fall protection also must be provided when working over dangerous equipment and machinery, regardless of the fall distance.

    In addition to concerns about working at height, it’s important to remember that it’s possible to fall from ground level to a lower level. Sometimes there are gaps in floors or holes in the ground that are big enough to stumble into. Potential fall hazards should be properly marked with protective barriers and warning signs. PPE must be appropriate for the job and the right fit for men and women. Consistent use and comfort is key. One slip without proper use of PPE can be fatal.

    Did You Know?

    WorkCare staffs and manages onsite clinics and emergency response teams in all industries. To learn more about the ways we support employee health from hire to retire, visit our Onsite Services & Clinics webpage and contact us at info@workcare.com.

  • Opioids Impact Labor Force Participation

    Opioids Impact Labor Force Participation

    We recently posted a blog about the U.S. Food and Drug Administration’s approval of over-the-counter Narcan nasal spray to reverse the effects of opioid overdose and save lives. We also published tips to streamline workplace drug testing to detect prescription and illicit drugs that can impair performance and increase accident and injury exposure risk.

    At WorkCare, we support employers in the addition of naloxone (Narcan) to onsite first aid kits for use by trained personnel and the delivery of cost-effective drug testing programs. We also do our part to help prevent opioid use disorder by providing care guidance at the onset of work-related injuries – before physical discomfort becomes a workers’ compensation claim involving medical treatment and prescription pain medication.

    In addition, our occupational physicians engage with local treating providers to facilitate safe return to work during recovery after an injury, while our occupational health nurses provide injury case management assistance and coordinate referrals to employee assistance programs that provide individual and family counseling services.

    Labor Force Impacts

    There is a growing body of evidence that employers should pay close attention to the impacts of opioid use in the workforce and solutions aimed at opioid abuse prevention and management. These impacts include fewer people who are qualified to work safely.

    In a recent blog post, Brookings cites statistics that indicate the national opioid epidemic measurably reduces U.S. labor force participation.

    “Opioid misuse can compromise labor supply in a variety of ways, including absenteeism, increased workplace accidents, and withdrawal from the labor force due to disability, incarceration or death,” the Brookings authors say. (The blog post was written by a team at the USC-Brookings Schaeffer Initiative for Health Policy, a partnership between Economic Studies at Brookings and the University of Southern California Schaeffer Center for Health Policy & Economics.)

    Evidence cited in by Brookings researchers includes:

    • Occupational injury statistics (2019 and 2021) that indicate U.S. industries with the highest rates of overdose fatalities also have higher than average injury rates for fractures and musculoskeletal disorders, which are risk factors for long-term opioid use.
    • A 2021 research paper that documents the negative effects of opioid use on long-term company growth and valuations. Firms located in counties with high opioid prescription rates were found to have lower employment and sales growth than companies located in regions with low prescription rates. Impacted companies invested more in information technology to compensate for labor force shortages than less-impacted companies.
    • A 2020 study published in the International Journal of Social Determinants of Health and Health Services that found an estimated 12.6 percent of the U.S. workforce, or about 21 million workers, received one or more outpatient opioid prescriptions per year, with private health insurance covering half of total medication costs.
    • A 2019 National Safety Council survey in which 75 percent of responding employers said their workplace was impacted by opioid use.
    • A 2018 report on occupational patterns of drug overdose deaths that ranked workers in the following industries as high risk for opioid-related mortality: construction; extraction; food preparation and serving; health care practitioners and technical health care support; and personal care and service.

    We’re Here to Help

    WorkCare offers 24/7 telehealth triage coverage, onsite clinical services, a nationwide drug testing network, and injury prevention and wellness programs to help employers sustain safe and healthy workplaces. Contact us to learn more.

  • Tips to Streamline Your Company’s Drug Screening Process

    Tips to Streamline Your Company’s Drug Screening Process

    WorkCare has a team dedicated to helping U.S. companies efficiently manage regulated drug and alcohol screening and non-regulated drug-free workplace programs. While drug screening seems like a routine function, it can be a complicated and time-consuming process for employers.

    WorkCare’s clients rely on us to ensure regulatory compliance. We provide timely urine, hair, blood, oral fluid or breath-alcohol testing, results reporting and documentation. Testing may be conducted as part of the hiring process, after an accident, for cause or reasonable suspicion, before returning to work after an absence, randomly or periodically.

    We schedule testing at convenient offsite specimen collection locations and perform screenings at some client worksites. This helps employers expedite hiring, minimize work disruptions and respond quickly in the event of an incident. WorkCare negotiates rates with certified laboratories and manages random testing pools to provide cost-effective solutions.

    Our drug and alcohol screening team is familiar with detectable illicit and prescription substances that can affect decision-making, alertness, mood and physical reaction times. WorkCare’s Medical Review Officers, who are listed on the Federal Motor Carrier Safety Administration’s National Registry of Certified Medical Examiners, are skilled at interviewing employees about their test results and making informed judgments about their fitness-for-duty.

    Streamlining the Process

    Here are some tips from the WorkCare team to help employers streamline the drug screening process while complying with federal and state regulations and best industry practices:

    • Understand the type of screenings that apply to your workforce and the circumstances under which testing will be performed.
    • Consult with experts when developing or updating your company’s drug and alcohol screening policy.
    • Inform job candidates and employees about the policy, including reasons for testing and consequences for violations.
    • Train supervisors on policy enforcement and how to evaluate and respond to behaviors that may indicate impairment by drugs or alcohol.
    • Provide reassurance that test results are confidential and that designated employer representatives are only informed about a positive, negative or non-negative result.
    • Be prepared to support employees who test positive for drugs, such as referral to an employee assistance program or community resource.
    • Use your drug testing program to demonstrate your commitment to workplace and community health and safety.

    WorkCare’s Medical Exams & Travel capabilities include a secure information technology platform and personalized service. Contact us to learn more about how we help companies streamline the drug screening process, save time and money, and allow human resources and environment, health and safety personnel to focus on other essential functions.

  • Having Naloxone Onsite to Reverse Overdoses Can Save Lives

    Having Naloxone Onsite to Reverse Overdoses Can Save Lives

    The U.S. Food and Drug Administration has approved Narcan 4 milligram (mg) naloxone hydrochloride nasal spray for over-the-counter (OTC) use, making it the first naloxone product to become available without a prescription.

    The manufacturer, Emergent BioSolutions, expects OTC NARCAN® Nasal Spray to become available in U.S. retail stores and online by late summer.  The manufacturer determines the timeline for availability and price per dose. While many insurers cover some or all of the cost of prescription Narcan, OTC medications typically are not covered by insurance.

    Saving Lives

    Naloxone can be given to any adult who shows signs of an opioid overdose. Prescription Narcan is administered with a nasal spray or injected into the muscle, under the skin or into the veins. Naloxone restores normal breathing to a person who has overdosed, but it has no effect on someone who does not have opioids in their system.

    Signs of overdose include:

    • Unconsciousness
    • Tiny pupils
    • Slow or shallow breathing
    • Vomiting
    • Inability to speak
    • Faint heartbeat
    • Limp arms and legs
    • Pale skin, purple lips and fingers

    Naloxone saves lives by rapidly reversing and blocking the effects of heroin, fentanyl and opioids in certain prescription medications. When it is administered by non-medical personnel, it is essential to immediately call emergency responders. Its effect wanes within 30 to 90 minutes.

    The FDA’s approval of OTC Narcan supports nationwide efforts to prevent overdose deaths. The opioid epidemic is an urgent public health concern. In the U.S., more than 101,750 fatal overdoses were reported in the 12-month period ending October 2022, with the majority of deaths linked to synthetic opioids such as illicit fentanyl. By comparison, about 50,000 people died from an opioid-involved overdoses in 2019.

    The number of lives saved is more difficult to quantify, partly because the social stigma associated with drug use makes people reluctant to report incidents. A National Institute on Drug Abuse policy brief refers to a statistical model that suggests high rates of naloxone distribution among first responders and in the general public could prevent 21 percent of opioid overdose deaths. The brief also cites studies that show overdose deaths decreased by 14 percent in states that have enacted naloxone access laws. In Tennessee, the state Department of Mental Health & Substance Abuse Services documented at least 60,000 lives saved after Regional Overdose Prevention Specialists distributed more than 450,000 units of naloxone from October 2017 to March 2023.

    Recommendations

    In its employer toolkit on overdose prevention, the National Safety Council advises employers to follow this checklist before making naloxone available onsite:

    • Assess workplace readiness for having naloxone in the workplace
    • Ensure all legal and liability concerns are addressed
    • Establish policies and procedures for responding to potential overdose scenarios
    • Provide training on how to respond to an opioid overdose with naloxone

    The Substance Abuse and Mental Health Administration’s (SAMHSA) Opioid Overdose Prevention Toolkit is also a helpful resource.

    WorkCare’s Response

    The workplace clinics staffed and operated by WorkCare stock naloxone (either nasal spray or pre-filled syringes/autoinjectors for intramuscular administration) in their emergency response kits. Standing orders support Narcan administration by trained onsite personnel within their scope of practice, explains Patrick O’Callahan, M.D., M.P.H., WorkCare’s vice president of onsite clinical operations.

    WorkCare’s consulting medical directors advise client companies that do not have onsite clinics to incorporate training for Narcan nasal spray administration into the CPR, AED and first aid training curriculum for both non-medical (lay people) and medical emergency responders. Narcan can be added to emergency response kits once responders are trained.

    Dr. O’Callahan doesn’t expect WorkCare’s recommendations for businesses to change significantly in response to the FDA’s approval of OTC Narcan. “Ideally, businesses should have a trained first response team whose members are certified in CPR, AED use and first aid measures, including Narcan administration,” he said. “There should be an appropriate number of first responders to cover all shifts. In situations where Narcan administration is indicated, it’s likely that ventilatory support and/or cardiopulmonary resuscitation will also be required. We will have best outcomes if lay responders have appropriate training and equipment.”

    All states have naloxone access laws, and most states have expanded Good Samaritan protections to cover lay people who administer naloxone when they respond to a suspected opioid overdose.

    Visit WorkCare’s Onsite Services & Clinics for more information.

  • Be Prepared to Respond to Bites and Stings

    Be Prepared to Respond to Bites and Stings

    It’s the first day of spring, ushering in the promise of renewal along with a period of increased insect activity as soil warms and thaws, larvae hatch and flowers bloom to attract pollinators.

    Insect bites and stings are a relatively common occurrence in many occupations. Reactions to bites and stings are usually mild and can be self-managed with first aid, but in some situations they can be serious or potentially deadly.

    This year America’s Poison Centers marks National Poison Prevention Week on March 19-23. The centers, a consortium of 55 organizations, operates a helpline (1-800-222-1222) for people who have questions about exposures including bites and stings, accidental medication overdoses, and drinking, inhaling or touching toxic substances.

     

    WorkCare Recommendations

    WorkCare’s Nursing Guidelines for 2023 include emergency response and first-aid instructions for bites and stings from bees, wasps, hornets, yellow jackets, spiders, scorpions, fire ants, mosquitoes, lice, ticks, fleas and other insects. According to the guidelines, reactions can range from mild local itchiness or pain to severe life-threatening systemic reactions.

    Patients with a known history of systemic reactions who are stung around the mouth or throat, or who have been stung multiple times, have a higher risk for severe reactions and should be carefully evaluated by a medical professional. Systemic reactions occur when inflammation caused by toxins, allergies or infection spread from a localized area, such as the skin, to other organs in the body.

    Anaphylaxis is an acute, potentially fatal reaction to an allergen. In addition to bites and stings, triggers for anaphylaxis may include certain foods (such as nuts or shellfish), medications or substances. Anaphylactic shock is a state of extremely low blood pressure (hypotension) and rapid heart rate (tachycardia) that requires an immediate emergency response.

    Signs and Symptoms

    Signs and symptoms of local bite or sting reactions include:

    • Itchiness
    • Redness
    • Pain
    • Swelling
    • Burning, numbness or tingling

    Systemic bite or sting reactions include

    • Hives
    • Abdominal pain, nausea, vomiting, diarrhea
    • Shortness of breath, wheezing or high-pitched whistling sound
    • Generalized swelling, or swelling of the face or throat
    • Chest pain, tachycardia, hypotension, low blood pressure
    • Dizziness, altered consciousness, fainting

    For emergency systemic reactions, after calling 911 or onsite emergency responders, a qualified person may administer CPR, an EpiPen® (or equivalent) and/or Benadryl® (diphenhydramine), as clinically indicated. In non-emergency situations, the following steps are recommended:

    1. Assess heart rate and blood
    2. Check airway and
    3. Inspect bite or sting
    4. Check for systemic reactions (e.g., hives, swelling, wheezing).
    5. Remove rings or constricting items because swelling may
    6. Scape to remove an embedded stinger; do not squeeze the stinger with an
    7. Cleanse the bite or sting area with soap and

    At WorkCare, we staff onsite clinics and have occupational nurses and physicians available 24/7 to provide telehealth triage. (Refer to our Onsite Services & Clinics and Incident Intervention service lines.) While remaining at work, employees whose employers are clients of our Incident Intervention program and those with WorkCare onsite clinical personnel can get advice on the use of ice and elevation of the affected area and over-the-counter topical antibiotic ointment or hydrocortisone cream, analgesics to reduce pain and inflammation and antihistamines for itchiness.

    It is recommended to re-evaluate all insect bites and stings after 24 hours.

    Prevention

    WorkCare clinicians advise employers to reinforce prevention strategies such as using insect repellant containing DEET; keeping exposed skin covered; not provoking insects whenever possible; avoiding wearing perfumes or brightly colored clothing; and not eating outdoors when insects are active. Individuals with known systemic insect allergies should be encouraged to carry an EpiPen, as prescribed by their primary care provider, and wear a Medic Alert-type bracelet or neck chain.

  • The Right Fit: The Importance of Proper Fitting in Women’s PPE

    The Right Fit: The Importance of Proper Fitting in Women’s PPE

    Today is International Women’s Day with the theme “Embrace Equity,” prompting us to observe that women’s personal protection needs are similar to but not exactly the same as they are for men in certain work environments.

    In the U.S., employers who are subject to Occupational Safety and Health Administration (OSHA) regulations are required to ensure all workers have properly fitted personal protective equipment (PPE) and that protective outer wear and clothing (PPC) is not damaged or worn out. While many vendors offer equipment and clothing designed to fit all body types, experience shows that female employees are still more likely than male employees to have improperly fitted PPE. This is of particular concern in hazardous occupations in which men tend to outnumber women in the workforce.

     

    Getting the Right Fit

    OSHA advises employees to test employer-provided PPE for proper fit and check PPE and PPC for wear. It’s a best practice for employers to offer employees a range of choices and access to suppliers who carry equipment, outer wear and other clothing to fit all body types.

    Optimally, PPE should be fitted based on anthropometric data, according to OSHA. Core elements of anthropometry are height, weight, head circumference, body mass index, body circumferences (waist, hip and limbs) and skinfold thickness. In adults, body measurements are typically used to help assess overall health, nutritional status and disease risk, and in some cases to diagnose obesity.

    According to the International Journal of Environmental Research, personal safety improves when anthropometric measurements are used in the production of clothing, gloves, footwear, and head, eye and face protection devices. These measurements also help ensure user comfort and consistency. In addition, anthropometric data may be used to inform the design of ergonomic workplaces, machines and tools while accounting for the use of PPE. Dimensional allowances for PPE may be further refined using 3D scanning methods.

     

    Reproductive Health

    In some workplaces, both men and women require personal protection due to exposure hazards that could affect their reproductive health. Additional layers of protection, or even a temporary job change, may be needed when a woman is planning to get pregnant or is pregnant.

    A pregnant woman who wears PPE and/or PPC may find it no longer fits correctly. Similarly, a woman’s shifting center of gravity may affect her balance and increase her risk of injury. Temporary adjustments may need to be made for pregnant women who do jobs that involve exposure to toxic substances, prolonged standing, excessive physical exertion or working in extreme temperatures.

    Pregnant employees can be encouraged to:

    • Consistently wear properly fitted PPE and PPC
    • Avoid bringing potentially contaminated PPE home
    • Review exposure risk information with their physician
    • Frequently wash their hands while working

    WorkCare’s occupational health clinicians provide guidance on ways to reduce exposure hazards and help employers protect and promote employee health in the workplace. Contact us for more information on how to safeguard the health and well-being of your employees in the workplace.

  • Pain Scale Tells Just Part of the Story

    Pain Scale Tells Just Part of the Story

    A pain scale is often used to help assess pain severity associated with an injury, disease or surgical procedure. You may wonder which scale is best to use when evaluating an employee’s response to a work-related injury, including non-specific muscle or joint pain.

    There are many types of pain scales. Commonly used scales include numerical, face, visual analog and verbal. There are also more comprehensive pain-scoring methods.

    At WorkCare, where our Incident Intervention clinicians evaluate thousands of non-emergency work-related injuries a year, we know that the way physical discomfort is evaluated and managed at onset can make a significant difference in the outcome. Each employee’s initial pain experience is shaped by a myriad of biomedical, psychosocial (e.g., belief system, expectations, mood) and behavioral factors.

    For example, two similar employees with the same job and similar injuries may have notably different perceptions of pain. In this scenario, assume each employee receives the same information from a WorkCare occupational clinician about the nature of their injury and expectations for recovery. These two employees may either choose clinician-guided self-care/first aid and remain at work or elect to be referred to an offsite clinic for follow-up. An employee who perceives pain as temporary and manageable is more likely to remain at work while recovering than an employee who reports intense pain and fears that working could make the injury and pain worse.

    When an injury does not quickly resolve and transitions from acute, to sub-acute, to chronic, related pain becomes particularly difficult to resolve. Chronic pain syndrome has been described as “a constellation of related symptoms and conditions that usually do not respond to the medical model of care,” and complex regional pain syndrome, which involves prolonged pain and inflammation following injury to an arm or leg, as a “biopsychosocial challenge.”

    Asking Questions

    Context is needed for an evaluating clinician to get a clear sense of an employee’s pain. In some cases, a clinician might ask an injured employee to remember the worst pain he or she has ever experienced in comparison with their current pain. The provider can then use that information to assess the effectiveness of interventions and pace of recovery.

    When a WorkCare occupational clinician asks an injured employee to rate their degree of pain on a scale of 0-10 during an Incident Intervention telehealth triage call, they may ask other questions, as well, because they know pain is a subjective experience. For instance:

    • Have you had pain other than everyday kind of pain during the past three days?
    • How does the pain you have now affect you physically and mentally?
    • Has the pain made you change your activity level?

    In addition, when an injured employee remains at work in a full or modified duty capacity during recovery, a WorkCare nurse will check in and see how they are feeling, whether their pain has decreased, stayed the same or gotten worse, and assess any other physical or psychological aspects of their pain that may be affecting their work.

    Types of Pain Scales

    Pain scales are often categorized as numerical, visual analog or categorical. A numerical rating scale is commonly used to assess physical pain on a continuum of 0-10, 11-item (counting 0) scale, with 0 no pain and 10 severe pain. Some scales, such as the widely used Wong-Baker FACES® Pain Rating Scale, features numbers as well as faces with expressions and descriptions so children and adults can choose the face that best illustrates their pain:

    A visual analog scale (VAS) is a horizontal or vertical line anchored by two verbal descriptors: “no pain” (score of 0) and “worst pain possible.” The VAS is used to measure a characteristic or attitude that is believed to range across a continuum of values that cannot easily be directly measured. A color analog scale uses a gradual transition from green to yellow to red to represent a continuous pain spectrum rather than a specific number or description.

    Another method, the Brief Pain Inventory (BPI), is a short form developed to measure pain intensity and the extent to which pain interferes with life activities. The BPI asks respondents to rate their current pain intensity, pain experienced in the last 24 hours and the degree to which pain interferes with seven domains of functioning: general activity, mood, walking ability, normal work (outside the home and housework), relations with other people, sleep and enjoyment of life (0 =does not interfere and 10 = interferes completely.)

    The McGill Pain Questionnaire uses another approach. It consists primarily of three major classes of word descriptors – sensory, affective and evaluative – that are used by respondents to specify subjective pain experience. It also contains an intensity scale and other items to determine the properties of pain experience. This questionnaire is designed to provide quantitative measures of clinical pain that can be treated statistically.

    Whatever type of scale is used, clinical interpretation is required. In situations in which a pain scale is used, a clinician trained in occupational medicine can provide useful insights at the onset of a work-related injury and through the recovery process.

  • More Employees Back in the Office Than You Think

    More Employees Back in the Office Than You Think

    It’s time to pay closer attention to the occupational health and safety needs of office employees who worked remotely during the COVID-19 pandemic. While remote and hybrid work schedules will continue to be popular alternatives, attitudes about returning to the office are shifting.

    Last week, Amazon’s CEO Andy Jassy announced the company will require office employees to be at work in person at least three days a week starting May 1 to make collaborating and learning from each other easier. The move by Amazon follows work-from-office announcements from other major tech employers, and it is expected to have strong ripple effects in other industries.

    In a blog post, Jassy said he’s “optimistic that this shift will provide a boost for the thousands of businesses located around our urban headquarter locations in the Puget Sound, Virginia, Nashville, and the dozens of cities around the world where our employees go to the office.”

    Kastle, a property technology and managed security company, monitors workplaces in more than 2,600 buildings in 138 U.S. cities. According to its Back-to-Work Barometer, post-pandemic office building occupancy is gradually increasing. It reached an average of 48.6 percent in 10 major U.S. cities during the week ending Feb. 8; Tuesday was the most heavily occupied day of the week and Friday, not surprisingly, was the lowest.

    In New York, the Partnership for New York City conducted a Return-to-Office survey of 140 major Manhattan office employers and found that:

    • 52 percent of Manhattan office workers are now at their workplace on an average weekday, up from 49 percent in September 2022
    • The share of fully remote workers dropped from 16 percent in September 2022 to 10 percent in January 2023
    • 82 percent of respondents said a hybrid office will be their predominant staffing model this year
    • 59 percent of full-time employees with hybrid schedules will work in the office at least three days a week

    In a Resume Builder survey of 1,000 business leaders, 90 percent of respondents said employees will be required to return to the office at least part of the week this year; a fifth said they will fire workers who do not return. In that survey, 66 percent of employers said employees are already required to be in the office.

    Meanwhile, researchers from Ladders, Inc., a career site for professionals, report that remote job opportunities represented about 15 percent of all $100,000-plus a year job listings in the third quarter of 2022, indicating that the majority of senior leaders are expected to be in the workplace at least part of the time.

     

    Understanding Vulnerabilities

    Other surveys have found that remote employees would be more willing to return to the office with the assurance that their health, safety and well-being will be protected. This is true in other types of workplaces, as well.

    In addition to health-related concerns, there are many other reasons why some office workers want to continue to work from home – flexibility, saving time and money by not having to commute, childcare or eldercare demands, and fewer distractions – to name a few. At the same time, many people crave human connection at a time when there is increasing dependence on technology for communication.

    In its spring 2022 survey of 20,000 people in 11 countries, Microsoft analyzed trillions of Microsoft 365 productivity signals, along with LinkedIn labor trends and Glint People Science findings to uncover workplace trends: 85 percent of responding employees said they would be more motivated to return to the office if they knew they would be socializing with co-workers and rebuilding team bonds.

    During the pandemic, managers had to re-evaluate ways to assess office worker productivity. The Microsoft survey contradicts an assumption made by some that remote employees are inclined to be less productive than those who come to the workplace. Microsoft found:

    • The number of meetings held per week has increased 153 percent for the average Microsoft Teams since 2020
    • Overlapping meetings increased by 46 percent per employee in 2022
    • Declines and tentative RSVPs has increased by 84 percent and 216 percent, respectively.
    • 42 percent of employees send emails or pings during online meetings

    In addition, 48 percent of employees and 53 percent of managers reported that they’re burned out. (Occupational burnout has been shown to be a contributing factor for productivity decline, exhaustion, depression, anxiety and other physical and mental health concerns.)

    Whether employees are in remote, hybrid or in-office settings, their employers face the challenge of preventing and managing work-related physical discomfort associated with prolonged sitting and screen time, as well as mental health disorders associated with stress, burnout, lack of human connection and “brain drain.”

    WorkCare has a solution. Our Industrial Athlete Program features onsite and virtual office consultations provided by industrial injury prevention specialists with training in ergonomics (people, workstations and tasks), sports medicine, wellness and safety. They coach office employees on best work practices and managers on ways to help employees be comfortable and productive.

    Contact us to learn more.