Understanding pain and pain management in the construction workforce is critical due to the physically demanding nature of their work. This study aimed to describe pain and quality of life among construction workers, characterize the methods they use for pain relief, identify usage patterns of those methods; and to examine associated factors. Researchers conducted a cross-sectional survey of active construction workers (n=551) in four U.S. states from April to December 2023. The survey assessed pain severity and interference, self-reported health, pain-relief methods used and perceived effectiveness, and demographic and work characteristics. The results found some most commonly used pain‑relief methods (e.g., exercise and nutritional supplements) were less likely to be rated as "Very Helpful," while less frequently used options (e.g., nerve blocks) received higher proportions of "Very Helpful" ratings. Latent class analysis identified four usage groups: conservative, self-managed, alternative-integrative, and all-option treatment users. Multivariable ordinal logistic regression models found that pain interference, race/ethnicity, employment status, and use of cigarettes, alcohol, and opioids were associated with group membership. These factors, with the observed mismatch between methods used and perceived helpfulness, suggest the need for accessible, culturally responsive pain management approaches tailored to this workforce's unique needs. PERSPECTIVE: This study investigates pain severity, pain interference, relief methods, and self-reported health among construction workers. It identifies four distinct user groups and associated factors, highlighting the complex pain management patterns in this workforce. The findings underscore the need for tailored pain-relief approaches that address their unique challenges.

Introduction:While organizations leading community initiatives play a crucial role in tackling public health challenges, their difficulties in designing rigorous evaluations often undermine the strength of their proposals and diminish their chances of securing funding. We developed a matching service funded by the Robert Wood Johnson Foundation's Evidence for Action program to bridge these gaps. This service identified matched applicants involved in community-engaged research with evaluation experts to provide complementary expertise, strengthen evaluation capacity, and enhance participants' ability to secure funding. Methods:We conducted a mixed-methods evaluation of the pilot phase of the Accelerating Collaborations for Evaluation Matching Service from August 2018 to February 2021. Data sources included program records, participant surveys administered at 3-, 6-, and 12-months post-match, and semi-structured interviews conducted at 12-18 months post-match. We assessed outcomes such as match success, resubmissions, funding rates, and participant satisfaction. Results:Over the 2.5-year pilot period, the matching service successfully matched 20 of 24 referred applicants. Among these, 50% submitted revised proposals, and a third of secured funding. Survey results indicated widespread satisfaction with the partnerships. One-year interviews highlighted complementary expertise, bidirectional learning, and capacity-building as key benefits of these partnerships. Conclusion:This pilot demonstrated the feasibility, acceptability, and impact of the matching service in creating rewarding collaborations for community-engaged researchers. Beyond funding outcomes, participants uniformly valued the partnerships and described them as mutually satisfying. This model offers a scalable approach to creating research partnerships to build capacity for the evaluation of community initiatives.

Background: Burnout among healthcare workers (HCWs) threatens workforce stability and patient care, particularly in rural hospitals where staff shortages, limited resources, and professional isolation amplify stress. Peer support interventions have demonstrated promise in urban centers, but their feasibility and impact in rural settings remain underexplored. Methods: We implemented and evaluated the Johns Hopkins RISE (Resilience in Stressful Events) peer support program across two rural hospital systems in the Mid-Atlantic United States. Using pre- and post-implementation surveys, we assessed anxiety (GAD-7), burnout (Maslach Burnout Inventory), resilience (CD-RISC), and perceptions of organizational culture of well-being. Linear and logistic regression models adjusted for age, site, and employment duration were used to evaluate outcomes over time. Results: A total of 868 respondents participated across three time points. Burnout and anxiety declined modestly post-implementation, while resilience improved initially but was not sustained at 2-year follow-up. Older employees demonstrated lower anxiety and burnout, while mid-career employees (3-10 years of employment) reported significantly higher distress. Importantly, access to peer support and perceived availability of supportive resources improved significantly over time, reflecting growing program integration. Conclusions: RISE was adapted successfully in rural hospital settings, with evidence of reduced burnout, lower anxiety, and increased perceived access to peer support. While resilience gains were not sustained, results suggest that a peer support program tailored to each organization can mitigate workforce distress in rural health systems. Addressing implementation and contextual barriers and sustaining organizational commitment are important for long-term impact. Expanding peer support to rural hospitals may improve workforce retention and care delivery in underserved communities.

Introduction: COVID-19 has amplified existing challenges to healthcare in rural areas, including a lack of access to care, increased staff turnover, and poor staff morale. Although there was increased awareness about healthcare workers’ stress and burnout during the COVID-19 pandemic, most of the support interventions tended to be in urban healthcare centers. Given the unique challenges rural healthcare workers face, we sought to systematically identify the types of interventions specifically designed and utilized to support the well-being of healthcare workers practicing in rural settings. Methods: We conducted a comprehensive search of the literature through electronic databases (Medline, Embase, PsycINFO, Web of Science, CINAHL, Emerald, SCOPUS databases, Google Scholar, ProQuest Dissertations and Theses Global, American Doctoral Dissertations, Open Access Theses and Dissertations) to identify quantitative, qualitative, and mixed methods studies describing supportive interventions for rural healthcare workers with well-being-related outcomes. We used the Effective Public Health Practice Project (EPHPP), Mixed Methods Assessment Tool (MMAT) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist to evaluate the study quality. Results: Out of 1583 identified records, 25 studies were included in the analysis. The studies described a wide range of supportive interventions and outcomes. The overall quality of the studies was weak to moderate. None of the studies were randomized, and only six included controls. The included interventions had high acceptance by rural healthcare workers. Quantitative and qualitative themes identified shared decision-making, effective supervision, and proactive cultural change as the most fruitful interventions. Financial interventions alone were not effective. Most of the studies were either unfunded or were funded internally by the institutions. Conclusions: Support interventions for healthcare workers, especially second-victim support programs, are underutilized in rural settings.

With health equity growing as a priority within health care, health systems must transform that calling into action within their social, economic, and political environments. The current literature has not compared how different organizations manage the same health disparities intervention. This qualitative study aims to illustrate how different organizations navigated the implementation and sustainability of a hypertension disparities intervention by comparing experiences across Federally Qualified Health Centers (FQHCs), a private health system, and other non-clinical partnering organizations. As a study within a randomized controlled trial designed to reduce disparities in hypertension care, we conducted interviews with health care leaders before and after participation in the trial’s multi-level intervention. Before participation, we interviewed five health care leaders representing five health systems. Following the intervention, we interviewed 14 leaders representing the five health systems and two partnering organizations. Discussions focused on intervention implementation and plans for sustainability. The primary considerations in implementation were appropriate staffing and multi-level organizational buy-in. When discussing long-term planning, health systems prioritized the structure of a stepped-care protocol incorporating community health workers (CHWs) and case managers. The sustainability of the CHW intervention at FQHCs was dependent on funding, whereas a private, non-FQHC physician practice network focused on expanding current resources for more patients. These findings serve as anticipatory guidance for organizations aiming to reduce hypertension disparities and provide support for policies that financially assist these interventions. Further investigation is warranted on the organizational factors that may influence the degree of success in eliminating health care disparities.

AbstractPurposeTo explore the personal and work‐related stressors of healthcare workers in Puerto Rico and the organizational support they received during the pandemic.Design and MethodsWe used a qualitative descriptive design and from April – November, 2021, conducted semi‐structured individual interviews with Puerto Rican frontline healthcare workers (n = 12) and supervisors (n = 5).FindingsThematic analysis revealed five major themes: (a) Organizations' response to COVID‐19; (b) increased complexity of patients; (c) intensified work and psychological demand for nurses; (d) overwhelmed and overworked; and (e) recommendations for healthcare leadership. Participants explained that their organizations' responses to COVID‐19 were insufficient for meeting the demands and acuity of the patients. Closure of outpatient services contributed to people presenting to hospitals with exacerbated chronic conditions – especially the elderly. With COVID‐19 precautions prohibiting family visitation, nurses became responsible for total care, including emotional support of patients. In addition, the shortage of staff contributed to nurses assuming greater workloads, feeling overwhelmed and overworked, and healthcare worker resignations. Given their experiences, healthcare workers recommended that healthcare leadership show more appreciation for staff, demonstrate empathy, include frontline workers in decision‐making, and provide mental health resources for staff.ConclusionsThis study with Puerto Rican frontline workers and supervisors uncovers the multiple stressors experienced during the COVID‐19 pandemic. Our findings underscore the need for prioritizing the well‐being of healthcare workers, preparing healthcare leadership on how to support staff, and mandating nurse‐to‐patient ratios.Clinical RelevanceHealthcare workers explained the barriers they experienced for providing quality care to their patients. They also presented recommendations for healthcare leadership to facilitate supporting frontline workers, which ultimately contributes to optimal patient care.

ABSTRACT This mixed-methods study aims to understand what the perceptions of leaders and healthcare professionals are regarding causes of disparities, cultural competence, and motivation before launching a disparity reduction project in hypertension care, contrasting perceptions in Federally Qualified Health Centers (FQHCs), and in a non-FQHC system. We interviewed leaders of six participating primary care systems and surveyed providers and staff. FQHC respondents reported more positive cultural competence attitudes and behavior, higher motivation to implement the project, and less concern about barriers to caring for disadvantaged patients than those in the non-FQHC practices; however, egalitarian beliefs were similar among all. Qualitative analysis suggested that the organizational missions of the FQHCs reflect their critical role in serving vulnerable populations. All system leaders were aware of the challenges of provider care to underserved groups, but comprehensive initiatives to address social determinants of health and improve cultural competence were still needed in both system types. The study provides insights into the perceptions and motivations of primary care organizational leaders and providers who are interested in improving chronic care. It also offers an example for care disparity programs to understand commitment and values of the participants for tailoring interventions and setting baseline for progress.

Today's healthcare system and the people it serves face an urgent need for researchers and healthcare providers to address widespread inequitable care. Despite state and national policy initiatives seeking to improve population health and reduce health disparities, and despite the presence of a burgeoning evidence base of effective clinical and community-based approaches to reduce disparities, interventions have not been widely translated into real-world practices and communities. The observed gaps between evidence and practice, and among different racial, ethnic, and rural/urban populations, is in some part due to failure to implement known evidence effectively, consistently, and appropriately. Dissemination and translation initiatives to promote health equity are critical to efforts to reduce healthcare disparities. This chapter provides an overview of implementation science approaches and frameworks and describes their utility for healthcare equity research, using as an example the Reducing Disparities and Controlling Hypertension in Primary Care Project (ReD CHiP), a pragmatic trial funded by the National Heart, Lung, and Blood Institute. It then offers important lessons and “best practices” in healthcare disparities implementation science. A following section discusses challenges and opportunities of using implementation science in healthcare disparities research, notably in stakeholder engagement; in accounting for contextual differences in implementation settings; and in intervention design and implementation. The chapter closes with a discussion of future research areas. By incorporating implementation science methods and approaches, researchers and healthcare providers may improve the effectiveness of dissemination and translation initiatives, spreading and enhancing sustainment of evidence-based approaches to reduce healthcare disparities. These efforts may ultimately accelerate the realization of equitable healthcare for all.

Patient and family engagement (PFE) is critical for patient safety. We systematically reviewed types of PFE strategies implemented and their impact on medication safety.

Purpose - The purpose of this paper is to provide a practical framework that health care organizations could use to decrease preventable healthcare-acquired harms.Design/methodology/approach - An existing theory of how hospitals succeeded in reducing rates of central line-associated bloodstream infections was refined, drawing from the literature and experiences in facilitating improvement efforts in thousands of hospitals in and outside the USA.Findings - The following common interventions were implemented by hospitals able to reduce and sustain low infection rates. Hospital and intensive care unit (ICU)leaders demonstrated and vocalized their commitment to the goal of zero preventable harm. Also, leaders created an enabling infrastructure in the way of a coordinating team to support the improvement work to prevent infections. The team of hospital quality improvement and infection prevention staff provided project management, analytics, improvement science support, and expertise on evidence-based infection prevention practices. A third intervention assembled Comprehensive Unit-based Safety Program teams in ICUs to foster local ownership of the improvement work. The coordinating team also linked unit-based safety teams in and across hospital organizations to form clinical communities to share information and disseminate effective solutions.Practical implications - This framework is a feasible approach to drive local efforts to reduce bloodstream infections and other preventable healthcare-acquired harms.Originality/value - Implementing this framework could decrease the significant morbidity, mortality, and costs associated with preventable harms.

Objectives: Fungi belonging to the Metarhizium anisopliae complex comprise ubiquitous arthropod pathogenic moulds used as mycopesticides. Rare cases of human infections due to M. anisopliae have been reported. We hypothesize misidentifications of fungal strains implicated in these cases or used in mycopesticides. Methods: A review of the literature was conducted to identify previously published cases. We collected some of these previous described strains and reported new cases, and a French mycopesticide containing M. anisopliae. All identifications were performed based on elongation factor-1 alpha gene sequencing. Results: We report eight new cases of Metarhizium infection in humans (three from France and five from Australia). The strains isolated from these cases, and three others from already published cases and reported as M. anisopliae, were molecularly identified based on elongation factor-1 alpha (Ef1-alpha) gene sequencing as follows: Metarhizium robertsii (six), Metarhizium guizhouense (three), Metarhizium brunneum (one) and Metarhizium pingshaense (one). Conclusions: In this study, we report new human cases of Metarhizium infections, and, based on Ef-1 alpha gene sequencing, we demonstrate the misidentification of species in case reports. We also correct the species identification of a strain reported as M. anisopliae used in a commercially available mycopesticide. According to our results, none of the strains from the human infection reports reviewed belongs to the species M. anisopliae. Crown Copyright (C) 2017 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.

A national collaborative helped many hospitals dramatically reduce central line–associated bloodstream infections (CLABSIs), but some hospitals struggled to reduce infection rates. This article describes the development of a peer-to-peer assessment process (CLABSI Conversations) and the practical, actionable practices we discovered that helped intensive care unit teams achieve a CLABSI rate of less than 1 infection per 1000 catheter-days for at least 1 year. CLABSI Conversations was designed as a learning-oriented process, in which a team of peers visited hospitals to surface barriers to infection prevention and to share best practices and insights from successful intensive care units. Common practices led to 10 recommendations: executive and board leaders communicate the goal of zero CLABSI throughout the hospital; senior and unit-level leaders hold themselves accountable for CLABSI rates; unit physicians and nurse leaders own the problem; clinical leaders and infection preventionists build infection prevention training and simulation programs; infection preventionists participate in unit-based CLABSI reduction efforts; hospital managers make compliance with best practices easy; clinical leaders standardize the hospital's catheter insertion and maintenance practices and empower nurses to stop any potentially harmful acts; unit leaders and infection preventionists investigate CLABSIs to identify root causes; and unit nurses and staff audit catheter maintenance policies and practices.

A national collaborative helped many hospitals dramatically reduce central line-associated bloodstream infections (CLABSIs), but some hospitals struggled to reduce infection rates. This article describes the development of a peer-to-peer assessment process (CLABSI Conversations) and the practical, actionable practices we discovered that helped intensive care unit teams achieve a CLABSI rate of less than 1 infection per 1000 catheter-days for at least 1 year. CLABSI Conversations was designed as a learning-oriented process, in which a team of peers visited hospitals to surface barriers to infection prevention and to share best practices and insights from successful intensive care units. Common practices led to 10 recommendations: executive and board leaders communicate the goal of zero CLABSI throughout the hospital; senior and unit-level leaders hold themselves accountable for CLABSI rates; unit physicians and nurse leaders own the problem; clinical leaders and infection preventionists build infection prevention training and simulation programs; infection preventionists participate in unit-based CLABSI reduction efforts; hospital managers make compliance with best practices easy; clinical leaders standardize the hospital's catheter insertion and maintenance practices and empower nurses to stop any potentially harmful acts; unit leaders and infection preventionists investigate CLABSIs to identify root causes; and unit nurses and staff audit catheter maintenance policies and practices.

African Americans living in poor neighborhoods bear a high burden of illness and early mortality. Nonadherence may contribute to this burden. In a prospective cohort study of urban African Americans with poorly controlled hypertension, mortality was 47.6% over a median follow‐up of 6.1 years. Patients with pill‐taking nonadherence were more likely to die (hazard ratio, 1.80; 95% confidence interval [ CI ], 1.18–2.76) after adjustment for potential confounders. With regard to factors related to nonadherence, poor access to care such as difficulty paying for medications was associated with prescription refill nonadherence (odds ratio [ OR ], 4.12; 95% CI , 1.88–9.03). Pill‐taking nonadherence was not associated with poor access to care; however, it was associated with factors related to treatment ambivalence including lower hypertension knowledge ( OR , 2.97; 95% CI , 1.39–6.32), side effects ( OR , 3.44; 95% CI , 1.47–8.03), forgetfulness ( OR , 3.62; 95% CI , 1.78–7.34), and feeling that the medications do not help ( OR , 2.78; 95% CI , 1.09–7.09). These data suggest that greater access to care is a necessary but insufficient remedy to the disparities experienced by urban African Americans with hypertension. To achieve its full promise, health reform must also address treatment ambivalence.

Using data from the Keystone ICU project, this study examined whether the intensive care units (ICUs) that implemented the Comprehensive Unit-based Safety Program (CUSP) would have greater improvement in safety climate, team progress barriers, and central line-associated bloodstream infections (CLABSIs) than ICUs not implementing CUSP. The study population consisted of 103 ICUs; 60 ICUs (58%) used CUSP, with 6 of them later discontinuing CUSP, and 17 ICUs (16.5%) never used CUSP. The researchers could not determine CUSP use status for the remaining 26 ICUs because of missing data. The use of CUSP was associated with improved safety climate, job satisfaction, and working conditions after a 2-year period, as measured by the Safety Attitudes Questionnaire. Study results on barriers and CLABSIs are inconclusive. This study demonstrated that unit-based, formalized processes targeting cultural improvements in teamwork, communication, self-identification of hazards, and hazard mitigation can improve several aspects of patient safety climate in ICUs.

This study aimed to: (1) investigate the extent to which Family Centered Care (FCC) principles are currently applied in clinical practice by healthcare providers working in inpatient units; (2) evaluate the extent to which FCC principles are perceived as necessary; and (3) examine the associations between FCC principles and socio-demographic and job characteristics of participants.Design and MethodsA cross-sectional study was conducted at a large pediatric hospital using the Italian version of the FCC Questionnaire Revised (FCCQ-R). Univariate and multivariate analyses were performed.Data from 469 healthcare providers were used for analysis. Scores for the FCC daily practices (Current activities) were significantly lower than those for their perceived necessity (Necessary activities) (p < .001). Participants who were male, younger, with work experience >20 years and working in rehabilitation reported a significantly higher perception of Current activities of FCC than others. The older and the more educated the participants, the greater was the perceived necessity of FCC activities. Female, older, and less experienced participants employed by the hospital but not working in the rehabilitation setting perceived a greater gap between Necessary and Current activities of FCC.Scores for the Current and Necessary activities of FCC were lower than those reported in other studies. The lower scores in the Current activities and the significant gap can be due to organizational barriers or lack of skills, but the lower scores in the Necessary activities should be interpreted as a deficit of knowledge about FCC.There is a need for further education about FCC in order to increase its perceived relevance in clinical practice.

Background: Central line-associated bloodstream infection (CLABSI) remains one of the most common and deadly hospital acquired infections in the United States. Creating a culture of safety is an important part of healthcare-associated infection improvement efforts; however, few studies have robustly examined the role of safety climate in patient safety outcomes. We applied a pattern-based approach to measuring safety climate to investigate the relationship between intensive care unit (ICU) patient safety climate profiles and CLABSI rates.Methods: Secondary analyses of data collected from 237 adult ICUs participating in the On the CUSP: Stop BSI project. Unit-level baseline scores on the Hospital Survey on Patient Safety, a survey designed to assess patient safety climate, and CLABSI rates, were investigated. Three climate profile characteristics were examined: profile elevation, variability, and shape.Results: Zero-inflated Poisson analyses suggested an association between the relative incidence of CLABSI and safety climate profile shape. K-means cluster analysis revealed 5 climate profile shapes. ICUs with conflicting climates and nonpunitive climates had a significantly higher CLABSI risk compared with ICUs with generative leadership climates.Conclusions: Relative CLABSI risk was related to safety climate profile shape. None of the climate profile shapes was related to the odds of reporting zero CLABSI. Our findings support using pattern-based methods for examining safety climate rather than examining the relationships between each narrow dimension of safety climate and broader safety outcomes like CLABSI. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.