In the aftermath of medical error : Caring for patients, family, and the healthcare workers involved

Medical errors, in particular those resulting in harm, pose a serious situation for patients ("first victims") and the healthcare workers involved ("second victims") and can have long-lasting and distressing consequences. To prevent a second traumatization, appropriate and empathic interaction with all persons involved is essential besides error analysis. Patients share a nearly universal, broad preference for a complete disclosure of incidents, regardless of age, gender, or education. This includes the personal, timely and unambiguous disclosure of the adverse event, information relating to the event, its causes and consequences, and an apology and sincere expression of regret. While the majority of healthcare professionals generally support and honest and open disclosure of adverse events, they also face various barriers which impede the disclosure (e.g., fear of legal consequences). Despite its essential importance, disclosure of adverse events in practice occurs in ways that are rarely acceptable to patients and their families. The staff involved often experiences acute distress and an intense emotional response to the event, which may become chronic and increase the risk of depression, burnout and post-traumatic stress disorders. Communication with peers is vital for people to be able to cope constructively and protectively with harmful errors. Survey studies among healthcare workers show, however, that they often do not receive sufficient individual and institutional support. Healthcare organizations should prepare for medical errors and harmful events and implement a communication plan and a support system that covers the requirements and different needs of patients and the staff involved.

Scarring Effects of Early Unemployment among Young Workers with Vocational Credentials in Switzerland

Background Using a unique, longitudinal survey that follows school-to-work transitions of pupils who participated in PISA 2000, this paper investigates adverse consequences, so-called scarring effects, of early unemployment among young adults who acquired vocational credentials in Switzerland. Methods As social, individual and contextual factors influence both early unemployment and later employment outcomes, taking into account endogeneity is of utmost importance when investigating scarring effects. In this regard we make use of nearest-neighbour propensity score matching and set up statistical control groups. Results Our results suggest that young adults who hold vocational credentials are more likely to be neither in employment nor in education, and to earn less and be more dissatisfied with their career progress later in work life than they would be, had they not experienced early unemployment. Conclusions We conclude that unemployment scarring also affects young adults with vocational credentials in a liberal labour market setting that otherwise allows for smooth school-to-work transitions. This finding runs counter to expectations that standardised vocational degrees, a liberal and flexible labour market structure, and predominantly short unemployment spells protect young skilled workers from scarring in case they happen to experience early career instability.

Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review.

BACKGROUND A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization's guideline on personal protective equipment in the context of the ongoing (2013-present) Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases. METHODS Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude), full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments. RESULTS Thirty non-comparative studies (8 related to Ebola virus disease) were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor. CONCLUSIONS Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus.

Health education intervention to reduce risk of infectious disease transmission among community health workers and their clients

Indigent and congregate-living populations have high susceptibilities for disease and pose a higher risk for disease transmission to family, friends and to persons providing services to these populations. The adoption of basic infection control, personal hygiene, safe food handling and simple engineering practices will reduce the risk of infectious disease transmission to, from and among indigent and congregate-living populations. ^ The provision of social services, health promotion activities and other support services to indigent and congregate-living populations is an important aspect of many public health-related governmental, community-based and other medical care provider agencies. ^ In the interest of protecting the health of indigent and congregate-living populations, of personnel from organizations providing services to these populations and of the general community, an educational intervention is warranted to prevent the spread of blood-borne, air-borne, food-borne and close contact-borne infectious diseases. ^ An educational presentation was provided to staff from a community-based organization specializing in providing housing, health education, foodstuffs and meals and support services to disabled, low-income, homeless and HIV-infected individuals. The educational presentation delivered general best practices and standard guidelines. A pre and post test were administered to determine and measure knowledge pertinent to controlling the spread of infectious diseases between and among homeless shelter-living clients and between clients and the organization's staff. ^ Comparing pre-test and post-test results revealed areas of knowledge currently held by staff and other areas that staff would benefit from additional educational seminars and training. ^

Cross-culture perspectives on fear of HIV disease and AIDS in health care workers

Health care workers have been known to carry into the workplace a variety of judgmental and negative attitudes towards their patients. In no other area of patient care has this issue been more pronounced as in the management of patients with AIDS. Health care workers have refused to treat or manage patients with AIDS and have often treated them more harshly than identically described leukemia patients. Some health care institutions have simply refused to admit patients with AIDS and even recent applicants to medical colleges and schools of nursing have indicated a preference for schools in areas with low prevalence of HIV disease. Since the attitudes of health care workers do have significant consequences on patient management, this study was carried out to determine the differences in clinical practice in Nigeria and the United States of America as it relates to knowledge of a patient's HIV status, determine HIV prevalence and culture in each of the study sites and how they impact on infection control practices, determine the relationship between infection control practices and fear of AIDS, and also determine the predictors of safe infection control practices in each of the study sites.^ The study utilized the 38-item fear of AIDS scale and the measure of infection control questionnaire for its data. Questionnaires were administered to health care workers at the university teaching hospital sites of Houston, Texas and Calabar in Nigeria. Data was analyzed using a chi-square test, and where appropriate, a student t-tests to establish the demographic variables for each country. Factor analysis was done using principal components analysis followed by varimax rotation to simple structure. The subscale scores for each study site were compared using t-tests (separate variance estimates) and utilizing Bonferroni adjustments for number of tests. Finally, correlations were carried out between infection control procedures and fear of AIDS in each study site using Pearson-product moment correlation coefficients.^ The study revealed that there were five dimensions of the fear of AIDS in health care workers, namely fear of loss of control, fear of sex, fear of HIV infection through blood and illness, fear of death and medical interventions and fear of contact with out-groups. Fear of loss of control was the primary area of concern in the Nigerian health care workers whereas fear of HIV infection through blood and illness was the most important area of AIDS related feats in United States health care workers. The study also revealed that infection control precautions and practices in Nigeria were based more on normative and social pressures whereas it was based on knowledge of disease transmission, supervision and employee discipline in the United States, and thus stresses the need for focused educational programs in health care settings that emphasize universal precautions at all times and that are sensitive to the cultural nuances of that particular environment. ^

Use of intranet and other interventions to increase influenza vaccination among health care workers

Influenza (the flu) is a serious respiratory illness that can cause severe complications, often leading to hospitalization and even death. Influenza epidemics occur in most countries every year, usually during the winter months. Despite recommendations from the Centers for Disease Control and Prevention (CDC) and efforts by health care institutions across the United States, influenza vaccination rates among health care workers in the United States remain low. How to increase the number of vaccinated health care workers is an important public health question and is examined in two journal articles included here. ^ The first journal article evaluates the effectiveness of an Intranet intervention in increasing the proportion of health care workers (HCWs) who received influenza vaccination. Hospital employees were required go to the hospital's Intranet and select "vaccine received," "contraindicated," or "declined" from the online questionnaire. Declining employees automatically received an online pop-up window with education about vaccination; managers were provided feedback on employees' participation rates via e-mail messages. Employees were reminded of the Intranet requirement in articles in the employee newsletter and on the hospital's Intranet. Reminders about the Intranet questionnaire were provided through managers and newsletters to the HCWs. Fewer than half the employees (43.7%) completed the online questionnaire. Yet the hospital witnessed a statistically significant increase in the percentage of employees who received the flu vaccine at the hospital – 48.5% in the 2008-09 season as compared to 36.5%, 38.5% and 29.8% in the previous three years (P < 0.05). ^ The second article assesses current interventions employed by hospitals, health systems and nursing homes to determine which policies have been the most effective in boosting vaccination rates among American health care workers. A systematic review of research published between January 1994 and March 2010 suggests that education is necessary but not usually sufficient to increase vaccine uptake. Education about the flu and flu vaccines is most effective when complemented with easy access and making the vaccine free, although this combination may not be sufficient to achieve the desired vaccination levels among HCWs. The findings point toward adding incentives for HCWs to get vaccinated and requiring them to record their vaccination status on a declination/consent form – either written or electronic. ^ Based on these findings, American health care organizations, such as hospitals, nursing homes, and long-term care facilities, should consider using online declination forms as a method for increasing influenza vaccination rates among their employees. These online forms should be used in conjunction with other policies, including free vaccine, mobile distribution and incentives. ^ To further spur health care organizations to adopt policies and practices that will raise influenza vaccination rates among employees, The Joint Commission – an independent, not-for- profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States – should consider altering its standards. Currently, The Joint Commission does not require signed declination forms from employees who eschew vaccination; it only echoes the CDC's recommendations: "Health care facilities should require personnel who refuse vaccination to complete a declination form." Because participation in Joint Commission accreditation is required for Medicare reimbursement, action taken by the Joint Commission to require interventions such as mandatory declination/consent forms might result in immediate action by health care organizations to follow these new standards and lead to higher vaccination rates among HCWs.^ 1“Frequently Asked Questions for H1N1 and Seasonal Influenza.” The Joint Commission - Infection Control: http://www.jointcommission.org/PatientSafety/InfectionControl/h1n1_faq.htm. ^

Community health workers: The critical link to sustainable, healthy societies in low-resource settings---A model for the Baylor Shoulder to Shoulder Foundation

Community health workers (CHWs) can serve as a bridge between healthcare providers and communities to positively impact social determinants of health and, thus, the overall health of the population. The potential to effect lasting change is particularly significant within resource-poor settings with limited access to formally trained health care providers such as the small, rural village of Santa Ana Intibucá, Honduras and surrounding areas—located on the geographically and politically isolated border of Honduras and El Salvador. The Baylor Shoulder to Shoulder Foundation (BSTS) works in conjunction with Santa Ana's volunteer health committee to bring a health brigade that has provided health care and public health projects to the area at least twice a year since 2001. They have also hired a full-time Honduran physician, a Honduran in-country administrative director, and built a clinic; yet, no community health worker program exists. This CHW program model is the response to a clear need for a CHW program within the area served by BSTS and presents a CHW program model specific to Santa Ana Intibucá and surrounding areas to be implemented by BSTS. Methods used to develop this model include reviewing the literature for recommendations from leading authorities as well as successfully implemented CHW programs in comparable regions. This information was incorporated into existing knowledge and materials currently being used in the area. Using the CHW model proposed here, each brigade, in conjunction with the communities served, can help develop new modules to respond to the specific health priorities of the region at that time, incorporating consistent modes of contact with the local physician and the CHWs to provide refresher courses, training in new topics of interest, and to be reminded of the importance of community health workers' role as the critical link to healthy societies. With cooperation, effort, and support, the brigade can continue to help integrate a sustainable CHW system in which communities may be able to maximize the care they receive while also learning to care for their own health and the future of their communities.^

Attitudes of health-care workers toward pregnant, HIV -positive women

The management of HIV infection with antiretroviral drugs has succeeded in increasing survival rates, but the subject of pregnancy in HIV-positive women continues to garner debate. Discrimination and stigma have been identified as barriers to health care, suggesting that women with HIV may be disinclined to seek prenatal care if health-care workers exhibit negative attitudes toward the women's pregnancies. To optimize prenatal and medical care for women with HIV infection, it is important to understand the general social conditions and cultural context in which these women have children. Goffman's treatise on stigma, Foucault's discussion of the knowledge/power matrix, and Bandura's Social Cognitive Theory offer theoretical perspectives by which we can evaluate the gender, race, and class issues that are inherent in pregnancy decision-making for women with HIV infection. It is also necessary to evaluate prevailing attitudes on childbearing toward HIV-positive women and to review the historical background of prejudice in which HIV-positive women make decisions regarding childbearing. ^ This qualitative study used a survey instrument and one-on-one interviews with HIV-infected women to elicit their perceptions of how they were treated by care providers when they became pregnant. It also included interviews with health-care workers to determine what their feelings are about pregnancy within the context of HIV infection. Results of the ethnographic inquiry reveal that most of the women had negative experiences at some point during a pregnancy, but that the situation improved when they sought care from a provider who was familiar with HIV infection. The health-care providers interviewed were firm in their belief that HIV-positive women deserved optimal care and treated the women with respect, but these are individuals who are also experts in providing care to HIV-positive patients. The question remains as to what kind of care HIV-positive women are receiving generally and what types of attitudes they are being subjected to if they see less experienced providers. Further research is also needed to determine whether HIV-positive women from a broader ethnic representation and higher socioeconomic status experience similar negative attitudes. ^

Jóvenes y políticas públicas de terminalidad educativa : un estudio sobre capital social y estrategias de vida

Desde una perspectiva teórica centrada en el relacionismo, el presente artículo tiene como objetivo abordar las relaciones entre capital social y estrategias de vida. Específicamente, nos preguntamos por la construcción de redes sociales en el trabajo y en la educación y las formas de intervención en las estrategias de vida de jóvenes que se encuentran estudiando en el Plan FinEs2. Retomamos una perspectiva metodológica cualitativa y realizamos entrevistas en profundidad a jóvenes estudiantes y trabajadores de un barrio del Gran La Plata durante el periodo 2012-2013. Finalmente, sostenemos que la experiencia del Plan FinEs2 posibilita la construcción de nuevas redes sociales -colectivas e individuales desplegadas en las estrategias de vida que los jóvenes estudiantes desarrollan.

Regulación social del mercado de trabajo en contextos productivos flexibles : Una mirada desde la contribución de los trabajadores en la producción de cine publicitario argentino

En esta tesina presentamos los resultados de un proceso de investigación orientado a describir y analizar las influencias que tienen los mecanismos desarrollados por los trabajadores sobre la estructuración de algunas dimensiones claves del mercado de trabajo en el sector de producción de cine publicitario (PcP). La PCP se caracteriza por una modalidad de organización muy flexible y efímera, basada en proyectos individuales, que congrega a los trabajadores y recursos necesarios de forma temporaria. La transitoriedad de los proyectos plantea desafíos formidables con respeto a su coordinación y regulación en el tiempo. Sin embargo, los mismos funcionan sobre una organización permanente sustentada sobre una red de contactos sociales gestados entre los miembros. En este marco, surge nuestro interrogante acerca del papel que juegan las lógicas de los propios trabajadores en el incierto mercado de trabajo de la PCP. La perspectiva teórica adoptada en nuestro trabajo, parte de la consideración de que los mercados de trabajo son producto de construcciones sociales que se diferencian histórica y espacialmente y que por tanto, se hallan socialmente regulados por una diversidad de influencias. Por ello, hemos priorizado la investigación empírica del caso particular. Nuestro objetivo principal, ha supuesto la indagación de distintas dimensiones analíticas. Así, en primer lugar, presentamos las características socioproductivas y económicas más relevantes del sector para luego centrarnos en las cuestiones nodales de nuestro estudio que contemplaron un análisis detallado de los procesos de regulación de algunas dimensiones del mercado de trabajo, a saber: acceso, reclutamiento, calificación y movilidad. Así, esta tesina pretende ser un aporte al análisis de la dinámica de los mercados de trabajo en contextos productivos flexibles, así como una contribución al conocimiento de sectores escasamente abordados por los estudios del trabajo

El nacionalismo frente a la cuestión social en Argentina (1930-1943) : Discursos, Representaciones y prácticas de las derechas sobre el mundo del trabajo

Nuestra investigación se centró fundamentalmente en las distintas formas en que las derechas respondieron a los conflictos suscitados en el mundo del trabajo durante el período de entreguerras. En primer lugar, advertimos que la cuestión social fue adquiriendo un rol protagónico en la agenda nacionalista tal como puede verse, por ejemplo, a través del análisis de los periódicos. En efecto, los diarios más importantes adscriptos al nacionalismo desarrollaron un discurso radical respecto a los problemas sociales e incluyeron secciones específicas para tratar estas cuestiones y expresar una posición al respecto. Las respuestas del nacionalismo argentino frente a la cuestión obrera han sido múltiples y han abarcado distintas esferas de la vida social. Lejos de esperar que la solución a los problemas sociales proviniera exclusivamente de las medidas restrictivas y represivas hacia el movimiento obrero, los nacionalistas elaboraron programas sociales, políticos, económicos y culturales que formaron parte de su proyecto de nación autoritaria y jerárquica. Los proyectos sociales y las propuestas de organización sindical fueron en gran parte inspirados por los fascismos europeos los cuales incluyeron programas de contención social dentro de un orden político totalitario. En este sentido los nacionalistas argentinos intentaron mediante sus propuestas imponer un orden que contemplara las necesidades básicas de los sectores populares y que preservara las jerarquías sociales limitando la participación política o sindical de los trabajadores y eliminando definitivamente alas fuerzas de la izquierda revolucionaria. Las organizaciones obreras nacionalistas incluyeron todo tipo de trabajadores en sus filas y procuraron captar tanto a los afiliados de los sindicatos autónomos como a los trabajadores socialistas. Algunas de estas organizaciones fueron efímeras mientras que otras tuvieron más éxito y lograron atraer adherentes. Las mismas conformaron la corriente que hemos denominado nacionalismo sindicalista, la cual desarrolló su propia doctrina social fuertemente influenciada por las encíclicas papales. Las manifestaciones nacionalistas en el espacio público porteño han sido también analizadas in extenso. Existieron distintos tipos de manifestaciones para movilizar a los seguidores del nacionalismo y para captar nuevos adherentes, especialmente aquellos provenientes de los sectores populares. Las manifestaciones se convirtieron en el escenario de las disputas ideológicas mantenidas tanto contra la política liberal como contra la revolucionaria. La "revolución nacionalista", según la formulaban sus partidarios, implicaba trascender los aspectos políticos y económicos incorporando transformaciones en otras áreas de la vida social: las costumbres, las formas de vida, los gustos culturales, los valores. Los nacionalistas advirtieron que para lograr este tipo de "revolución" debían hacer usa de los medios de comunicación masivos y diseñar proyectos para regular las industrias culturales. El objetivo de representar a los sectores populares fracasó rotundamente. El discurso nacionalista que condenaba la diversidad étnico-religiosa, que amenazaba con eliminar las distintas voces políticas existentes, y que expresaba un odio visceral a sus enemigos (ya fueran judíos, anarquistas, comunistas, o liberales) fue extremadamente desafortunado para quienes procuraron ensanchar las bases de un movimiento antidemocrático originalmente elitista que, a la luz del contexto internacional y de las condiciones locales, devino en populista

La estrategia de valorización de una multinacional de cosméticos : Explotación sexuada del trabajo y Responsabilidad Social Empresaria (RSE)

Este artículo se propone analizar el modo a través del cual en la empresa de cosméticos Avon se articulan explotación sexuada del trabajo con responsabilidad social empresaria, para configurar una estrategia de valorización singular. Adentrándose en los mundos de las revendedoras y las operarias de Avon -la mayor empresa multinacional dedicada a la producción y venta de cosméticos a través del sistema de "venta directa"- se indaga cómo la empresa capitaliza en su beneficio las ventajas de la utilización de fuerza de trabajo femenina. Si bien las políticas empresarias de Avon se presentan como inconexas entre sí, pueden ser leídas como una estrategia de valorización particular, pasible de ser desagregada analíticamente en dos elementos que se encuentran articulados. El primero, que denominamos explotación sexuada del trabajo, consiste en la utilización intensiva de fuerza de trabajo femenina tanto para la producción (en la fábrica) como para la comercialización de los productos (a través del sistema de venta directa). El segundo se basa en la implementación de políticas de RSE como elemento crucial de la valorización, tanto en la esfera productiva como en la esfera de la comercialización.

Córdoba : Izquierda obrera y conflicto social durante el gobierno de Amadeo Sabattini

Este artículo centra su atención en el tipo de relaciones establecidas entre el gobierno radical de Amadeo Sabattini (1936-1939) y el movimiento obrero desde una perspectiva de análisis que correlaciona tres planos: el desarrollo de nuevas prácticas estatales marcadas por la conciliación y el arbitraje en los conflictos laborales, la expansión de las corrientes sindicales de izquierda y su unificación en una sola central obrera, y las respuestas que frente a ambos fenómenos ofreció el conservadorismo cordobés. En este último aspecto, se indaga especialmente en el papel desempeñado por el Partido Demócrata y por la Iglesia Católica

Migraciones temporarias, ciclos laborales y estrategias de reproducción social : El caso de las unidades domésticas del área rural de Bernardo de Irigoyen (Misiones, Argentina)

Este artículo versa sobre un conjunto de unidades domésticas ubicadas en el área rural de Bernardo de Irigoyen (Misiones), en las que algunos de sus integrantes migran temporalmente al empleo forestal de otras provincias. El objetivo es comprender la práctica migratoria y su peso con relación a los demás mecanismos de reproducción social en las unidades domésticas. La metodología es de tipo cualitativa mediante la realización de entrevistas a trabajadores migrantes y sus parientes. El trabajo concluye que la movilidad espacial es un recurso al cual los trabajadores y sus familias acceden de modo desigual para lograr su reproducción social

El socialismo europeo en la encrucijada : Debates sobre cuestión nacional y revolución social en la Segunda Internacional

Este artículo tiene por objetivo reinterpretar la relación abierta en la Segunda Internacional entre la cuestión nacional y la lucha de clases, planteando que las causas de la posición triunfante en 1914 deben ser buscadas en los años anteriores al estallido bélico. El análisis de textos fundamentales producidos antes y durante la Gran Guerra por los teóricos más influyentes del socialismo europeo en torno de las naciones y las nacionalidades permite captar en toda su significación de qué manera en dicha coyuntura se jugó la concepción socialista de "revolución social", indisolublemente atravesada por el carácter sociopolítico que se estuvo dispuesto a conceder a las masas proletarias y a sus formas de intervención práctica